Director, Care Strategies

• Nov 2022 - Present

Director, Care Strategies

• Oct 2022 - Present

Senior Care Strategy Consultant

• Oct 2013 - Present

Case Management Workflow Analysis Develop of Training Plans Instruct and Assist with Case Management Department Redesign

Clinical Educator

• Jun 2011 - Present

Partner with clients to perform training needs assessments for requested training deliverables. Engage clients in the learning process through the collaborative development of annual or on-going training plans Author written training proposals and training case closure summary to define scope and outcome of training. Interact with clients to identify opportunities for expanded use of the Care Guidelines products licensed by a client. Deliver training on all Milliman Care… Show more Partner with clients to perform training needs assessments for requested training deliverables. Engage clients in the learning process through the collaborative development of annual or on-going training plans Author written training proposals and training case closure summary to define scope and outcome of training. Interact with clients to identify opportunities for expanded use of the Care Guidelines products licensed by a client. Deliver training on all Milliman Care Guidelines products and formats per established standards in various venues

Clinical Educator, RN, MSN, CCM, CTT+

• 2011 - Present

Senior Manager, Care Strategies

• Sep 2022 - Nov 2022

Manager, Care Strategies

• Mar 2019 - Sep 2022

Inpatient Case Manager Specialist

• Jan 2010 - May 2011

Planned, implemented and evaluated appropriate health care service in conjunction with the physician’s treatment plan. Handled complex, high acuity cases and/or account sensitive cases. Performed prospective, concurrent, and retrospective reviews for inpatient acute care, rehabilitation, referrals and select outpatient services including DME. Ensured that case management program objectives are met by evaluating the effectiveness of alternative care services and that cost effective… Show more Planned, implemented and evaluated appropriate health care service in conjunction with the physician’s treatment plan. Handled complex, high acuity cases and/or account sensitive cases. Performed prospective, concurrent, and retrospective reviews for inpatient acute care, rehabilitation, referrals and select outpatient services including DME. Ensured that case management program objectives are met by evaluating the effectiveness of alternative care services and that cost effective quality of care is maintained. Performed leadership role on team when implementing new tools for case management, organization and negotiation skills

Inpatient Case Manager, RN

• Sep 2009 - May 2011

Quality Clinical Coordinator Specialist

• Sep 2007 - Jan 2010

Lead Peer Review committee activities Conducted clinical review of adverse events Conducted medical records review Supported preparation for regulatory audits Lead clinical quality improvement through focused activities on the HEDIS process. Collected, documented and organized of evidence for NCQA/state audits

Inpatient Case Manager Specialist

• Jan 2005 - Sep 2007

Planned, implemented and evaluated appropriate health care service in conjunction with the physicians treatment plan. Handled complex, high acuity cases and/or account sensitive cases. Performed prospective, concurrent, and retrospective reviews for inpatient acute care, rehabilitation, referrals and select outpatient services including DME. Ensured that case management program objectives are met by evaluating the effectiveness of alternative care services and that cost effective… Show more Planned, implemented and evaluated appropriate health care service in conjunction with the physicians treatment plan. Handled complex, high acuity cases and/or account sensitive cases. Performed prospective, concurrent, and retrospective reviews for inpatient acute care, rehabilitation, referrals and select outpatient services including DME. Ensured that case management program objectives are met by evaluating the effectiveness of alternative care services and that cost effective quality of care is maintained. Performed leadership role on team when implementing new tools for case management, organization and negotiation skills

Staff Nurse

• Aug 2001 - May 2011

RN; Provided patient care under physician orders including conducting thorough assessments, administering medications, assisting with activities of daily living and maintaining patient records. Supervised coordination of care provided by nursing assistant staff. Assessed the condition and care of patients to determine if there is a need to contact the physician RN; Provided patient care under physician orders including conducting thorough assessments, administering medications, assisting with activities of daily living and maintaining patient records. Supervised coordination of care provided by nursing assistant staff. Assessed the condition and care of patients to determine if there is a need to contact the physician

Staff Nurse

• Sep 2004 - Dec 2004

Travel; Provided patient care under physician orders including conducting thorough assessments, administering medications, assisting with activities of daily living and maintaining patient records. Supervised coordination of care provided by nursing assistant staff. Assessed the condition and care of patients to determine if there is a need to contact the physician Travel; Provided patient care under physician orders including conducting thorough assessments, administering medications, assisting with activities of daily living and maintaining patient records. Supervised coordination of care provided by nursing assistant staff. Assessed the condition and care of patients to determine if there is a need to contact the physician

Advocate

• Aug 2002 - Aug 2004

Inpatient Care; Planned, implemented and evaluated appropriate health care service in conjunction with the physician’s treatment plan for commercial and Medicare D enrollees. Performed prospective, concurrent, and retrospective reviews for inpatient acute care, rehabilitation, referrals and select outpatient services. Ensured that case management program objectives are met by evaluating the effectiveness of alternative care services and that cost effective quality of care is maintained Inpatient Care; Planned, implemented and evaluated appropriate health care service in conjunction with the physician’s treatment plan for commercial and Medicare D enrollees. Performed prospective, concurrent, and retrospective reviews for inpatient acute care, rehabilitation, referrals and select outpatient services. Ensured that case management program objectives are met by evaluating the effectiveness of alternative care services and that cost effective quality of care is maintained

Eligibility Consultant

• May 1991 - Aug 2001

Investigated and resolved escalated and complex customer service questions, calls and complaints by obtaining necessary information from policies, procedures and practices. Served as primary contact and liaison between health plans, service centers and functional areas. Provided guidance, training and instruction to new representatives. Determined best method to resolve problems ensuring customer satisfaction and adherence to company policies. Investigated and resolved escalated and complex customer service questions, calls and complaints by obtaining necessary information from policies, procedures and practices. Served as primary contact and liaison between health plans, service centers and functional areas. Provided guidance, training and instruction to new representatives. Determined best method to resolve problems ensuring customer satisfaction and adherence to company policies.