Registered nurse

Education:

Diploma of Registered Nursing. Lutheran Deaconess Hospital School of Nursing 1982.

Employment:

West Valley Hospital: August 2009- present

Registered Nurse Case Manager. Responsibilities include reviewing charts of all new admissions for Medicare criteria of inpatient admission verses observation status. Discuss cases where criteria is not met with Hospitalist and adjust admission status accordingly. Daily multidisciplinary rounds with Hospitalists, staff nurses, physical, occupational, speech and respiratory therapists, pharmacy and dietary to discuss and plan discharge needs. Work with patient, family and appropriate vendors to set up discharge needs when patient is unable to discharge to home ie: hospice, SNF, rehab, and home health. Review charts and compile reports using Interqual criteria for admission, concurrent and discharge reviews. Review charts and compile reviews for insurance companies when requested. Provide patient with any durable medical equipment needed.

Blue Cross Blue Shield of Minnesota: February 2008 – August 2009

RN Case Manager, Case Coordinator. Responsibilities include initial and concurrent review of skilled nursing facility, home health care and hospice services for medical necessity. Monitoring and documenting cost savings. Retrospective review of claims for services that did not receive prior authorization. Requesting, organizing and summarizing medical records for medical director review in cases with questionable medical necessity. Participated in a pilot program combining case management and disease management called ‘Whole Person Health Support’.

Medica: May 2007 – February 2008

RN Case Manager. Responsibilities included review of cases requiring prior authorization to determine medical necessity and appropriateness. To work collaboratively as a member of an 8 nurse clinical review team. To compile, organize and summarize information for review by a 7 doctor team of medical directors when medical necessity is not readily determined. To actively participate in the ongoing evaluation and review of clinical review policy.

America’s TPA: February 2007 – May 2007

RN Case Manger. Responsibilities included general customer service, performing utilization review, screening for and providing complex case management services, High risk maternity management and disease management (asthma, diabetes, cardiac disease). Claims review, special projects and employee education.

Sunrise Assisted Living: 2000 – 2001

Cottage RN. Responsibilities included care planning, family conferencing, providing medical treatments to residents, arranging hospital admissions and MD appointments including transportation. Ordering and dispensing medication, arranging hospice services when necessary, training and supervision of unlicensed personnel.

Independent Contractor-Case Manager : 1997 – 2001.

Provided case management services to John Alden Insurance as an independent contractor.

John Alden Insurance: 1993 - 1997

Case Manager 1996 – 1997. Responsibilities included certification of medical necessity of care in complex cases, assisting in discharge and care planning, negotiation of costs of more expensive treatment ie: chemotherapy, physical rehabilitation, home health care and hospice

Utilization Review Nurse 1993 – 1996. Responsibilities included certifying medical necessity of hospital admissions, surgeries, outpatient testing and therapies.

Abbott Northwestern Hospital: 1982 – 1993

Staff RN. Primary clinical areas included Orthopedics, Rehabilitation, and Cardiology. Responsibilities included total patient care, Primary Nurse, Charge Nurse, care planning, and care conferencing.

References:

Provided upon request.

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