Nurse Consultant Director of Case Managment

Kimberly Gillette MSN, RN, CCM

**** ********, ************, **, *****

Home 219-***-****, Cell 219-***-****, ******@***.***

SUMMARY

Expertise and knowledge of Case Management and Patient Flow throughout the continuum of care

Senior level management and nurse consultant of managed care recipients establishing health screenings and case management for chronic population

Negotiated insurance contracts for LTACH population with major international companies

Managerial skills to improve departmental productivity and increase revenue while promoting excellent quality patient care.

Executive level nursing leadership

Proven record of improving revenue while decreasing lengths of stay.

Clinical documentation improvement physician chart review

Pre-op, intra-op and post-op care nursing care

Occupational health nurse/ADON for large corporations

Home health care management

EDUCATION

Doctorate of Nursing Practice projected 5/2022

Grand Canyon University, Phoenix, AZ

Master of Science in Nursing, Focus in Hospital Leadership Systems, 2017,

Grand Canyon University, Phoenix, AZ

Bachelor of Science in Nursing, 2003, Indiana Wesleyan University, Marion, Indiana

AS, Nursing, 1998, South Suburban College, South Holland, IL

CERTIFICATIONS / LICENSURE

RN, State of Illinois, State of Indiana

PROFESSIONAL EXPERIENCE

Franciscan Alliance, Crown Point, IN

Not-for-profit community hospital with the following service lines: Emergency, ICU, Cardiology, Telemetry, Surgery, Mother/Baby, NICU, and Medical/Surgical Units

Manager of Care Management, 7/2018-present

Direct a team of 27 FTE

Excellent partnership skills with physicians, directors, and community leaders to enhance services to effectively treat the patient population

Aligned care management and hospitalists to improve patient throughput

Initiated hospice care contracts with outside agencies

Coordinated behavioral health emergency dept. process with outside behavioral health agencies

Coordinate care of patients with other disciplines and ancillary services

Established coordination of case management’s daily communication with ACO patient population case managers for effective utilization of resources including discharge planning and improve quality of care

Obtained precertification’s for skilled facilities, acute rehab hospitals, and long-term acute care services

Decreased care length of stay

Decreased observation case percentage from 30% to 22%, observation hours average 26 hours

Education of physicians on clarification of documentation related to patient’s condition and co-morbidities

Developed and facilitates patient throughput committee

Leader of Utilization Review Committee

Established care transitions nursing role to decrease readmission through post-discharge follow-up

nurse consultant for ACO to improve patient outcomes through continuity of inpatient and outpatient care management, improving patient compliance with their health plans

Facilitator of daily nurse manager department safety huddles

Developed and facilitate daily interdisciplinary unit rounds

Developing advanced care planning for patients with social workers and palliative care nurses

Member of Leadership, Quality, Regulatory, Cancer, Trauma, Stroke, and Patient Throughput Committees setting standards and policies

Collaboration with quality department to resolve patient and family complaints and conflict

Able to coordinate complex discharge plans, involving providers in foreign countries, solve difficult cases resolution while always having the best interest for quality care of the patient

Expertise in chart review utilizing MCG criteria to determine level of care

Developed appeal process to insurance companies including appeal letter writing education to staff

Assisted clinical denial specialist in appealing cases and negotiating statuses with managed care providers

Arranged in-services with multiple agencies to provide current trend/education to all staff

Able to adapt and work without supervision

Competent with EPIC and Microsoft Office: Word, Excel, Outlook, and PowerPoint

Home health nurse case manager, 12/2017-present

Clinical Home Health/Home Care Services of Northwest Indiana

Community based organization serving south suburbs of Chicago and Northwest Indiana by providing home health to Medicare, Medicaid, and insurance clients throughout the continuum of care.

