Case Management High Risk
Resume:
Teresa A Ross, BA, RN, CCM
Charleston, WV 25304
**************@*****.***
Aetna a CVS Health Company, remote
September 2015 – December 2022
Transplant Case Management/Utilization Management:
Performed telephonic case management for transplant patients.
(bone marrow, heart, lung, kidney, liver)
Responsible for management of patients through the continuum of care for the four phases of transplantation (evaluation, procurement, transplant, 180 days post- transplant).
Responsible for facilitating consistent communication data analysis to ensure that all cases are handled appropriately.
Responsible for high-risk assessments, medication reconciliation and care plans.
Responsible for intensive patient education on diagnosis, treatment plan, immunosuppression, management of side effects and steps to recovery for best outcomes.
Responsible for coordination of inpatient case management needs to ensure safe, timely discharge and coordination of discharge needs.
Responsible for network steerage and network contracting with transplant centers of excellence.
This position required extensive clinical research using resources such as: NCCN Guidelines, Clinicaltrial.gov and Aetna Clinical Policies Bulletin (CPB) guidelines.
Responsible for all transplant related authorizations using Milliman Care Guidelines including Physician Review preparation for all transplants.
CenCal Health, Santa Barbara, California
October 2014 – September 2015
Case Management/Utilization Management
Responsible for management of Medicaid Members for Santa Barbara and San Luis Obispo Counties.
Responsible for assisting members in accessing local programs for medical, housing, transportation and emotional needs.
Attended and participated in interdisciplinary meetings for care coordination for best patient outcomes.
Responsible for high-risk assessments, medication reconciliation and care plans.
Responsible for patient education and emotional support for members with various social- economic challenges.
Responsible for utilization management for acute inpatient and outpatient needs using InterQual Clinical Guidelines.
Responsible for coordination of inpatient case management needs to ensure safe, timely discharge and coordination of discharge needs.
Responsible for Physician Review for authorizations that did not meet medical requirements. Heritage Provider Network, Los Angelos, California May 2013 – October 2014
Case Management
Responsible for telephone and on-site clinic case management of Medicare SNP members and Glendale high-risk members.
Responsible for facilitating consistent communication data analysis to ensure that all cases are handled appropriately.
Responsible for high-risk assessments, medication reconciliation and care plans.
Responsible for coordination of inpatient case management needs to ensure safe, timely discharge and coordination of discharge needs.
Attended and participated in interdisciplinary meetings for care coordination for best patient outcomes.
Provided extensive patient education for disease process/management, for related co- morbidities, medication management, and signs/symptoms to report.
Participated in after-hour on-call via PALS Line, covering Los Angelos, Burbank, and San Fernando Valley.
Participated in weekend on-call follow-up for all discharged patients on Friday; including coordination of care as needed.
Previous Experience:
Cedar Sinai Medical Center, Beverly Hills, California: Staff RN - Liver/Kidney Transplant
Saint Thomas Hospital, Nashville, Tennessee: Staff RN - Cardiac Telemetry/Heart Failure
H. Lee Moffitt Cancer Hospital, Tampa, Florida: Staff RN - Bone Marrow Transplant
Vanderbilt University Medical Center, Nashville, Tennessee: Bone Marrow Transplant Coordinator
Education/License/Certification:
Hobe Sound Bible College: BA Music Education
Parkland College: Associate degree Nursing
Tennessee Department of Health: RN 000*******/compact states, expiration: 12/31/2023
Certified Case Manager (CCM), expiration: 05/31/2025
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