Experience

Choate Mental Health

• United States
• Individual and Family Services
• 1 - 100 Employee

• • Jul 2022 - Present

• • Aug 2020 - Jul 2022



Union County Hospital

• Anna, Illinois

• Director of Case Management Services

  • Aug 2016 - Aug 2020

  Oversee and participate in all social work/case management/discharge planning in acute care, swing bed unit and emergency room. Oversee and participate in utilization management. Oversee and ensure appropriate patient admission and status. Oversee observation-to-inpatient process coordination. Balance optimized revenue with patient’s needs, assist with complex case management cases and ensure coordination of care. Ensure supportive documentation across all avenues of care as required by regulatory guidelines. Oversee, assist and participate in obtaining prior authorizations, faxing clinical reviews. Participate in denial prevention. Oversee and participate in the transition of care program, perform medical necessity reviews and refer appropriate cases to the physician advisor and/or UM committee. Compilation, organization, tracking and reporting of data to corporate and at Utilization Review Committee meetings, including but not limited to: readmissions, observation stays, 0/1 day medicare stays, Important Message From Medicare, patient choice letters, peer to peer completions, transfer of care program enrollees, outliers, avoidable days, length of stay, denials, total denial costs, inpatient downgrades, etc. Suggest/Oversee Implementation of new processes to improve based on data results. Serve on the following committees: Utilization Management, Patient Safety, Infection Control, Quality Assurance, Corporate Compliance, Denial Management, Finance/Revenue Team. Daily attendance in Emergency Room Safety huddle and Acute Care Safety meeting. Daily attendance in Interdisciplinary Team Meetings. Monthly reporting to Corporate Compliance. Participate in marketing and networking with local hospitals on a monthly basis. Participate in reviewing potential swing bed candidates. Participate in community education through Senior Lifestyles program. Assist with policy changes/reviews. BLS CPR certified. Show less



Saint Francis Healthcare System

• United States
• Hospitals and Health Care
• 500 - 600 Employee

• • Apr 2014 - Aug 2016

  ALS Clinic: coordination of all aspects of clinic in compliance with ALSA and AAN guidelines, while seeking to become a Certified Center of Excellence for ALS. In addition, responsible for all aspects of patient care and case management coordination, including organization of patient files, organization and expedition of orders for home care needs, insurance preauthorizations, community referrals. Pain Clinic: In a sterile environment, assist physician with various injections to alleviate pain. These include, but not limited to, epidurals, blood patches, radiofrequency ablations, joint injections, spinal cord stimulators, selective nerve root blocks, refills of implanted pain pumps, reprogramming pain pumps. Oversee ordering of medical supplies, patient charges, telemetry of pain pumps, education materials. Assist with intake, discharge, narcotic agreements, patient education, preparing patients for procedures. Conscious sedation, ACLS and BLS CPR certified. Show less

• • Apr 2007 - Oct 2014

  Compilation and presentation of neurosciences quality indicator measurements for joint commission, assist with and be present for joint commission surveys, member, Stroke Team, Neurology departmental team, Medication use committee. Patient/staff education, neurology/neurosurgery. Case management/discharge planning of neurology/neurosurgery patients. ALS clinic: Coordinator of clinic per ALSA and AAN guidelines. Assisted in all aspects of initial start up of the clinic.Carotid Occlusion Surgery Study: Site coordinator for Washington University research trial. In coordination with medical director, responsible for identifying potential appropriate candidates and enrolling them into the trial. Certified in NIH stroke scale, medical research certification (certified clincial research coordinator). Responsible for coordination of all files and patient information, reporting to internal IRB annually, hosting annual review of files by Washington University Research Team. Show less

• • Aug 2005 - Apr 2007