Shirley Sims

Director Government Programs Clinical Operations at Blue Cross Blue Shield of Montana
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Contact Information
us****@****om
(386) 825-5501
Location
US

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Credentials

  • Certified Case Manager
    CMSA
    Dec, 2011
    - Nov, 2024
  • Certified Rehabilitation Registered Nurse
    ARN
    Nov, 2011
    - Nov, 2024

Experience

    • United States
    • Insurance
    • 100 - 200 Employee
    • Director Government Programs Clinical Operations
      • Dec 2015 - Present

    • United States
    • Hospitals and Health Care
    • 700 & Above Employee
    • Director of Case Management
      • 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.

    • Hospitals and Health Care
    • 700 & Above Employee
    • National Supervisor ECF
      • 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.

    • United States
    • Hospitals and Health Care
    • 700 & Above Employee
    • Nurse Case Manager
      • 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.

Education

  • American Sentinel University, Denver
    Master's Degree, Nursing / Case Management
    2012 - 2015

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