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Click here or scroll down to respond to this candidateCandidate's Name
Integrity and RespectStrong Work EthicsReliable and ConsistentStrengthsStrong knowledge of Case Management and Population HealthTraining Program DevelopmentProject and Product ManagementUser Requirement and Workflow Analysis from a clinical perspectiveDischarge PlanningMedical Necessity reviews on experimental, investigational, and international cases.Areas of ExpertiseClinical consulting in Population Health, Government, and Case ManagementTraining for Technology and system use at the user levelClinical and Business AnalysisEducationBachelor of Science NursingAmerican Sentinel University, Aurora, CO (Graduated Suma cum Laude)Diploma, Nursing, Brandywine Hospital School of Nursing, Coatesville, PA (Graduated with Honors)Licenses and CertificationsPennsylvania Registered NurseGeorgia Registered Nurse-eNLCCertified Case Manager (CCM)Certified Medicaid Professional (MCMP-I)Train the Trainer Certification, Penn StateProfessional, Academy for Healthcare Management (PAHM) designationManaged Healthcare Professional (MHP)Certified Managed Care Nurse (CMCN)PROFESSIONAL SUMMARY:Professional nurse with experience in clinical nursing, utilization management, comprehensive care management, nursing management, clinical consulting, business analysis for clinical software development and implementation training, education. Strengths include adult education, leadership, creative problem solving, mentoring, proactive teamwork, and analytic skills. Respected for timely project completion, reliability, integrity, collaboration, and for providing supportive supervision. Maintain current licensure in nursing and case management certification by fulfilling annual continuing educational requirements.CAREER BACKGROUND AND HIGHLIGHTS:Clinical Consultant Utilization and Care ManagementWest Monroe 2017 to 2023Healthcare and Life Sciences ConsultingChicago, ILDemonstrate best practices of all aspects of Utilization Management, Care Management, and Population Health to internal employees, current customers, and prospects.Staff augmentation for customers filling roles from staff UM/ CM through Assistant Director of Care Management.Application of Milliman(MCG) and McKesson(Interqual) guidelines and medical policies for PA, PRED, and Concurrent reviews for medical necessity and level of care reviews.Apply clinical background for successful selection, installation, and maintenance of the healthcare management systems solution.Review, analyze, and consult on customer workflow and work procedures providing optimal use of existing resources and healthcare management systems with efficiency, customer satisfaction, and quality improvement.Internal team and client team training and healthcare education to include the development of needed materials.Collaborate with cross-departmental teams to ensure successful, on-time healthcare projects and ongoing satisfaction of clients.Sr. Clinical ConsultantMedecision, Inc. 2005 to 2017Population Health Management Software Aerial SolutionWayne, PADemonstrate best practice use of The Aerial solution set for Utilization Management, Care Management, and Population Health to current customers and prospects.Apply clinical background for successful installation and maintenance of the Aerial solution.Review, analyze, and consult on customer workflow and work procedures providing optimal use of the Aerial solution with efficiency and customer satisfaction.Train the trainer for customers, conduct training, and provide ongoing customer solution education and support.Collaborate with cross-departmental teams to ensure successful, on-time installation and ongoing satisfaction of the Aerial solution.CHESTER COUNTY HOSPITAL, West Chester, PA 2007-2012Case ManagerPerformed utilization management reviews for admission, continued stay level of care, and prior authorizations for all discharge needs inpatient and outpatient services.Performed interim Assistant Director of Case Management role, training new staff, and developing evening and weekend ER CM duties and roles.Delivered comprehensive patient education.Conducted discharge planning interviews.Interviewed patients and family members to assess home safety and health needs to ensure safe discharge and reduce the risk of readmission.Documented assessments and findings.Coordinated patient needs with multiple facilities and patient care continuum.Provided crisis intervention coverage for Emergency Department behavioral health patient needs and transitioned to an appropriate level of care.Other career experience, knowledge, and skills acquired in Health Insurance, Nursing Homes, and Long-Term Care Facilities holding varied roles and responsibilities:RN Comprehensive Case ManagerPerformed catastrophic case management, concurrent review, discharge planning, and prior authorizations for members.Collaborated with Medical Directors to assess members clinical needs.Completed medical necessity reviews on experimental, investigational, and out-of-country cases.Expertise with MCG (Milliman) and Change Healthcare (McKesson) Interqual criteria for medical necessity determination.Provided comprehensive case management for solid organ, bone marrow, and stem cell transplantation members.Nursing SupervisorSupervised nursing staff in a 99-bed skilled care facility.Conducted in-service education for front-line staff and certified nursing assistant certification training.Conducted monthly new employee orientation program.Organized and chaired infection control and fall prevention committees.Managed unemployment documentation and attended hearings.Supervised nursing staff in a 140-bed long-term care facility.Provided staff scheduling and in-service training for multiple shifts.Provided nursing care as needed to cover staff call-outs.Performed reviews and provided feedback and coaching for nursing resources.Director of Training and EducationCoordinated staff education, orientation, and employee health for a 300-bed long-term care facility.Initiated and facilitated the tracking of all training and infection control for tuberculosis and hepatitis B vaccines for state survey requirements.Developed a personal improvement and professional growth career ladder for non-licensed personnel (nurse aide staff).Coordinated with outside agencies to provide English as a Second Language and literacy training for entry-level positions.References available upon request |