Provided nurse case management to complex patients and their families

Nursing assessments, recertification’s, and discharge OASIS

Facilitator and participant in weekly patient care conference

Able to perform complex home nursing care, i.e., ostomy, wounds, diabetic management, tube feeding and medication administration/management

Make recommendations of care plan to improve quality of life

Facilitate ancillary staff coordination of patient care

Consulted physicians and community workers regarding additional care needs of client

Maintained close contact with patient and families to provide updates and revised patient care plans as needed

Norwegian American Hospital, Chicago, IL

Safety-net community hospital with the following service lines: ICU, Cardiology, Telemetry, Surgery, DETOX, behavioral health, Mother/Baby, and Medical/Surgical Units

Director of Care Management, 6/2015-9/2017

Direct a team of 13 FTE

Excellent partnership skills with physicians, directors, and community leaders to enhance services to effectively treat the patient population

Assists VP of Development with marketing to outside agencies to integrate partnerships

Initiated and completed palliative care contract with Chief Medical Officer

Coordinate care of patients with other disciplines and ancillary services

Established coordination of case management’s daily communication with MCO patient population case managers for effective utilization of resources including discharge planning and improve quality of care

Obtained precertification for inpatient procedures

Decreased care length of stay

Education of physicians on clarification of documentation related to patient’s condition and co-morbities

Developed and facilitates monthly Readmission Committee

Leader of Utilization Review Committee

Director of Care Transitions

Managed Care nurse consultant for PHO to improve patient outcomes through outpatient care management, catastrophic case management, and improve patient compliance with their health plans

Facilitator of Daily Nurse Manager Huddles

Facilitator of Daily Safety Meetings

Developed and facilitate daily interdisciplinary unit rounds

Developing advanced care planning for patients with ACNO

Member of Leadership, Quality, Regulatory, Infection Control, and Patient Throughput Committees setting standards and policies

Able to coordinate complex discharge plans, involving providers in foreign countries, solve difficult cases resolution while always having the best interest for quality care of the patient

Expertise in chart review utilizing Interqual criteria to determine the level of care

Developed appeal process to insurance companies including appeal letter writing education to staff

Decreased insurance payor denials by 50% in a one-year period

Arranged in-services with multiple agencies to provide current trends/education to all staff

Able to adapt and work without supervision

Competent with Microsoft Office: Word, Excel, Outlook, and PowerPoint

Metro South Medical Center, Blue Island, IL

Community-based hospital system with the following service lines: Orthopedics, Cardiology/Open Heart Surgery, Mom/Baby Unit and Medical/Surgical Units

Director Case Management, 10/2014-4/2015

Direct a team of 10 FTE

Superb rapport with physicians, administration, nursing, respiratory and other healthcare providers to ensure quality patient care through quality documentation

Coordinate care of patients with other disciplines and ancillary services

Established coordination of case management’s daily communication with MCO patient population case managers for effective utilization of resources to decrease readmission rate and improve quality of care

Obtained precertification for inpatient surgical/obstetrical patient procedures

Decreased managed care length of stay

Education of physicians on clarification of documentation, specificity of diagnosis with etiology

Leader of Utilization Review Committee

Facilitator of Daily Care Plan meeting

Member of Leadership, Quality, and Leadership Committees setting standards and policies

Able to coordinate complex discharge plans, involving providers in foreign countries, solve difficult cases resolution while always having the best interest for quality care of the patient

Expertise in chart review utilizing Interqual criteria

Review of documentation for accuracy of capturing all diagnoses being treated

Drafted appeal letters to insurance companies that issued denials

Arranged in-services with multiple agencies to provide current trends/education to all staff

Able to adapt and work without supervision

Competent with Microsoft Office: Word, Excel, Outlook, and PowerPoint

KINDRED HEALTHCARE, Chicago, IL

Long Term Acute Care Hospital system, service lines include ventilator weaning, complex wound management and complex medical. Known for taking care of the ‘sickest of the sick’.

