Utilization Review Wellness Coordinator
Resume:
Paula Thomas RN, BSN
**************@*****.***
CAREER EXPERIENCE
Thomas and Associates Inc.
January 2015 to Present
Position: Managing Owner and December 2020 to present Healthcare and Miscellaneous Manager of Recruitment, September 2016 to December 2020, Director of Case Management-Multiple Travel Assigments. JANUARY 2014 to December 2016 Utilization Review and Medicare/Medicaid Audits and other Healthcare HEDIS Review education as requested by clients-Contract and prn
Achievements: Advancement from Travel Case Management to Director of Case Management.
MidAmerica Sleep Company, Inc.
July 2013 to January 2016
Position: RN Educator/Marketing, Physician Recruitment, Director of Precertification/Utilization Review, Invested Owner/Operator-Full time.
Achievements: Corrected billing issues immediately by coordinating Billing Company and Blue Cross meetings to correct computer feed glitch and secured a Sleep Study Physician Specialist and Internal Medicine Specialist as investors and to serve on the MidAmerica Sleep Board of Directors and Medical Directorship.
Truman Medical Centers
August 2012 to March 2014
Position: Supervisor Case Management/Utilization Review-Full time.
Achievements: Recovered $26 Million in failed bills, denied authorizations, and corrected computer glitch to correctly bill the proper amounts for each department. Restructured the Case Management department and expanded the Transitional Care, Bariatric and CHF programs to reduce the readmission rate and realized a reduction of Medicare denials. Corrected the Important Medicare Letter problem and revised the reduced the average length of stay from 21 days to 4-7 days in less than 6 months during my tenure. Reduced avoidable days in 2 years and realized a cost savings of $31 Million dollars by sharing psychiatric resources to reduce overtime and hiring additional staff. Successfully implemented paper documentation system new Allscripts electronic medical record system project leader.
Amerigroup-MCO Kansas Medicaid
December 2011 to August 2012
Position: Supervisor Utilization Review and Project Implementation for new start up office and Contract Manage Care Organization-Contract 3 years.
Achievements: Promoted from staff RN Utilization Coordinator to Supervisor of Utilization. Corrected a $670 thousand deficit for particiation Home Health agencies by attending Medicare Stakeholder calls and identified a lack of service codes being used to specify the service for proper electronic medical record flow of billing codes.
Aveta Kansas City
September 2009 to December 2011
Position: Supervisor Care Management Team-Risk Management Review Team and Medicare RAF/MRA Consultant-Contract 2 year.
Achievements: Recovered a total of $21 milion dollars in lost Physician billing and income from services rendered from January 2010 to September 2011, Improved HEDIS scores in 6 Primary Care Physician offices for Humana Gold Plus from a average score of 67% to 97% quality rating via 1:1 Physician documentation re-education, improving the billing coding departments, correcting incorrect coding practices, developing a Independent Physician Alliance, Implementing a Utilization Committee, and conducting a Chart Sweep program via Altegra Health Services under my direction. Managed, hired and trained 4 RN to assist in the development of a new Utilization program to improve the readmission rates from 87% to 18 % in less than 8 months. Developed, revised and tested Availity Web portal from on-line pre-authorizations for United Healthcare, Blue Cross, Humana, and Aetna Insurance Companies to reduce delays in Authorization, reduce denied days, and improve patient satisfaction.
Concentra Health Services-GE Transportation/Global Signaling
February 2005 to September 2009
Position: Occupation Health and Wellness Coordinator-Contract 1.5,
3 years contract extended.
Achievements: Achieved VPP Status with OSHA at the Warrensburg GETS location; Reduced open Worker’s Compensation claims from 10 to 0 in less than 8 months at the Grain Valley GETS location. Realized a cost savings of $870 thousand dollars from February to September 2005
North Kansas City Hospital
August 2004 to February 2006
Position: RN Charge Neuro-Ortho Surgical Unit-Full time and PRN
Achievements: Advanced to Charge nurse in less than 3 months and assisted in the Cerner Electronic Medical Record creation.
