Experience

• 

  Ohio valley hospital, steubenville, oh

  Jan 1981 - Jan 1986

  Staff rn

  Team nursing up to 15 pts w/ LPN and aide to assist. Also medication nurse for entire floor, charge nurse. On general med-surg unit

• 

  Mt carmel health system

  Jul 1986 - Aug 2000

  Case manager on acute care unit included UM process and discharge planning staff RN on endo-renal unit CAPD/HD and diabetic patientsexperience w/ Cycler for CAPD, tele, ventilatorsdiabetic education

  • RN CM

    Aug 1999 - Aug 2000

  • Staff RN

    Jul 1986 - Aug 1999
• 

  United healthcare

  Aug 2000 - May 2002

  Diabetic disease manager*

  telephonic follow-up with patients after hospitalization to assure maximizing benefits, follow-up, referrals, discharge needs and also calls to new diabetic patients identified for diabetic educationAlso performed Preadmission calls for scheduled member surgery to assist with discharge planning proactively ie assist with transportation or arrange DME/rehab *remained contingent status @ MCHS in CM dept

• 

  (formerly) st angela's

  Jun 2002 - Oct 2002

  Clinical educator/cm

  assisted with Policy and Procedure manual in preparation for JCAHO accreditation.Worked as facility RN supervisor on weekendsCase manager

• 

  Mt carmel health system

  Nov 2002 - Sept 2012

  .Weekly precertifications for weekend admissions.Governmental audits for RACs including Quickbase database-.Tracking appeal process including EHR appeals.Resource for MD offices w/ payor issues specific to hospital precertification.Train/orient new Case managers to CM-specific programs and payor websites used..Anthem, Caresource and Cigna liason.Tracking denials for PI.Trace and Interqual super user/trainer.Genesis DOER for electronic health record rollout April 2012.Resource to case managers and revenue coordinator for case review for patient type, processes, contact info, payor issues.Monthly PI audits.Collaboration with denial/retro team.New physician orientation to CM process.Proficient in Milliman and Interqual criteria Show less .Job includes correct patient typing from admission in ER, precertifications, collaboration interdisciplinary and interdepartmental. .Coverage of Observation unit(chest pain accredited). Train/orient new employees to case management programs/online payor sites.Anthem liason-quarterly meetings..Contact for PI.New Physician orientations.PEPPER audits.Yearly Peer Utilization Management audits for evaluations.PI department audits .Genesis DOER to prepare for electronic health record rollout.Assisted with rollout of Interqual software to MCHS CM depts.Six Sigma training for assistant guide.Resource to CM dept and revenue coordinator for correct patient type.Utilization of Milliman and Interqual inpatient guidelines.TRACE super-user/trainer.Review payor denials specific to CM dept for PI.Weekly coverage for precertifications of weekend admissions.RACS reviews for medical necessity Show less

  • UR Case management Specialist

    Apr 2011 - Sept 2012

  • ER RN CM

    Nov 2002 - Mar 2011
• 

  Sound physicians

  Sept 2012 - Jul 2015

  Transitioned to role of Transition Care RN identifying qualifying patients in BPCI, telephonic management of patient including education, resourcing and assisting with healthcare needs. .Measurably improve quality, satisfaction and financial performance of healthcare delivery. .Monitor core processes w/identification of barriers and development of solutions. .Partner w/ chief to engage physician team. .Assist w/ facilitating clinical processes. .Hospital committees.

  • Transition Care RN

    Apr 2015 - Jul 2015

  • Hospitalist RN

    Sept 2012 - Apr 2015
• 

  Large insurance company

  Jul 2015 - now

  Care manager

  Telephonic case management assisting members with education and support in healthcare journey including medications, disease management, emotional support and more