Carol Day BS
Resume:
Carol Day, BS
Farmers Branch, Texas 75234
Career Objective:
Dynamic, creative and proactive Care Coordination Team Leader with broad health care experience. Strong communicator experienced in supervising, quality monitoring, conflict resolution, team and individual training with proficient computer skills. Developed expertise in various sectors of healthcare including utilization management, clinic, psychiatric, medical/surgical and obstetrical nursing.
Education:
Strayer University
Currently enrolled - Masters in Health Services Administration
Kaplan University, Fort Lauderdale, FL
Bachelor of Science, Management with Applied Management Concentration
Primary focus on Quality Management and Conflict Resolution.
May 2006
Southwestern Michigan College, Dowagiac, MI
Associates Applied Science
August 1987
Southwestern Michigan College, Dowagiac, MI
Licensed Practical Nurse
August 1986
Work Experience:
CareGuide, Inc, Dallas, TX
Care Coordinator Team Leader/Supervisor July 2002-Present
• Manage Care Coordination team with up to 8 employees and over 100 client groups.
• Write programs for Quality Improvement.
• Audit cases for internal Quality Assurance.
• Coordination with clients to ensure client satisfaction.
• Review planned documents for advice to clients and brokers for new contracts.
• Criteria training for appropriate usage.
• Actively working and monitoring the Appeals process.
• Quality monitoring to meet URAC guidelines through audits and training.
• Hire and terminate employees as needed.
• Monitor progress of new employees and provide additional training as needed.
• Provide retraining for employees with quality difficulties.
• Conduct case intake for medical and psychiatric cases for review.
• Provide decision making for authorizations and extended hospitalization stays as determined by clinical criteria.
• Apply proficient computer skills for proper and appropriate documentation.
• Utilize Medical Director for physician review as appropriate.
• Stay updated with URAC accreditation changes in order to manage cases appropriately.
• Conflict resolution for team management as well as customers and clients.
Review Med, L.P., Dallas, TX
Workman’s Compensation Review Nurse Feb 2002-July 2002
• Workman’s compensation related utilization reviews for medical necessity.
• Remain updated with Texas Workman’s comp and Texas Insurance Laws.
• Supervise non-nursing personnel in processing preauthorization requests.
• Keep files up to date and be available to answer phone calls requiring medical knowledge.
Dallas Diagnostics Association, Dallas, TX
Internal Medicine LVN/LPN 2001-2002
• Assist Internal Medicine Physician in daily care of patients with procedures and care of patients in an office setting. This includes nursing care of patients from vital signs to injections to calling in prescriptions.
Memorial Health System, South Bend, IN
Family Practice LPN 2000-2001
• Assist Family Practice Physician in daily care of patients with procedures and care of patients in an office setting. This includes nursing care of patients from vital signs to injections to calling in prescriptions.
Logan Center, South Bend, IN
Health Services Nurse 1996-2000
• Nursing care of adults with developmental disabilities in a sheltered workshop and group home setting. This position allowed me the opportunity to coordinate services with my previous contacts at Madison Hospital for psychiatric services for those with a dual diagnosis of mental illnesses. I was afforded the opportunity to assist with opening a facility for inpatient services for this population. While working for Logan Center I remained an employee PRN with Madison Hospital.
Madison Center and Hospital, South Bend, IN
Psychiatric Nurse 1993-2000
• Psychiatric nursing care of the acute inpatient adult. This included both mentally ill and substance abuse patients. General nursing care including medication administration, group therapy, milieu management, emergency assessment and management and care of psychiatric nursing.
Other Work Experience
• Medical surgical nursing, Berrien General Hospital, Berrien Center, MI
• Obstetrical nursing, Lee Memorial Hospital, Dowagiac, MI
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