Theresa Shotton
Manager; Clinical Health Services (Manager of Case Management) at American Health Holding- Claim this Profile
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Bio
Credentials
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CCM (Certified Case Manager)
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Experience
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American Health Holding
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United States
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Wellness and Fitness Services
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100 - 200 Employee
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Manager; Clinical Health Services (Manager of Case Management)
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2019 - Present
Manager of Case Management, Work from Home● Lead direct reports and support staff; Team Work● Spearhead projects related to process improvement and case management● STARSource: Interview & hire nurses for case manager positions & collaborate with HR● Collaborate/Implement with both Account Executives and new/current clients, assist with client demos● Policy & Procedure reviews/revisions● Host/Lead weekly Supervisor Meetings & Town Hall meetings● Proficient in: Microsoft Office (Excel spreadsheets, PPT, TEAMS), MySuccess, Concur, AccessNow, Exchange Admin Center (Distribution Lists), Team Hierarchy (eServices) Show less
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CM Supervisor
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2016 - 2019
Case Management Supervisor, Work from Home● Lead/Coach team of case managers— guided, supported & educated● Completed mid and end of year performance reviews● Reviewed client invoices & collaborated with clients● Hosted monthly team and 1 on 1 meetings● Interviewed and hired new nurses● Completed Yellow & Green Belt training, CB ABX CI Basics Training
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RN/Oncology Case Manager
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2014 - 2016
Oncology Case Manager, Work from Home● Completed telephonic health assessments, care plans, medication assessments, medical necessity reviews, motivational interviewing, preparation for Physician reviews, nonCERTs & patient education, Utilization Review, Authorizations for medical necessity● Utilized Milliman, Clinical Policy Bulletins, NCCN, Lexicomp, Redbook, ICD/CPT● Proficient with iSuite: EMR charting & cost savings● Mentored new case managers● Completed White Belt training Show less
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ALERE HEALTH
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Belgium
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Wholesale
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Nurse Care Manager
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2011 - 2014
Chronic-Complex Case Manager, Work from Home ● Performed telephonic assessments, patient education related to chronic-complex health conditions ● Knowledge of ICD-9 coding, web based charting ● Collaborated with physicians, ancillary staff, and families ● Implemented compliance with URAC & NCQA guidelines Chronic-Complex Case Manager, Work from Home ● Performed telephonic assessments, patient education related to chronic-complex health conditions ● Knowledge of ICD-9 coding, web based charting ● Collaborated with physicians, ancillary staff, and families ● Implemented compliance with URAC & NCQA guidelines
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Pike County Health Department, Home Care & Hospice
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United States
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Medical Practices
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Hospice Coordinator
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2010 - 2011
Hospice Coordinator ● Supervised staff, scheduling, evaluations & personnel issues, budgeting, expense reports & chart audit ● Reviewed medical necessity for hospice, home health & DME ● Hosted IDT (Interdisciplinary Team Meeting), 24/hr call ● Marketed with participating facilities ● Prepared for state inspections Hospice Coordinator ● Supervised staff, scheduling, evaluations & personnel issues, budgeting, expense reports & chart audit ● Reviewed medical necessity for hospice, home health & DME ● Hosted IDT (Interdisciplinary Team Meeting), 24/hr call ● Marketed with participating facilities ● Prepared for state inspections
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CMSA
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1 - 100 Employee
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member
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2006 - 2010
CMSA and CMSS member (Case Management Society of America and St. Louis) Member, treasurer CMSA and CMSS member (Case Management Society of America and St. Louis) Member, treasurer
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RN Case Manager
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2005 - 2010
Oncology Nurse Case Manager, Work from Home ● Performed onsite & telephonic assessments ● Decisioned medical necessity of oncology treatments and supportive drugs Oncology Nurse Case Manager, Work from Home ● Performed onsite & telephonic assessments ● Decisioned medical necessity of oncology treatments and supportive drugs
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Hannibal Regional Hospital
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United States
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Medical Practices
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1 - 100 Employee
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Registered Nurse
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1999 - 2006
Registered Nurse: ER, Cardiopulmonary Rehab, Medical/Surgical, Pediatrics & Orthopedic Licensure: CPR, ACLS, PALS, TNCC Registered Nurse: ER, Cardiopulmonary Rehab, Medical/Surgical, Pediatrics & Orthopedic Licensure: CPR, ACLS, PALS, TNCC
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Pike Lincoln Technical Center
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Higher Education
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1 - 100 Employee
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Health Sciences Instructor
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2001 - 2005
High School instructor for entry level health care programs. Health Sciences Instructor: Lecture and Lab Demonstration, Evaluate by written tests and clinical experiences, Smart Board capabilities, PowerPoint, MS Word, Excel, Write lesson plans, Observe clinical sites, Set up clinical sites, Salary Committee member for Pike R-III school, HSTW member, High School that Work program to write curricula, MSTA member (MO State Teacher Association), Mo ACTE & MoSAHOE member, Cluster Chair for Health Sciences Teacher of Missouri . Adult Phlebotomy Instructor: evening adult instructor, 12 week course, Lecture and Lab Demonstration & clinical supervision/set-up Show less
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Pike County Memorial Hospital
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United States
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Hospitals and Health Care
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1 - 100 Employee
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Registered Nurse
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1993 - 2002
staff nurse, team leader med/surg, outpatient surgery pre-op & recovery, GI Lab. staff nurse, team leader med/surg, outpatient surgery pre-op & recovery, GI Lab.
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Missouri Cancer Care
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United States
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Hospitals and Health Care
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Chemotherapy nurse
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1999 - 2001
Chemotherapy nurse, mix & deliver chemotherapy Chemotherapy nurse, mix & deliver chemotherapy
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Education
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2012 - 2016
University of Missouri-Columbia
Masters of Science Nursing, Leadership and Mangement -
1993 - 1996
Hannibal LaGrange College
Rn, BSN, Nursing
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