Case Manager Management
Resume:
Sylvia Harris MHA, BSN, RN
***** *** ***** **. **** Texas 78610
Objective: To obtain a nursing position where I may incorporate my 39 years of Nursing Practice and Nursing
Leadership experience. To become a member of a facility that values team concept of their employees.
Education:
University of Texas at Austin BSN 12/19/1981
University of Mary Hardin Baylor MHA 05/10/2003
Work Experience Synopsis:
Jan.2023-Mach 2023
Pam Health ( Warm Springs Rehabilitation Hospital- As a RN Case Manager of the 20 bed North Unit
my role was to do patient admissions into Case Management and coordinate discharge plan from day
one to future discharge of Chronic . Disease Diabetic, CHF, COPD, Sepsis Patients . Grand Rounds
With Hospitalist physicians and attended Interdisciplinary Team Meeting with Hospitalists participation,
CEO, every ancillary department Directors with staff involved in patient coordination of care. I Worked
closely with family and Patient. Followed InterQual Quality Standards and JCHO followed .
Dec. 2021- Feb. 2022 Aveanna Health LLC. – Supervisor Case Manager Screened New Clinical
Staff, interviewed and skills testing of clinical staff. Assessment and Reassessment of new Clients.
Review of physician orders, communication with field staff and clients family. Utilization Review and
Case Management of Diabetic, Vent Dependent, Gastric Tube clients .physical needs for medical
Necessity determination.
May 2021-present- Independent Owner and Consultant of Paparazzi Accessories Jewelry Line.
Provide Live shows introducing new jewelry and fulfilling orders. Private Jewelry shows for clients.
(Break in working Due to care for Mother with Alzheimer’s until her Death April 5,2020)
September 2018-April 2019 Providers of Texas Home Care – Worked with Adults
Disabled Adults in South Austin /East Austin area providing physician ordered care of clients in their home.
Chronic Disease clients with DMII, HTN, CHF, Cardiac arrhythmias, Sepsis in recovery, wound care and did
All evaluations for Start of Care, D/C, Resumption of Care, Recertifications and disease process education.
Supervised care performed by LVN and CNA.
March 2018-August 2018- RN Case Manager Dell Children's Medical Center- Bilingual RN managing 960
Middle School students in a Title 1 needy school. I worked closely with behavior health, cancer, diabetes and
Special Needs children with numerous neurological and other major disease processes. I worked closely with
AISD school counselors, vice principals and teachers. I was responsible for evaluation and treatment of acutely
ill and injured student and staff. Supervisor- Kathy Stanton RN, BSN 512-***-****
July 3, 2017- Nov. 2017 Pinnacle Senior Care, RN Case Manager Bilingual Field Nurse Case Manager
Providing care to Homebound Medicare, Medicaid and Private Insurance patients. Responsible for SOC, ROC,
Discharge and skilled nurse visits. Types of visits Provided are wound care, blood draws, Assessments and
Monitoring of Chronic Disease DMII, CHF,COPD, HTN,ESRD and Cancer patients.
I took 9.5 months off work to help my Mother,whom has Alzheimer’s Disease recover from Broken ankle
Surgery and Rehabilitation.
May 23,2016 – December 9,2016 HCA St. DAVIDS South Austin Medical Center, Care Coordinator Case Manager
400 bed Acute Care Hospital. I provided care coordination and medical necessity review for Medical Surgical Telemetry.
I helped other RN Case Managers with patients with DMII, and amputations of Lower extremity Med Surgical Floor.
I provided care coordination throughout hospital for all DMII, Sepsis, CHF and COPD patients for DRG coding.
June 28, 2015-December 31, 2015 MEDIX HealthCare Staffing RN Outpatient Complex Care Manager assignment
At WellMed Medical Management at WellMed Ben White. Coordination of the care management of the patients
For WellMed Ben White Clinic, Buda Kyle WellMed Clinic, and Springtown Way Clinic in San Marcos Texas. Telephonic
And Face to Face Home and Clinic visits of WellMed patients needing guidance in their complex medical conditions with
The physicians, Health Coach, Social Workers, Specialty and Contracted Physicians. Patients referred to Medical
Management for DMII, CHF, COPD Health Education, social-economic needs and home safety needs. Transition Care
coordination from Hospital to appropriate care facility or home for rehabilitation.
