Case Manager Medical Director
Resume:
KARMA WILSON
**********@*****.***
EXPERIENCE
*/**** – PRESENT
SUPERVISOR INPATIENT CASE MANAGEMENT, regal medical group
Time keeping on ADP for staff.
Assist the Medical Director with daily rounds.
Reviewing the census daily for OBS level of care.
Assist with retraining and counseling of nurses as needed.
Weekly leadership huddles to discuss LOS, Outliers, any obstacles presented.
Ensure that all admissions meet MCG criteria, and that the nurses are applying these guidelines accordingly.
Daily charting/EMR.
10/2022 – 6/2023
TEMP-INPATIENT/SNF CASE MANAGER, Prospect medical
Daily case load of acute/SNF cases reviewed for MCG criteria
Discharge planning, and delegating to care coordinators as needed.
Presented cases during rounds daily with MD and IDT
Issued NOMNC/LCDs to SNFs
Daily charting/EMR
04/2020-06/2022
INPATIENT NURSE REVIEWER, ALIGNMENT HEALTHCARE
Concurrent and retro reviews done daily
Rounds with IDT and the MD
Weekly huddles to discuss barriers to discharges/LOS
Reviewing MCG criteria
Responding to Livanta appeals as needed.
Delegating discharge needs to care coordinators
11/2018-04/2020
UTILIZATION REVIEW NURSE, HCP/DAVITA/OPTUM
Reviewing authorizations for MCG criteria
Daily huddle to discuss TAT/Productivity
EMR charting
3/2017-01/2018
INPATIENT REVIEW NURSE, PPMC/AGILON HEALTH
Reviewed daily inpatient census of MCAL patients.
Concurrent reviews
Prepared cases for discharge planning. Delegating needs/clerical duties to coordinators.
EMR/Charting.
Weekly rounds with MD and Other disciplines.
Liaison between the Acute hospital Case managers/SNFs and the Medical Group.
2/2016-2017
TEMP CASE MANAGER/NURSE, MEDICAL PROFESSIONALS
3/2013-1/2015
NURSE CASE MANAGER, ALTA HOSPITALS (NORWALK COMMUNITY)
Reviewed case load for ICU, Tele daily for Interqual criteria.
Lead CM, weekly rounds with CM director and IDT.
Trained all incoming/new nurses.
Delegated/assisted our discharge coordinators with discharge needs.
** REFERENCES PROVIDED UPON REQUEST**
EDUCATION
09/2024-PRESENT
RN, BSN, NIGHTENGALE COLLEGE OF NURSING
01/2003-5/2004
VOCATIONAL NURSE, american career college
8/1996-5/1997
MEDICAL ASSISTANT, northwest college
It’s okay to brag about your GPA, awards, and honors. Feel free to summarize your coursework too.
SKILLS
Leadership training
Proficient in MCG guidelines
Interqual
Access Express/Microsoft Excel/Word
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