RN Case Manager

Barbara Saak mha rn chc ccep LNCC

*******@*****.*** 714-***-****

Huntington Beach, CA 92647

CASE MANAGEMENT REGISTERED NURSE

Dynamic, results-oriented, highly engaged health care professional with an unwavering record of success spanning 25 years of broad healthcare experience. Expert in developing, implementing and monitoring all aspects of health care quality, patient safety, risk, compliance, performance improvement, and patient relations. Strong knowledge of regulatory, accreditation and health care standards of practice. Consensus builder and team player capable of developing and leading high functioning teams with diverse backgrounds. Confident professional able to proactively resolve issues. Excellent interpersonal and organizational skills to present, communicate and interact effectively at all levels. Demonstrated exceptional operational performance managing operational departments.

Areas of Strength

Risk Assessment

Risk Mitigation

Experienced R.N.

Regulatory Compliance

Policy and Procedures

Root Cause Analysis

Loss Control

Risk Program Integration

Strong Collaborator

Patient Safety Focus

Analysis and Reporting/Auditing

Six Sigma Green Belt

Claims Administration

Strategic Planning

Accountable leader

Professional Experience

Laguna Treatment Hospital

2021-present

Dual Diagnosis Behavioral Health facility

Chief Executive Officer

Aliso Viejo CA

Hired as Director of Compliance and Quality then promoted to CEO in 3 months.

Chief Executive Responsible for overall daily operations of 93 bed JCAHO accredited dual diagnoses behavioral health and substance use disorder hospital, including strategic direction and the overall clinical, medical, quality, compliance, administrative operations and management of the facility. Responsible for annual budget preparation and operations business plan; ensures compliance to accreditation standards and requirements including federal, state and local certifying and licensure bodies. Participates in treatment program changes and developments, confers with mental health providers, medical providers and facility leadership to formulate treatment policies and management of resources. Works closely with Sales team to ensure referrals of patients and maintenance of daily census. Sits on facility governing board.

Kabafusion Home Infusion Care

2020-2021

VP Compliance

Cerritos, CA

During pandemic, provided temporary COVID support and assisted General Counsel in development of Compliance program.

Loma Linda University Health Care

2018-2020

Executive Director

Compliance, QM, Risk, Case Mgmt.

Loma Linda, CA

Strategic, operational leadership of Compliance, Quality, Case Management and Risk Management for academic medical group practice of Loma Linda University Health Care including medical and behavioral health. Scope of responsibility includes ensuring compliance with contractual and regulatory requirements, auditing and monitoring, oversight, corrective action plan development and monitoring, adverse event investigations, and post discharge case management. Cultivates environment of accountability, education and transparency through collaboration with providers, staff and patients. Reports to Board of Directors. Position eliminated when COVID pandemic resulted in closure of all clinics, for which this position had oversight.

University of California –Irvine Medical Center and Clinics

2016-2018

Healthcare Risk Management

Orange, CA

Responsible for the daily risk management function, including review and investigation of risk issues and analysis of risk management function for medical and behavioral health hospital. Oversight of QM operations. Provide guidance to operational areas and oversees handling of complex legal and risk issues. Oversees quality of care issues, corrective action plan development and implementation. Reviews proposed programs, activities, partnerships and relationships to identify and mitigate organizational risks and compliance to the organization’s mission and strategic plan. Establishes and maintains close strategic partnerships with physicians and providers, providing internal and external stakeholders consultation on various initiatives and projects.

Consulting Engagements

2014-2016

VP Compliance and Healthcare Practice

Los Angeles, CA

Developed, planned, and implemented a Compliance, Risk and Quality plan and program for system of mental health clinics. Served as Compliance Officer and ensured Compliance program was resourced appropriately and executed effectively. Analysis of regulatory requirements and policy development represented company to government and provider agencies as well as trade associations and lobbyists. Reported to Board Compliance Committee.

Consulting Engagement

2014-2016

Chief Regulatory Compliance & Privacy Officer

Newport Beach, CA

Principal strategist and consultative expert in charge of providing necessary guidance and assistance to a Federally Qualified Health Clinic (FQHC). Completed organization-wide risk assessment to identify vulnerabilities to organization; partnered with operations executives to revise processes to ensure risks were mitigated. Compiled compliance policies and performed all investigations of harassment, discrimination and retaliation. Reported to CEO and Board of Directors.

CalOptima Health Plan

2013-2014

Executive Director, Office of Compliance & Privacy

Orange, CA

Responsible for managing compliance operations ensuring organization-wide transparency. Promoted awareness and understanding of ethical and moral principles of organization. Reported directly to the CEO and Board of Directors on the effectiveness of the Compliance program and notification of any materially significant risk to the organization. Ensured development, implementation and monitoring of effective and appropriate goals consistent with government standards, regulations and the organization’s mission. Performed all investigations of discrimination, harassment and retaliation. Interacted with health network management, partnership with Quality department, legal counsel, state and federal representatives and others as required. Accountable for all internal compliance and auditing activities including conducting regular risk assessments and internal audits to ensure appropriate financial and administrative controls. Led, directed and administered a comprehensive and complex program, which included compliance professionals with expertise and responsibilities for the following areas: Medicare Compliance, Medi Cal, Special Investigations, (Fraud, Waste and Abuse), Privacy Officer, participating provider group oversight, policies and procedures, and organization-wide training on compliance activities. Oversaw all Regulatory Affairs issues. Led, facilitated and coordinated significant consulting engagements.

