Manager Medical
Resume:
LYNN GONZALES, RESUME ****
OBJECTIVES
*. To return to working in Case Management or Quality Management
2. To obtain either CCM certification or CPHQ certification
3. To obtain my MSN within the next 5 years
4. To work for one company for the next ten years, and if positions are available, to advance as I get my BSN and MSN.
QUALIFICATIONS AND ATTRIBUTES
----Committed, enthusiastic, and people-oriented; Strong patient advocate.
----Excellent written and verbal communication skills
----Diplomatic and assertive in dealing with people at every level
----Excellent problem-solving abilities
----Equally effective working independently or as a team member
----6 years of experience in Case Management, both in-hospital and for insurance company
----5 years of experience in Quality Management, in-hospital
----8 years of bedside nursing, 7 of which were in ICU
----3 years of outpatient clinic nursing
EXPERIENCE in CASE MANAGEMENT
July 2005 to October 2005
California Hospital Medical Center, 1401 Grand Ave, Los Angeles, CA 90015
Case Manager for med-surg floors. Many MediCal TARS, work with homeless
and indigent patients as well as insurance patients, utilization review and discharge planning
April, 2004 to 7/2005
MCR, Inc., Westwood, California
Ambulatory Case Manager for HMO – Telephonically assist clients at home to manage their chronic diseases by facilitating access to DME and Home Health personnel, but mainly by educating them about their diseases, symptoms of decompensation of the disease and preventative behaviors. Also per diem Registry Case Manager for Midway Hospital, Cardiac Observation Unit and ICU, and UCLA Medical Center.
1994-1999-- CASE MANAGER Brotman Medical Center, Culver City, CA
Responsibilities: Assess needs of patients and families for follow-up home care either for Durable Medical Equipment, Home Health nursing, MediCal referrals, physical therapy, cardiac rehab and pulmonary rehab as well as for home safety evaluations. Identify patient and family responsibilities and options within coverage of the health plan. Make referrals to long term care facilities, acute rehab facilities, catastrophic long term care facilities or independent living facilities as appropriate within the guidelines of their insurance plans. Advise physicians, third party payors, long term care providers, and home health providers as to appropriate levels of care. Facilitate transfers to covered acute or subacute facilities. Approve admissions based on IS, SI and Interqual criteria. Educate patients, families and physicians as to services provided at various levels of care. Educate physicians as to documentation necessary to support stated levels of care and recommend appropriate alternative levels of care. Make referrals to other departments as indicated. Identify issues requiring intervention of Quality Improvement personnel. Identify issues of bioethics, complex discharge planning, quality of care, and sentinel events. Participate in multidisciplinary rounds regarding complex cases. Worked as Preadmission Nurse Coordinator to prevent inappropriate transfers to acute care and to facilitate timely work-up and diagnosis to shorten length of stay and improve patient outcomes. Attend Department of Utilization Management physician meetings making referrals to appropriate physicians and physician peer review committees for inappropriate or outlying episodes of care. Worked on all units including med-surg, DOU, ICU, CCU, Acute Rehab, Skilled Nursing Facility, Subacute, OB, Psych.
1987-1994 PREADMISSION NURSE
Responsibilities: Screen all medical and surgical admissions. Coordinate all interfacility transfers. Approve all MediCal admissions. Review all Observation Bed admissions and Skilled Nursing Facility transfers. Coordinate preop teaching, preop testing and plans for discharge in Ambulatory Care Unit as Patient Care Coordinator. Resource for Admitting personnel. Committees - Surgical Services, Nursing Division, Utilization Review, Program Services Functional Team and Admitting Department meetings
1999-2003--PERFORMANCE IMPROVEMENT COORDINATOR -
Responsibilities: Attend medical staff committees; review medical records, initiate and participate in peer review process, supply Medical Staff Office with trended data for physician credentialing. Consult with Department Directors to develop performance improvement activities, track and trend data, display data
for PIC Committee and Quality Council review; develop PI plan and year-end evaluations for PI activities; take trended data to Medical Staff Committees for their review and input. Gather, tally and input ORYX data for HCFA compliance.
