Case Manager Utilization Review
Resume:
Marcia Simms, RN, BSN, CVRN, CM **** Brighton Hills Place NE Rio Rancho, NM 87144 520-***-**** adzybr@r.postjobfree.com
Professional Title: R.N., BSN, CVRN, CM
Registered Nurse (BSN)
Certifications: R.N. – licensed in New York, Arizona, Texas, Oklahoma
A.C.L.S. – May 2013 - 2015
Defibrillation certified – March 2015
BLS Certified – April 2013 - 2015
Cardiovascular RN Certification 2017
Languages: English, some Spanish
Education: Broome Community College in New York (1968-1970)
Associate of Applied Science Degree in Nursing
Wilkes College in Pennsylvania (1972-1973)
Nursing Education – no degree
Grand Canyon University in Arizona (2011)
Bachelor of Science in Nursing
GPA 3.97
Employment: Presbyterian Health Care System
Albuquerque, NM
RN CCM IV Care Coordination
Admission and discharge planning along with initial reviews and UR using Millimen criteria.
Systems used were Epic and Midas computer systems. Interaction and team planning with physicians and all disciplines of the hospital management group to ensure appropriate and safe discharges for all patients. 12/8/15 - current
Abrazo Health Care
Phoenix, Arizona
Pilot program for Kathleen Hawkins, VP of Abrazo Case Management
Educating ED physicians in correct admission status using Interqual for the purpose of remunerations to the hospital system for the initial port of entry. This was a highly successful project saving the hospitals millions of dollars in refused claims which were due to incorrect statuses. 1/1/12-6/12
Arrowhead Hospital
Glendale, Arizona RN Case Manager, Cardiac Unit, Medical Unit, ICU, Ortho
UR using Interqual and Midas, Admission and Discharge Planning using
Midas and Cerner 7/12 – 12/2014
Tucson Heart Hospital Tucson, Arizona 2007-2012
Cardiac RN, IV Case Manager Utilization Review, Admission and Discharge planning
Use of Interqual criteria, Midas and Cerner
Bridgestaffing Travel Nurses Mobile, Alabama 2006 –2007
Travel Telemetry RN Cardiac
Tucson Medical Center Tucson, Arizona 2004 – 2006
Core RN l I Cardiac Medical
Telemetry Unit Nursing care of cardiac medical patients; cardiac drips, telemetry-monitoring
Multiple co-morbidities
Hospice Unit – Inpatient RN PRN
Provided palliative care to end of life patient and their families
Specialty Nursing, Inc. Edmond, Oklahoma 1998-2004
Staff relief – Agency Owner - Manager
Worked as staff relief in telemetry and medical/surgical units of local hospitals
Sold the business in December 2004
Intracorp Medical Review Services Dallas, Texas 1988 - 1995
Utilization Review Specialist and Manager
Concurrent review of hospitalized patients in all 50 state using Interqual
Managed 28 full time RN’s, specialty stats for large insurance companies including Aetna, Cigna
CPT and ICD 9 coding
Medical Case Management Supervisor
Responsible for 15 full times Field Case Manager RN’s, interfacing with MD’s, DME providers and Insurance companies
Prepared and taught utilization review programs
Taught CPT and ICD-9 coding along with Utilization review to all new employees
Medical Personnel Pool Tulsa, Oklahoma 1984-1985
Private duty RN for one terminally ill child
Relocated to Dallas husband transferred
Franklin Memorial Hospital Broken Arrow, Ok. 1980-1983
Charge nurse – medical-surgical; pediatrics, orthopedics combined floor 30 patients
Hiring, firing, budgeting, staffing
Day House Supervisor - relief
Left for more flexible hours after childbirth in 1982
Granville C. Morton Cancer Research Hospital Dallas, Texas 1977-1980
Head research nurse and study coordinator
Adult and pediatric experimental chemo for last chance patients
Protocol in Adriamycin development and testing
Protocol in Interferon development and testing
Relocation to Oklahoma to marry in 1980
Official Professional Nursing Bureau Dallas, Texas 1977-1980
Private duty nursing and staff relief in area hospitals
This was a secondary position by referral only
Fort Whipple Veteran’s Administration Hospital Prescott, Arizona 1973-1974
Medical/ detoxification unit/ lock up
Relocation to Tucson under duress-personal
Handmaker Jewish Nursing Home Tucson, Arizona 1974-1975
Private Duty RN, days, for one patient
Relocation to Dallas- family emergency
St. Luke’s Medical Center New York City 1970-1972
Initial RN experience
Head Nurse medical/surgical, RN on orthopedics, neurology, heroin addiction unit
Set up my own medical unit
Left to continue education
Teaching Experience: Authored and implemented safety protocols for Adriamycin administration at Morton Hospital
Authored and taught protocols for Intracorp Medical Review Services regarding statistics, coding, utilization review, and telephone etiquette
Helped Dr. Noryan set up a free clinic in Dallas, Texas for Diabetic care and management
Hobbies: Crafting, painting, cooking, music
Individual Assets: Excellent communications skills, verbal and written: problem solve: detail oriented
Analytical skills, computer literate, positive personality, people person
References: Anita Rector, RN, BSN, NP
Tucson, Arizona
Marco Rebaza, RN, BS
Tucson, Arizona
Kathy Garris, RN, BSN Case Manager Director
Tucson, Arizona
Gary Straus, LMSW
Tucson, Arizona
Elly Shapiro, RN, BSN Case Manager
Tucson, Arizona
520-609-***-****
Allisande Cropp, RN, BSN
Tucson, Arizona
Tatyana Noryan, M.D., PhD, CDE
UTSW Medical Center
5323 Harry Hines Boulevard, Suite G4-100
Dallas, Texas 75390-8858
Pamela McAnally, M.S. Education
Spavinaw, Oklahoma
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