Kemper National Services
September 2001 to August 2004
Position: Senior Workers’ Compensation Field Case Management
Achievements: Promoted to Senior Field Case Manager in less than 6 months, achieved highest billable hours, and closed 36 for 36 claims to MMI within 6 months realizing a cost savings of $1.3 million in Worker’s Compensation reserves.
CAREER EXPERIENCE:
Fortis Benefits Disability Insurance Division
September 1996 to September 2001
Position: Disability Review Case Management
Achievements: “Stretch Award”- $2500 cash award for streamlining work on the computer and developing a Case Management tracking program to cross reference the Rehab system and budgetary system.
Recovered $2 million dollars in less than 6 mos. Assisted in educating team on Exel spreadsheet for tracking and reducing Insurance Commission Complaints and reduction of late reviews to “zero”. Promoted from Small Case Reviewer to Large Case Review Team Leader.
Novacare, Inc.
April 1994 to Sept 1996
Position: Business Development Manager Contract Service Division
Achievements: Achieved Recruitment renewal and renewal of 32 million in contract services via Foster account and implemented Clinical Ladder program and Polaris Medicare compliant program for Improving Medicare compliance and reduction of audits from 12% to 0%.
Therakinectic, Inc.
Position: Medical Device Sales-Business Development Manager.
Achievements: Achieved market sales and growth to new market of 97% sales market penetration to achieve 1.5 million in Sales.
Independence Regional Health Center
May 1990 to September 1996
Position: Telemetry and ICU Staff and Charge RN-Full time and PRN
Community Achievements: Energetic and health promoter as hobby-Part Time Fitness Business-New Start up Fitness Centers: Blue Springs Fitness-New Start up Group Fitness Instructor, Intel Medical Corporate Fitness, Byers Community Center-Temporary Group Fitness Instructor and Coordinator- 1997 to 2000, Lifetime Fitness 2009 to 2013, Independence Sermon Center Independent Contractor, All American Fitness 1985 to 2002-Group Fitness Coordinator- Paula’s Pilates and More 1987 to Present. Corporate fitness Contracts: Independence Regional Hospital Cardiac Rehab fitness and community and corporate fitness, Marion Laboratorys, At&t Corporate Fitness, Penn Valley Community College, Campfire Girls Fitness, Fortis Benefits Fitness, Marriott Fitness via Lifewise l, Golds Gym, Healthplus, Grain Valley Community Center, Kidsercise Woods Chapel United Methodist Church, World Gym Fitness Coordinator, New Start up programs -Blue Springs, AFAA examiner- Member of the CMSA and Occupations Nurses Association.
Formerly ACLS Certified.
Former CCM Certified.
Formerly ACE, AFAA Certified.
Formerly Zumba Licensed.
Television Show Experience, August 1992 to September 1994:
“15 Minute Stretch”- Channel 9 ABC.
Committees Served:
CMSA Event Committee Member 2007 to 2008
Easter Jackson County Mental Health Board 1993 to 1995
MS Society Member 1994
Head Injury Society Member 1994 to 2009
Created Therapeutic Swim-won National Aquatics award 2002
Bioethics Committee Presenter 1992
Developed St. Mary's Hospital Blue Springs, Mo.- Walking Trail Therapeutic Garden area, and Angel Garden- Committee Chair.
AWARDS RECEIVED:
2014 Corporate Challenge for Truman Medical Centers
Events contributed 16 points to overall team score. :
Swimming- Backstroke 7th Place overall KC Region Age: 55-over
Swimming-Butterfly 11th Place overall KC Region Age: 55-over
2013 Kansas Duathalon- Heritage Park 1st Place Age: 54 to 60-Qualified for the National Duatholon in Boston, Mass.
1981 William Jewell College 1st Place Swimming-Grinell Iowa- Breathstroke 50 meter record set.
1974 Jazz Band Competition Missouri State University-Rolla, Mo.-First Place.
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