August 28, 2011-May 28, 2015 Integrated Health Care Solutions Travel Nurse Staffing-RN UR RN Case
Manager 13 week Travel assignments to Acute Care Facilities In Colorado, Maine, Arizona and Texas
Providing Utilization Review and Case Management of Inpatients and Observation patients in Acute Care
Hospitals with Chronic Disease DMII, CHF, COPD, Cellulitis and Sepsis.Review of cases for medical
necessity and discharge planning from admission to discharge for the clients.
March 17, 2014- May 16, 2014 Calvert Home Health Care, LTD. (Lubbock,TX) RN Case Manager II
I was the Bilingual Case Manager for two offices in the region (Littlefield TX,) and Levelland, TX Office)
I did assessments and treatments involving: Infusion Therapy, IV puncture lab draws, injections, colostomy care,
Wound care, chest tube drainage education of treatments with caregivers or patients with DMII, CHF, COPD and
Cellulitis. Patients on Medicare, Medicaid and Commercial Insurance I performed start of care, and recertification
process with the patient or caregiver. I had to leave my position for our move to Colorado 5/23/2014 for my husband’s
new position.
Sept. 2013- March 2014 Enterprise Health Care Health Services – Austin Texas Bilingual RN Case Manager II
Telephonic Case Manager for Affordable Care Act Initiative for BCBS for Texas, New Mexico, Oklahoma and Illinois.
Clients were enrolled into the BCBS Database daily. Coordination of care services for Complex Care patients, organ
transplant clients, chronic disease and postoperative clients. Enrollment into the clients into the Case Management
program. Coordination of the client’s physician and clinic needs assignments. Discharge from program for some clients.
I had to leave the position to travel to Levelland, TX to assist my mother with Alzheimer’s Disease after
she fell and Broke her hip. She is now in assisted living facility with my father.
Jan. 18,201 3-Sept 2013 Parkland Health and Hospital System Dallas Texas – Care Coordinator Case Manager
Surgical ICU 4 Units A, B, C, D and cross trained to cover Medicine Floors 7-10. Concurrent and Prior
Authorization Reviews for all inpatient cases into the Surgical ICU’s. Complex Care and Trauma interdisciplinary
Care coordination. Assessments and reassessments of patients ongoing medical care needs. Coordination of care
For the patient s with physicians, insurance case managers and ancillary care teams and facilities for patient
Transition of care placement. Devon Bates Manager of Care Coordination Case Management.
March 2012-present Strategic Health Staffing – travel nurse, case management, utilization review 8-13 week
Assignments with extensions at facilities. Currently on 8 week assignment at Children’s Medical Center of Dallas
on Medical Management Improvement Project . The chart audits and data research analyst position is improvement
process to decrease emergency room visits and readmissions, stop loss accounting process. Kenneth Enad,
Manager at Children”s Medical Center that I report to. August 13, 2012 - October 6, 2012
January 16, 2012-Feb 25, 2012 Texas Medical Foundation Health Care Institute ( on travel short term assignment)
Palmetto Medicare Project, Case Management Retrospective Review of denied Medicare claims. Palmetto
Medicare from other states contracted with TMF in Texas for review of the Medicare denied claims. Palmetto could not
Provide enough work for the 25 Case Managers brought on temporarily to work through February.
August 29, 2011-January 7, 2012
Estes Park Medical Center UR Case Manager for Acute Care Medical Center ( on assignment through Integrated
Health Care Solutions for 17 weeks). Estes Park Colorado. Case Manager for busy Acute Care Hospital utilizing
Milliman and InterQual Health Care Guidelines for appropriate admissions into the facility. Providing Clinical review on
each individual Case. Coordination of Discharge Planning with patient, physician and family. Coordination of clinical
information to Insurance companies for claims payment,. January 18, 2013-April 6. 2013 Parkland Health and Hospital
Services Dallas TX Care Management Case Manager in Surgical ICUs and Surgical Orthopedic
Unit 5North Supervisor Constance Hoops RN Director of Nursing
01/03/11- July 22, 2011- FirstCare Health Plans, Lubbock, TX
MHA, BSN, RN : RN Medical Case Manager- Responsible for Utilization Concurrent /Retrospective Review of
Health Plan enrolled Members. Case Manager for a MCO Corporation responsible for Case Management and Inpatient
Acute Care Reviews for managed stop loss admissions of members. Coordination of members in the Acute Care
Facilities to be transitioned to an appropriate community setting for Rehabilitation services. As a case Manager
responsible for coordination of services of patient with Hospital, LTAC, SNF, and Home Health Agency case managers
for prior authorization of Services utilizing InterQual Criteria for all cases. Education of members with chronic disease
Diagnoses and co-morbidities
09/28/09-January 24, 2010 – Well MED Physicians Health Choice HMO, Austin, TX
MHA, BSN, RN, and CM: RN Utilization Concurrent /Retrospective Review Case Manager for a Large MCO Corporation
Performing Acute Inpatient On Site Reviews for managed stop loss admissions of PHC members. Coordination of the
Patients managed care case through transition to community setting for rehabilitation services. I am responsible for
coordination of services with Hospital, LTAC, SNF, and Home Health Agency case managers for prior authorization of
services utilizing InterQual Criteria for all cases.