Coordinate Partnership for Change data and teams. Review risk reports, code them for data entry and refer to Department Directors or Medical Staff committees for further actions. Track and trend and display trended data for department and committee review. Attend Medication Administration Team meetings. Participate in JCAHO preparation as directed. Had CPHQ certification
EXPERIENCE PATIENT CARE
October 2006 to October 2009
Marina del Rey Hospital, 4650 Lincoln Blvd., Marina del Rey, CA 90291
RN ICU nights, Recovery Room, 3-11p, full time
August 2006 – September, 2006
Mad River Community Medical Center, Arcata, CA 95521
Short term travel assignment, ICU, nights through Myriad Healthcare
April 2006 to August 2006
North Bay Medical Center, 1200 B. Gale Wilson Blvd., Fairfield, CA 94533
Travel assignment as ICU RN nights 13 weeks through AMS Healthcare.
January 2006 to April 2006
Supplemental HealthCare, 16000 Ventura Blvd. Suite 408, Encino, CA 91436
Per diem ICU and tele unit staff nurse at Kaiser West LA, at John
Muir-Mt. Diablo Hospital in Concord, and Mercy Hospital in Sacramento
December 2005 to March 2006
MGA Healthcare Staffing, Inc., 2800 N. 44th Street, Phoenix, AZ 85008
Per diem staff RN ICU at Hollywood Presbyterian, Long Beach Memorial, and Saint John’s Hospitals
Feb 2003 to April 8, 2003
Brotman Medical Center, Culver City, California
Staff RN, Surgical Intensive Care Unit
June 1983 to Feb 2003
Brotman Medical Center, Culver City, California
(a 436 bed general acute care hospital)
1983 - 1984----Staff nurse, Surgical Intensive Care Unit, Step-Down Unit, Brotman Medical Center. Frequently assumed Charge Nurse position in Step-Down Unit.
1984-1987----STAFF NURSE, AMBULATORY CARE UNIT, Brotman Medical Center. Preop and postop care and teaching, Charge Nurse for evening shift, Unit Preceptor for new staff. Translated forms into Spanish, initiated rough draft of ACU flow sheet
1980 to 1983 Medical Weight Control Clinic, Huntington Park, California
OFFICE MANAGER AND RN.
Responsibilities: Patient teaching and counseling, diet supervision. Facility administration including management of personnel, bookkeeping, food, and medication inventories, and staff training and retention.
1978 to 1980 Nursing Services, International, Inc., Beverly Hills, California
STAFF REGISTRY RN in various Intensive Care Units throughout Los Angeles including Burn ICU. At that time had ACLS and CCRN certifications.
1977 to 1978 UCLA Medical Center, Los Angeles, California
STAFF NURSE - Neurological medical-surgical floor and Intensive Care Units. Successfully challenged the UCLA ICU course.
1976 to 1977 St. Paul Hospital, Dallas, Texas
STAFF NURSE - Neurological and neurosurgical floor. Took and passed Intensive Care Unit Course.
LICENSE RN 279345, Current
EDUCATION
-----The College Network/Regis University RN to MSN program 12/2010, current
-----Best in Class Case Management seminar, October 2010- included Case Manager Role and Functions, Activities, Work Format and Communication Skills, Healthcare Delivery Systems, Coverage Issues, Community Resources, Legal Responsibilities of the Case Manager, Ethical and Cultural Issues in Case Management, Behavioral and Psychosocial Issues, Clinical Functional Satisfaction Outcomes, a case study, and Moving toward the future.
-----Medical Billing and Coding, Kaplan College, Panorama City, CA May 2010 – Jan 2011
Multiple chapters on details of various insurance companies, updates on rules and regulations of Medicare and MediCal, types of insurance, models of HMO practice, chapters on ICD9, CPT, HCPCS coding divided up by body systems, understanding of billing and use of the Medisoft computer system
-----A.A.S. Degree in Nursing, Niagara County Community College, Niagara Falls, New York, 1976
----- Certificate from Sawyer School of Business leading to position as legal secretary. Was notary public.
PROFESSIONAL ASSOCIATIONS AND CERTIFICATIONS
(RELATED TO CONCURRENT WORK SITUATIONS)
CPHQ, CCRN, ACLS, BLS
Case Management Society of America
American Association of Utilization Management Nurses
Healthcare Utilization Management Association
California Association Hospital Admissions Management
Southern California Association of Admitting Nurses (served as Secretary and President)
Awarded Nurse of the Year 1988 for PACU, ACU and Anesthesia Departments
RECENT UPDATES
BCLS June 2009 ACLS September 2009
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