Karma Wilson, LVN, CCM

909-***-**** adyq2v@r.postjobfree.com

PROFESSIONAL SUMMARY

My healthcare journey began in 1996 when I became a Medical assistant, where I worked in Pediatric and General medicine offices for many years. I became an LVN in 2004 and never looked back. I started out doing home health, Med-Surg, and Pediatric-Gtube care. I was introduced to case management in 2007 and the rest was history. I have experience in Acute hospital case management and have covered Med-surg, ICU, and Oncology. I also have years of experience in Managed care, from Health plans, IPAs and medical groups. I have trained multiple floor nurses and led rounds when needed. I work well with others and independently, as I have been working remotely since 2019. I am confident that with my experience and knowledge, I would be a great addition to the right team. SKILL HIGHLIGHTS

x UM/UR & Discharge planning

x Citrix

x TARS

x Interqual, Milliman

x Microsoft word/Excel

x Computerized charting specialist

x Familiarity with disease management

x Trained in in- and out-patient care

x Medication administration expert

x ELNEC training (End-Of-Life-Care)

x Psych and mental health care

x Geriatric treatment knowledge

PROFESSIONAL EXPERIENCE

Prospect Medical Systems; Orange, CA 10/24/2022- Present Inpatient Case Manager:

x Daily concurrent review of both Medicare/Medi-Cal members x Managing SNF admissions

x Weekly rounds/huddle to discuss length of stay and discharge obstacles. x Issuing LCD/NOMNC/NOAs as needed

x Proficient with Milliman Care Guidelines

x Delegate clerical/Discharge duties to Care Coordinators x Word/Excel, Outlook, TEAMS, IDX, Essette

Alignment Healthcare; Orange, CA 04/2020- 06/25/2022 Inpatient Review Nurse:

x Concurrent and Retro reviews of hospitalized Members x Daily rounds with Physician reviewers and Inpt team x SNF Appeals

x Weekly huddle

x Delegate clerical/Discharge duties to Care Coordinators x MCG, EPIC, Word/Excel, Outlook, Access Express, PING, AVA Davita Medical Group: Arcadia, CA 11/2018-02/2020

Utilization Review Nurse:

x Concurrent and Retro review of outpatient referrals x Daily team huddles to discuss productivity and turnaround times. x MCG, Touch works, Encoder Pro, Outlook, MS Excel/Word. Primary Provider Management Inc. Corona, CA 3/2017- 01/2018 In-Pt Nurse Case manager for Medi-Cal population in Fresno, CA x Daily Census of patients (75-100)

x Concurrent reviews

x Discharge Planning

x Charting

x Weekly team rounds to discuss Census and any obstacles to discharge and/or extended LOS. x Liaison between Hospital case manager’s and Medical group/Health plan. Medical Professionals, Rancho Cucamonga, CA 1/2016-2/2017 Registry Nurse: Managed care case management.

Alta Hospitals, Norwalk, CA, 2013 - 2015

Nurse Case Manager

x Daily case load of ICU, Telemetry patients (15-24) x Charting

x Clinical reviews sent to IPA/Insurances (time sensitive) & discharge planning x Patient/family teaching, LOS meetings

x Rounds with inter-disciplinary team

x Delegating to unit secretary and discharge planner x Educating Physicians about APR/DRG/Documentation Citrus Valley Health Partners, West Covina, CA, 2010 - 2012 Nurse Case Manager

Education and Training

x Daily case load of Med-surg/Orthopedic patients, x UM/UR & discharge planning

x TAR writing, patient/family teaching

x Daily rounds, LOS meetings with DON & VP of CM,

x Educating Physicians about compliance, documentation, Medi-cal, IPA/Insurance expectations regarding patient care/treatment and discharge

YOH Health Care, Woodland Hills, CA, 2009 - 2010

Registry Case Manager

x UR/UM, discharge planning for multiple IPAs/Medical Groups x Telephonic and Acute Care

Maxim Health Care, Pasadena, CA, 2004 - 2008

Staff LVN

x Went to assigned LTC, Home health facilities

x Medication nurse

x Med/surg

x LTAC

x Pediatric and Geriatric rotations

EDUCATION AND TRAINING

ACC Ontario, CA, USA

RN, BSN: Start date pending.

American Career College Los Angeles, CA, United States LVN: Nursing

Pasadena City College Pasadena, CA, USA

Associate of Science: General Education

***REFERENCES PROVIDED UPON REQUEST***

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