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Registered Nurse Case Manager

Location:
Brentwood, TN
Salary:
Negotiable
Posted:
October 20, 2022

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Resume:

**** ******** ****

Brentwood, TN *****

Wanda Pippin, RN / RHIA

615-***-****

Qualifications

Utilization Management

Disease Management

Dual Diagnosis/Addictions

Psychiatric Care

Home Healthcare

RHIA/Computer Literacy

Lifespan Care

Q.A NCQA Training

Healthcare Auditor

Profile

Clinical staff RN with proven success in Utilization Management and Disease Management. Served in management roles, supervising up to ten employees. Track record of producing desired outcomes.

Career Highlights

Analyzed the protocol and expressed a need for a screening tool. Result: Tool was added to protocol.

Offered eight and 12-hour shifts. Result: Increased nurse satisfaction.

Managed case loads with Utilization Management and Disease Management. Result: Positive outcomes.

Implemented quality improvements. Result: Increased performance and productivity.

Completed coding project with Utilization Management. Result: Obtained correct codes.

Experience

Medcor: COVID-19 Telephonic RN /Point of Entry RN Case Manager/State of Tennessee

Utilized Medcor’s screening tool for screening employees for Covid-19. Contract ended. 2021

Screens ED patients for admission criteria, utilizing Milliman, Cerner, and communicates results to MD’s and Bed Control.

PHNC-1, Compliant Hotline: Resigned/Re-Retired from the State of TN, with 15 years of State service.

State of Tennessee: RN3, MEU Unit. 2011-2018

Supervised two Employees. Evaluated Medicaid cases for Incapacity. Appeal, DAC Cases. Psych, Medical, IQ. Valued Evaluation. No disciplinary in my folder. 15 years of state service. AWS. Work process evolved to the EHR. RIF, due to low caseload. Retired from the State of TN.

Williamson Medical Center: Used Interqual and Meditech for Utilization MGT. 2008-2010

CCU, NICU, Telemetry, Oncology, Orthopedics, Med-Surg. Medicare, Workers Compensation. OB, CPC.

State of Tennessee

2006-2008

Health Records Auditor, RN3

Audit records using specific audit tools. Monitors medical records for compliance with local, state, and federal requirements, including ACA standards. Plans of correction for the monthly state facility monitors as well as the yearly institutional audits. Assists the infection control, and the continuous quality improvement departments with gathering of information on inmates with chronic conditions. Q.A. Projects for evaluation of continued compliance with ACA standards. Monthly chronic care survey. Interim Infection Control RN, 2007. Participated in the annual inspection of a facility and received “Best Annual Inspection” in 10 years with an “Exceptional” evaluation.

Managed Access, State of Tennessee

2005

Medical Record Data Collection

Project based; responsible for medical record data collection and capturing ICD-9-CM codes. State: Quality Oversight. EPSDT audits. Approved reading material. Collaborated with MCO’s.

HMC: Wellpoint Blue Cross Blue Shield

2003 – 2004

Registered Nurse

RN on the Diabetes team. Serviced CAD, CHF, Asthma, COPD, Peds, Screen Depression, and Hypertension Project. Fully productive evaluation. Merit Raise. Co. closed the Franklin, TN office.

VA Hospital

2002 – 2003

RHIA Outpatient Coder

Input E/M codes and ICD-9-CM codes. 3M coding. Generated billable versus non-billable visits. Fully successful evaluation.

First Health Corporation Incorporated

2000 – 2002

Registered Nurse

RN, RHIA, BCM-1. Utilization Management. Psych, Dual Diagnosis/Addictions. Responsible for telephone and paper record reviews for hospital stays (children through geriatrics). Input ICD-9-CM codes. Received 6.5 to 7.5 out of 9 on evaluations. Laid off. Consolidated and moved to VA.

Elk Valley Home Health

1999 – 2000

Registered Nurse

Diabetic teaching, wound care, assessments, histories, and discharges.

5116 Victoria Cove

Brentwood, TN 37027

Wanda Pippin, RN / RHIA

615-***-****

ads35d@r.postjobfree.com

Experience, Continued

Tennessee Christian Medical Center

1999

Registered Nurse

Served in addictions, dual diagnosis unit. Geriatric and adult partial treatment programs. Above standard evaluation.

Middle Tennessee Mental Health

1997 – 1999, 2003

Psychiatric Nurse

Served in acute treatment program and ETP Forensic Unit. Adults through geriatrics. Treatment Team. Supervised 5-10 employees. Superior evaluation.

First Hospital Corporation

1997

Psychiatric Registered Nurse

Served children through adults, prn. Hospital closed.

Education

RN B.S.N. Belmont University – Nashville, TN

B.S. Health Information Management / RHIA UTHCS - Memphis, TN



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