11/06- 08/01/2009 – Amerigroup Corporation, Austin TX
MHA RN: RN for SPW Disability Long-term Care Program with responsibility for medical necessity evaluation and
discharge planning of Medicaid members from Hospital, Long-term Care Facilities, and assisted living facilities,
representative for the corporation in member cases in Fair Hearing with the State Medicaid office, coordination of care
with Service Coordinators assigned to the members, liaison with community resources, and providers.
01/05- 08/31/06 HHSC – Office of Inspector General (OIG), Austin TX
MHA RN Research Nurse Analyst: RN for Provider Fraud and Abuse, responsible for research of providers claims
history using forensic software and databases, development of case with financial extrapolation for recoupment of
monies, presentation of the case to Legal Division of OIG for further analysis and referral to the Attorney General’s
Office or FBI focus for criminal case development, facilitator in meetings with provider and legal counsel.
02/04-10/04 – ACS Texas Medicaid Healthcare Partnership (TMHP), Austin TX
MHA RN: In-patient Prior Authorization Supervisor, responsible for management of 25 RNs reviewing member inpatient
prior authorizations, review of denied claims and generation of hospital bed board reports, provider calls and reports to
management for potential financial loss cases, payroll, disciplinary and annual reviews of RN’s.
01/03-12/06 – Intrepid USA Home Health, Austin TX
RN Case Manager: Senior Team Leader responsible for supervision and direction of 12 professional employees for
Medicaid and Medicare members in Home Setting for Skilled Services. I stayed on as PRN Case Manager for Pediatric
and Adult Skilled Nurse Case Management even while working for ACS as Intrepid needed help on Friday, Saturday
and Sunday.
03/01-01/03 – HHSC-DSHS Children with Special Healthcare Needs, Austin TX
RN Nurse Consultant IV: Medical Management Improvement Specialist, responsible for review of Medicaid Claims
denials, Policy and Procedure Development for the State Program, Program Representative for the Medicaid Vendor
Drug Review Board, responsible for the vendor drug program claims review for charges to the CSHCN program for
prevention of financial loses, responsible for report to the Legislative Budget Board, liaison for Provider and community
resources, Member of the DSHS Employee Advisory Board, and Nursing Leadership Board.
06/00-03/01 – City of Austin Primary Health, Austin TX
BSN RN Public Health: Responsible for Adult, Pediatric, Family Planning and Maternity Clinics, assisted in high risk
Maternity Ultrasound Clinic, surgical procedures, acute care client medical needs, immunizations, laboratory and IV
access, IUD placements, stabilization of medical crisis clients.
06/99-04/00 – St. David’s Healthcare Partnership/ South Austin Hospital, Austin TX
Clinical Health Educator: Conducted Performance Based testing and education of clinical staff, development of
Annual Competency Fairs, CPR Instructor, new employee orientation instructor for the Partnership Hospitals, CNE
and CME Development for the education of Professional clinical staff and Physicians.
04/96-02/99 – Seton HealthCare Network CHOA/Student Health Services, Austin TX
RN Supervisor Case Manager: Case Manager for Seton Home Care and then transferred to CHOA/SHS Division to
help in new initiative for Seton, responsible for LVNs, CNAs and AISD staff in the 2-Elementary schools, 2-Middle
Schools for 4000 students and 12 staff, Community Liaison and advocate for student health, Health Education of
Teaching Staff at AISD.