St. Joseph Health System

2009-2013

Regulatory Compliance & Privacy

Regional Director of Compliance

Irvine, CA

Led strategic direction for Ministry Integrity/Compliance Department in six St. Joseph Health System hospitals in Northern California as a member of hospital Administrative teams. Developed, reviewed and ensured implementation of compliance policies and procedures in these hospitals; monitored compliance of Administrative teams, staff and physicians to ensure compliance with policies, procedures and regulatory statues. Investigated and resolved all issues/complaints on compliance hotline. Lead Regulatory Affairs officer for these facilities. Responsible for all investigations of harassment, discrimination and retaliation. Conceptualized, devised and developed an investigation procedure methodology for various potential compliance and Quality of care issues.

TENET HEALTHCARE

2005-2009

Hospital Compliance & Privacy Officer

California Regional Office

Anaheim, CA

Deployed and facilitated implementation of Tenet's ethics and compliance program in Tenet facilities as lead Regulatory Affairs officer. Under the company’s mandatory Corporate Integrity Agreement, worked extensively on Quality of Care issues which required intense analysis, corrective action and monitoring. Responsible for all investigations of harassment, discrimination and retaliation. Collaborated with the OIG to ensure all Quality of Care issues were reported, handled and managed to the OIG’s satisfaction. Directly oversaw and managed the operational privacy and information security programs, ensuring compliance with state and federal regulations including JCAHO requirements, as well as interfacing with the OIG, DHS and OCR. Proactively identified risk areas and developed and implemented annual work plans for individual hospitals. Mentored, trained and educated staff on corporation's ethics, compliance and privacy program, policies and procedures. This position ensured that the Board of Directors, executives, medical and ancillary staff, management and employees met compliance with the laws, rules and regulations of government agencies and compliance with Tenet’s policies, procedures and Standards of Conduct. Chaired hospital Compliance Committee and worked with senior management as well as staff to ensure implementation of Compliance program, working closely with legal and human resources departments to formulate action plans and investigate policy violations.

TENET HEALTHCARE

Regional Manager, Clinical Quality Improvement and Case Management

Anaheim, CA

Implemented all quality initiatives in 9 Tenet facilities in California while monitoring quality of care at all facilities. Collaborated with STARS and HCAHPS teams on development of performance improvement methods, accurate analysis of patient satisfaction data, and training of staff on implementation of these methodologies. Oversaw quality and utilization management processes, case management, developed policies and procedures, facilitated meetings and directed progression of quality processes and programs. Assessed and ensured competency of department staff; sought solutions using sound judgment. Leveraged key clinicam,l expertise, management experience, utilizing strong communication, presentation and interpersonal communication skills to mentor and manage facility staff. Closely collaborated with the CEOs and administrative team as well as compliance and regulatory bodies to achieve hospital goals and objectives.

TENET HEALTHCARE

Director, Quality, Case Management, Compliance & Risk

Garden Grove Hospital and Medical Center

Garden Grove, CA

Led operations and controlled Management of Quality, Performance Improvement, Risk Management, Case Management, Infection Control, and Regulatory Compliance departments within Garden Grove Hospital. Implemented and oversaw corrective and disciplinary actions. Managed, controlled and allocated departmental budget. Responsible for constant survey readiness and ongoing assessment of hospital’s risk profile. Ensured high quality care standards by participation on patient satisfaction improvement, STARS and HCAHPS teams as well as on multiple hospital committees including Employee Injury Prevention, Customer Service, and Disaster Preparedness Teams. Lead Regulatory Affairs officer. Served as Staff to Medical Executive and Governing Board meetings. This position is considered Senior Management and includes placement on the hospital's "A-team."

President, Legal Nurse Consultant, Certified

2000-2005

Saak Consulting Services,

Overland Park, KS

Education, Training & Certifications

Master of Science Healthcare Administration, California State University, Long Beach, Summa Cum Laude

Graduate Student Honors Award, College of Health and Human Services, CSULB Commencement

Bachelor of Science, Nursing, University of Central Missouri, Cum Laude

Certified Six Sigma Green Belt

Certified Childbirth Educator

Certified in Healthcare Compliance

Certified, Compliance and Ethics Professional

Member, California Association for Healthcare Quality

Board Member, Kansas City Chapter, American Assoc. of Legal Nurse Consultants

Board Member, Women’s Transitional Living Center, Fullerton, CA 2013-present

Affiliations, publications and presentations

Thesis, Factors Affecting Parents Decision to Vaccinate their Daughters for HPV, 2011.

Health Care Compliance Academy, August 2012; "How to Respond to Regulatory Investigations."

Instructor, Institute for Paralegal Education, July 2001. “Analyzing Medical Records for the Missouri Paralegal”

Instructor, Medical Terminology, Brown-Mackie College, Overland Park Ks, 1990.

Contact this candidate