Kathy Stevens RN BSN CCM Retired

Experience

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  Blue Cross of Idaho

  Nov 1998 - Jan 2002

  RN Medical Management/ Case Manager

  Telephonic review of medical,surgical and rehabilitation cases for admittance to hospital or continued stay. Reviewed cases for medical necessity for surgical cares, appropriate level of care and Durable Medical Equipment. Reviewed outlier claims for medical necessity and appropriate billing. Negotiated w providers to obtain less costly cares and resources for members. Provided telephonic case management for Federal Employees Program focusing on transplants and catastrophic care needs.

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  ST LUKES REGIONAL MEDICAL CENTER

  Jan 2002 - Jan 2003

  RN Care Manager Home Health

  RN Team Leader for region of patients. Responsible for identifying and scheduling staffing needs, orienting other staff to new cases, performed initial and follow up assessments. Maintained contacts with staff to insure appraised of changes in condition and plan. Notified MD of changes and need for new orders or cares. Maintained all MD orders and paperwork for recertification. Obtained pre approval for services thru Medicaid or other insurance companies.

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  Idaho Department of Health and Welfare

  Nov 2002 - Jun 2006

  RN Senior

  See April 2008. Role included responsibility of managing Traumatic Brain Injury Waiver recipients assessment, provider plan of care reviews and determination for appropriateness. Caseload primarily in Residential Living Facility clients. Identified need for standardized training for providers and developed manual for new providers.

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  Community Ties Of America Inc

  Jan 2007 - Mar 2008

  RN Care Manager

  Perform in home initial and monthly assessments for clients on Home and Community Based Waiver Services. Work remotely to maintain telephonic contact with members, providers and State to insure member's plan of care was appropriate and assisting to resolve identified barriers to meeting service needs. Collaborate with hospital discharge planners to insure a awareness of member's services and to determine need for changes in plan of care to insure safe discharge.

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  Idaho Department of Health and Welfare

  Apr 2008 - Mar 2009

  RN Senior

  Perform medical eligibility assessments and determinations of level of care coverage for services under Idaho Medicaid State Plan and Aged and Disabled Waiver. Focus primarily in adult services in Client's home, Residential Assisted Living Facilities, Certified Family Home and Nursing Facilities. Role includes coordination of care, accessing community resources, educating members and providers regarding services, processes and resources. Function as liaison for other departments of the State, providers and members to find appropriate level of care for member's medical and psychological needs. Show less

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  Qualis Health

  May 2009 - Sept 2016

  RN Case Manager

  Work remotely to provide telephonic case management for Idaho Medicaid members with complex medical care needs. Includes monitoring utilization review, discharge planning, transitions of care and providing medical assessments and education. Collaborate with providers, members and customer to meet members needs to improve health engagement and outcomes. Researching and providing resources assisting members to overcome barriers impacting healthcare choices. Caseload priority includes newborns born prematurely or with other complications, rehabilitation and antenatal cases. Show less

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  Telligen Inc

  Sept 2016 - Jul 2019

  RN Case Manager
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  First Choice Health

  Aug 2019 - now

  RN Case Manager