Candidate Information Title Utilization Management Case Manager Target Location US-TN-Franklin Email Available with paid plan Phone Available with paid plan	20,000+ Fresh Resumes Monthly     View Phone Numbers     Receive Resume E-mail Alerts     Post Jobs Free     Link your Free Jobs Page     ... and much more Register on Jobvertise Free
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5116 Victoria CoveBrentwood, TN Street Address
Wanda Pippin, RN / RHIAPHONE NUMBER AVAILABLEQualificationsUtilization ManagementDisease ManagementDual Diagnosis/AddictionsPsychiatric CareHome HealthcareRHIA/Computer LiteracyLifespan CareQ.A NCQA TrainingHealthcare AuditorProfileClinical staff RN with proven success in Utilization Management and Disease Management. Served in management roles, supervising up to ten employees. Track record of producing desired outcomes.Career HighlightsAnalyzed the protocol and expressed a need for a screening tool. Result: Tool was added to protocol.Offered eight and 12-hour shifts. Result: Increased nurse satisfaction.Managed case loads with Utilization Management and Disease Management. Result: Positive outcomes.Implemented quality improvements. Result: Increased performance and productivity.Completed coding project with Utilization Management. Result: Obtained correct codes.MHIM: Standing in a Master of Informatics/Information program. Received my Certificate in Informatics/Information Management,2023.ExperienceElevance/GainwellRN BH Case Manager, RN Case Manager: MA Medicaid. (InterQual). 2022-2023.Screens members using clinical judgement, and criteria to assess needs. Conducts assessments to identify NEEDS AND develops a care plan. Monitors and evaluates EFFECTIVENESS AND modifies a plan. Supports members access to quality and effective care. Gainwell-RN, CASE MANAGER-MA MEDICAID. USED INTERQUAL FOR MA MEDICAID UM. MA WALL.Medcor: COVID-19 Telephonic RN /Point of Entry RN Case Manager, State of TN-PHNC-1Utilized Medcors screening tool for screening employees for Covid-19. Contract. 2021Regional One-Screens ED patients for admission criteria, utilizing Milliman, Cerner, and communicates results to MDs and Bed Control. Resigned. State of TN: Compliant hotline. Resigned/retired with 15 + years of state service.State of Tennessee: RN3, MEU Unit. 2011-2018Supervised two Employees. Evaluated Medicaid cases for Incapacity. Appeal, DAC Cases. Psych, Medical, IQ. Valued Evaluation. No disciplinary in my folder. 15 years of state service. AWS. The work process evolved to the EHR. RIF, due to low caseload. Retired from the State of TN.Williamson Medical Center: Used Interqual and Meditech for Utilization MGT. 2008-2010CCU, NICU, Telemetry, Oncology, Orthopedics, Med-Surg. Medicare, Workers Compensation. OB, CPC. Raise.State of Tennessee2006-2008Health Records Auditor, RN3Audit records using specific audit tools. Monitors medical records for compliance with local, state, and federal requirements, including ACA standards. Plans of correction for the monthly state facility monitors as well as the yearly institutional audits. Assists the infection control, and the continuous quality improvement departments with gathering of information on inmates with chronic conditions. Q.A. Projects for evaluation of continued compliance with ACA standards. Monthly chronic care survey. Interim Infection Control RN, 2007. Participated in the annual inspection of a facility and received Best Annual Inspection in 10 years with an Exceptional evaluation.Managed Access, State of Tennessee2005Medical Record Data CollectionProject based; responsible for medical record data collection and capturing ICD-9-CM codes. State: Quality Oversight. EPSDT audits. Approved reading material. Collaborated with MCOs.HMC: Wellpoint Blue Cross Blue Shield2003  2004Registered NurseRN on the Diabetes team. Serviced CAD, CHF, Asthma, COPD, Peds, Screen Depression, and Hypertension Project. Fully productive evaluation. Merit Raise. Co. Closed the Franklin, TN office.VA Hospital2002  2003RHIA Outpatient CoderInput E/M codes and ICD-9-CM codes. 3M coding. Generated billable versus non-billable visits. Fully successful evaluation.First Health Corporation Incorporated2000  2002Registered NurseRN, RHIA, BCM-1. Utilization Management. Psych, Dual Diagnosis/Addictions. Responsible for telephone and paper record reviews for hospital stays (children through geriatrics). Input ICD-9-CM codes. Received 6.5 to 7.5 out of 9 on evaluations. Laid off. Consolidated and moved to VA.Elk Valley Home Health1999  2000Registered NurseDiabetic teaching, wound care, assessments, histories, and discharges.5116 Victoria CoveBrentwood, TN 37027EMAIL AVAILABLEWanda Pippin, RN / RHIAExperience, ContinuedTennessee Christian Medical Center1999Registered NurseServed in addictions, dual diagnosis unit. Geriatric and adult partial treatment programs. Above standard evaluation.Middle Tennessee Mental Health1997  1999, 2003Psychiatric NurseServed in acute treatment program and ETP Forensic Unit. Adults through geriatrics. Treatment Team. Supervised 5-10 employees. Superior evaluation.First Hospital Corporation1997Psychiatric Registered NurseServed children through adults, prn. Hospital closed.EducationRN B.S.N. Belmont University  Nashville, TNB.S. Health Information Management / RHIA UTHCS - Memphis, TN, Certificate MHIM /Informatics/Information,2023.