Director Case Management, 2009 – 9/2014

Direct a team of 3 FTE

Proven leadership skills by improving department performance and decreasing staff turnover

Superb rapport with physicians, administration, nursing, respiratory and other healthcare providers to ensure quality patient care through quality documentation

Coordinate care of patients with other disciplines and ancillary services

Facilitated IDT meetings weekly on all patients

Education of IDT members Query processes and how to identify clinical indicators that are possible missed diagnosis

Education of physicians on clarification of documentation, specificity of diagnosis with etiology

Leader of Utilization Review Committee

Facilitator of Daily Care Plan meeting

Member of Leadership, Quality, and Leadership Committees setting standards and policies

Hospital Leader for the American Lung Association annual Chicago Lung Walk

Educator for new case managers and clinical liaisons for Chicago market

Able to coordinate complex discharge plans, involving providers in foreign countries, solve difficult cases resolution while always having the best interest for quality care of the patient

Expertise in chart review utilizing Interqual criteria

Decreased insurance denials while increasing hospital revenue

Review of documentation for accuracy of capturing all diagnoses being treated

Reviewed coding face-sheets and assisted in DRG accuracy

Drafted appeal letters to insurance companies that issued denials

Arranged in-services with multiple agencies to provide current trends/education to all staff

Speaker at in-services to outside area hospitals and skilled facilities for physician education of long-term acute care hospitals

Able to adapt and work without supervision

Competent with Microsoft Office: Word, Excel, Outlook, and PowerPoint

Select Specialty Hospital, Hammond, IN

Long Term Acute Care Hospital system that service lines include ventilator weaning, complex wound management and complex medical.

Director of Case Management, 2002 to 2009

Director of 2 to 3 FTE

Proven leadership skills by improving department performance and increasing revenue for the hospital

Superb rapport with physicians, administration, nursing, respiratory, and other healthcare providers to ensure quality patient care

Able to coordinate complex discharge plans, involving providers in foreign countries, solve difficult cases to resolution while always having the best interest of quality care for the patient

Leader of Utilization Review Committee

Member of Quality, Safety, and Leadership Committees

Team Conference Leader

Managed Care negotiator for multi-billion-dollar international companies and single-payer agreements

Expertise in chart review utilizing Interqual criteria

Decreased insurance denials

Marketer to physicians and skilled facilities

Coordinate patient care with numerous agencies

Proficient in Microsoft Office applications: Excel, Word, PowerPoint, and Outlook

Able to adapt and work without direct supervision

Excellent collaborative skills with other allied health professionals in providing a smooth transition of the patient through the throughput to the appropriate level of care for the patient

Dr. J. Park ENT/Plastic Surgery

Outpatient clinic including day surgery for plastic and ENT procedures

RN/MA, 1992-1999

Assist physicians with operating room and in-office surgical and non-invasive procedures

Provided pre-op and post-op education to patients and families

Surgical dressings, recovery, and follow up care provided to patients/families

Supervision of medical assistants

Performed sterilization of instruments, scopes, and maintained sterilization data logs

Obtained insurance authorizations for outpatient and inpatient procedures

Assisted office manager in maintaining quality assurance logs

Documented patient assessments and transcribed MD notes

Supply and inventory management

Ingalls Hospital System, Harvey, IL

Community based hospital system including Urgent Care's, satellite clinics with the following service lines: Urgent Aid, Occupational Health, Internal Medicine, Surgery Center, Pediatric Medicine

RN/MA, 1990-2002

Direct patient care for the emergency patient population including occupational medicine clients

Occupational charge nurse and case manager for catastrophic cases

Intra-operative and post-op nurse for outpatient surgical cases

Triage nurse

Nurse educator for both pediatric and elderly populations for complex conditions

Excellent collaborative skills with other allied health professionals in providing a smooth transition of the patient through the throughput to the appropriate level of care for the patient

Occupational Health nurse providing direct patient care, wound care, drug screening, audiology, and pulmonary functions

Arranged in-services to update key players with current trends and services

Effectively interact with a variety of disciplines to meet the needs of the patient

Works effectively in a multicultural environment

Professional Organization Membership

Case Management Society of America, Chicago Chapter

American Association of Occupational Health Nurses

American Nurses Association, National

Sigma Theta Tau International Honor Society of Nursing

Volunteer

St. Joseph’s Soup Kitchen, Hammond, Indiana

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