Shirley Sims
Director Government Programs Clinical Operations at Blue Cross Blue Shield of Montana- Claim this Profile
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Bio
Credentials
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Certified Case Manager
CMSADec, 2011- Nov, 2024 -
Certified Rehabilitation Registered Nurse
ARNNov, 2011- Nov, 2024
Experience
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Blue Cross Blue Shield of Montana
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United States
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Insurance
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100 - 200 Employee
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Director Government Programs Clinical Operations
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Dec 2015 - Present
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Bozeman Health
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United States
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Hospitals and Health Care
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700 & Above Employee
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Director of Case Management
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Jan 2012 - Present
Manager for Hospital Case Management. 87 bed hospital with newly enlarged Emergency Department, We offer access to care in Orthopedics, Cardiac, L&D, Mother / Baby, Pediatrics, Respiratory Intensivist. Full PT/OT/ST department. Many clinics and OP servicess and a fully functional Cancer Treatment Center. Manager for Hospital Case Management. 87 bed hospital with newly enlarged Emergency Department, We offer access to care in Orthopedics, Cardiac, L&D, Mother / Baby, Pediatrics, Respiratory Intensivist. Full PT/OT/ST department. Many clinics and OP servicess and a fully functional Cancer Treatment Center.
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Cigna Healthcare
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Hospitals and Health Care
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700 & Above Employee
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National Supervisor ECF
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Nov 2007 - Nov 2011
Worked with multiple RN Case Managers across the nation who transitioned patients from the Inpatient setting to the next level of care such as LTAC, Acute Rehabilitation, Subacute, Skilled Nursing Facilities, and Outpatient settings. Worked with multiple RN Case Managers across the nation who transitioned patients from the Inpatient setting to the next level of care such as LTAC, Acute Rehabilitation, Subacute, Skilled Nursing Facilities, and Outpatient settings.
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Northside Hospital
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United States
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Hospitals and Health Care
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700 & Above Employee
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Nurse Case Manager
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Oct 2004 - Nov 2005
Performed Reviews on all charts including medicare and reported to insurance companies the information to demonstrate medical necessity admission or continued stay. Also worked for discharge planning and interactions with families for selections relative to acute rehab, SNF, LTAC or Hospice facilities. Knowledge of Interqual and Milliman criteria. Performed Reviews on all charts including medicare and reported to insurance companies the information to demonstrate medical necessity admission or continued stay. Also worked for discharge planning and interactions with families for selections relative to acute rehab, SNF, LTAC or Hospice facilities. Knowledge of Interqual and Milliman criteria.
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Education
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American Sentinel University, Denver
Master's Degree, Nursing / Case Management