01/95-04/96 – HHSC-Chronic Disease Prevention Division, Austin TX
RN Nurse Consultant IV: Responsible for the State Initiative for the Put Prevention into Practice and the Breast and
Cervical Program, development of Policy and Procedure for the Adult Health Program and auditor monitor of the State
funded initiative in Regional, Local and Community Based Clinics in the State of Texas, Request for Funding contract
reviews with recommendations made for the dispersion of funds for the Texas Cancer Council grant, responsible for
Review and Corrective Action Recommendations for State funded programs, development of reports to the Legislative
Budget Board.
09/93-12/94 – HHSC-DSHS WIC Bureau of Nutrition Services, Austin TX
RN Consultant –IV: WIC Immunization Initiative for Texas, responsible for development of new State Initiative to
improve under-immunization statistics in Texas as we were 3rd in the nation for MMR outbreaks, liaison and networking
with CDC and Texas Medical Board, Community Resources to promote the initiative, oversight of 603 WIC Agency
programs in Texas with directive to train 309 RNs, LVNs in development of the program in Regional, Local Health
Department Clinics and Community Based Clinics, Policy and Procedure development and Report generation to the
Governor, Legislature and DSHS.
06/86-12/94 – Austin Regional P.A. Clinics (After Hours Emergency), Austin TX,
Clinic RN: Assisted in triage of acute care clients, supervised RNs, LVNS, and CNAs in Adult, Pediatric clinic, Internal
Medicine, Ob-GYN clinic, assisted in busy multi-site clinic. Facility in care of clients with minor to severe trauma, liaison
for smooth transition of clients for hospital admission, assisted physicians in casting and lumbar punctures of clients.
Stayed on and worked PRN weekends Friday-Sunday for Austin regional Clinic while I worked for the WIC Division at
the State of Texas.
12/89-08/91 – City of Austin Primary Health Division, Austin TX
BSN RN HIV Infant Case Manager: Assisted in triage of Pediatric, Adolescent, and Adult clients in crisis or acute
medical need, EKG, IV, ventilator client care, the Infection Control RN of the Clinic Facility, also responsible for Crash
Cart and Medical Emergency Policy and Protocol. I worked at Oltorf FQHC in Family Practice in 1987 before transferring to
East Austin Comal FQHC to work in Pediatric/Adolescent Clinic.
07/87-12-89; 12/81-12/83 – Brackenridge/CHOA Hospital, Austin, TX
BSN, RN PICU/PIMC and NICU RN: Supervising RN in a PIMC unit, and PICU RN in a busy Teaching Hospital,
assisted in emergency lumbar punctures and bladder taps, experience with IVP Lines, ICP Lines, Central Lines and
Cardiac Telemetry, Ventilator and CPAP apnea monitoring. Worked for Brackenridge Hospital as a new graduate nurse
in Medical Surgical/Pediatrics PIMC 12/81-12/83 then returned in 07/87-12/89 and worked PIMC/PICU and NICU
11/86-06/87 – South Austin Hospital, Austin, TX
BSN, RN OR Circulator and PACU: RN III Circulator also On-call for emergency surgical cases and recovered patients
in PACU, coverage of OB surgical suites in addition to Endoscopy, Cystoscopy emergency cases.
01/83-10/86 – South Austin Ear, Nose, and Throat Clinic, Austin, TX
Surgical Scrub Nurse: Worked with a busy ENT surgeon at 4 major hospitals, 2 Ambulatory Surgical Care Centers,
on-call for emergency trauma cases, scheduler for surgical cases and assisted in pre-op history and physicals, assisted
with emergency procedures in ICU.
References
Kathy Stanton RN, BSN Supervisor- Manager Dell Children's Medical Center AISD School Health ********@****.***
Cyndie McMahon RN, Supervisor Pinnacle Senior Care,
512-***-****, ********@**************.***
Sally Land RN, BSN St. David’s South Austin Medical Center Telemetry, 512-***-****
Kaytlin Sylvester Gaus MEDIX Health Care Staffing Senior Recruiter and Supervisor 972-***-****
Becky Prado RN, Director of Health Professions Calvert Home Health Inc. 806-***-****
Vanessa Daniel BSN, RN Manager, Enterprise Health Care Health Services 817-***-****,
**************@******.***
Ellen Kinsler, RN, Director of Enterprise Health Care Health Services ********@***.***
Darnell Griffin RN, Infection Control Nurse, Employee Health, Estes Park Medical Center 970-***-****
****************@*****.***
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