Texas
Expert No. 748

Texas

General

I am an RN Case Manager who is looking to continue in the case management field. I have 20 years of nursing experience With the last 10 years as an RN Case Manager. My Experience includes hospital case management, insurance telephonic case management in office and with telecommute experience at home. My experience is broad in working with transplants of all types, oncology, general high dollar patient's and those that are medically complex. I have CM, UM, UR, Appeals and Denials, Pre-Determinations and medical claim audit experience in addition to my other skills. CCM Certification is good thru November 2010. RN license current to 9-09.

Education

UTHSC Nursing School at Houston- graduated 8/89.
Bachelor of Science Degree in Nursing.

Skills and Certifications

CCM - Certification good thru 11/2010

Milliman Guidelines Training Complete April 10, 2009

Interqual training April and May 2006 . Additional Medicare training December 2007.

RN-State of Texas, good thru last day of 9/2009

BCLS current thru 2010

ACLS twice held- not current

TILE Class (Medicaid reimbursement) 1996. Medicaid training December 2007.

Chemo class at MD Anderson Cancer Center 1991

Labor and Delivery Course at Woman's Hospital of Texas- passed.1989-1990. (NALS experience/instruction included)

Critical Care Course at Methodist Hospital in Houston. CVICU. 1989.

Professional Student Nurse Extern- SICU (Now Shock/Trauma/Neurocritical Care Unit) Hermann Hospital. Houston. 1988-1989.

Clinical Nursing Instructor- At a College August 30, 2006 to October 20, 2006. Maternal Child LVN Clinical Rotation. Also, Institute 4 weeks- Med/Surg LVN rotation- was Clinical Nursing Instructor May 15, 2006 to June 22, 2006. Both subsitute work.

Long Term Care Consultant- Nursing Center. Summer of 1998. 2 week assignment.

Nursing Expert Witness for Medical Malpractice Law Firms. December 1993 until June 2003.

An Army Medical Center, MEPS Training Certificates completed in August 2007.

Work experience

11-30-2009 to Present
PHC or Physician's Health Choice.
Transitioned over from Temporary worker at All Medical Staffing to PHC on

11-30-09. Same duties as a
Telephonic RN Case Manager. Was hired full time. Work as RN Case Mgr. and Transplant CM.

4-1-09 to 11-30-2009
All Medical Staffing assignment as a temporary RN Case Manager for PHC Insurance. Currently working as a telephonic case manager and assisting with other duties in the UM department as needed.

12-1-08 to 2-5-09
Duties: Care Advocate RN. Telephone nursing to include gathering symptoms or data from patient's and then giving them the appropriate Care Advice and then giving them a final recommended disposition.
   

5-22-08 to 7-17-08
Duties: Director of Nursing. 122 Bed Long Term Care and Skilled Nursing and Rehab Facility.
Supervised 40 nursing employees and did complete facility oversight. Hiring, firing and counseling employees as well as maintaining facility compliance with federal and state requirements while keeping the nursing department operating within the prescribed budget.

11-11-07 to 12-19-07
Duties: Working as a temp telephone triage RN for Optum/United Healthcare Nurseline and assisting patient's all over the United States with their healthcare questions and directing their decision making about their care. This is a temp to hire position which ended on 12-19-07.
 
8-20-07 to 11-9-07
Professional Performance Development Group
Duties: To work as a lead case manager as an Army Contractor at An Army Medical Center as an Inpatient RN Case Manager and Physician Medical Extension. Did inpatient case management for the  Internal Medicine Hospitalist team.
Contract ended due to business reasons. Functioned as a PME/RN Case Manager, Social Worker, Discharge Planner.

6-11-07 to 7-26-07
Hospital
Duties: To work as an RN Inpatient Case Manager. Average
load was 15-20 inpatient patient's on ICU and other floors. Did CERME Interqual assessments  per policy. Responsible for work as a Case Manager, Social Worker and Discharge planner. Had to work in a quick turnaround timeframe to quickly get. Medically complex patient's to another level of care.
                                                 
4-3-07 to 5-20-07
Hospice
Duties: To work as a Triage RN for large hospice group. Would make patient visits and drop supplies or Pronounce patient's dead. Left due to sadness of this type of nursing I experienced.

8-20-06 to 10-20-06
College         
Duties: Temporary Clinical Nursing Instructor for Maternal Child Health Clinical Rotation for the LVN Nursing Student Program Took a group of 10 students on 4 week rotations through the Labor and Delivery, Newborn Nursery, Antepartum and Postpartum areas of the hospital as their Clinical instructor and guide. Did 2 rotations and then stopped as policy only allowed Instructors to teach 2 rotations in a grading period.

4-13-06 to 5-15-06
Hospital
Duties: Worked as an Inpatient RN Case Manager per diem 28 hours a week on the inpatient floors doing Interqual evaluations of each chart. Did private Hospital insurance review and government (Medicare, Medicaid) hospital
Insurance chart reviews to make sure patient meets medical necessity to establish support for hospital financial reimbursement per guidelines for each type of insurance. Contact person was Janis Madewell, RN- Supervisor of Case Mgmt.

1-2-01 thru 1-17-06
Benefit Planners/Avidynhealth/FiservHealth
Job Title: RN Case Manager
Duties: Telephonic case management of catastrophic illness in patient'�s for third party administrator for employer groups. I average about 40-50 cases in case management. Responsible for claims audit reviews, rounding and reviewing the medical letters for predetermination approval for medical necessity. Negotiate savings for company and the patient. Long Case Management files are kept and updated to manage the benefits for the patient. Attempt to keep patient'�s with network providers. Assist with referral to community resources. Help patient and company save money and resources. Assist hospital case managers and social workers with discharge planning needs. Assist with utilization review and phone pre-certification. Cost Savings and negotiations for drugs, equipment, transplants of all types are also part of the daily work as Long Case Manager. UM/UR duties. Appeals/Denials experience. Also, precepted new RN's in the past new to the position and have also created forms for department and acted as a resource for Administration and for other RN'�s.

Total Cost Savings 2001: $1,600,000
Total Cost Savings 2002: $3,000,000
Total Cost Savings 2003: $2,200,000
Total Cost Savings 2004: $2,000,000
Total Cost Savings 2005: $2,000,000

7-30-99 to 1-2-01
Prior to working at Benefit Planners, Inc. did nursing occasionally and got my Texas Real Estate License, worked as a Professional model.

Real Estate Jobs

2-1-00 through 1-1-01
Apartment Finders
Job Title: Licensed Real Estate Agent
Duties: Apartment Locator- assisted customers in finding apartments.
Received commissions based on sales.

8-1-99 through 1-31-00
Associates
Job Title: Licensed Real Estate Agent Supervisor: Jenny Bingham
Duties: Residential Real Estate Agent '" newly licensed agent. Showed
customers residential real estate. Took floor duty. Assisted with
sales calls and referrals. Received commissions based on sales.

Nursing Agency Work

Actively Since 2-1-00.
NC Resources
Job Title: Agency RN           
Duties: Worked as hospital agency nurse on telemetry, oncology, medical- surgical, rehab and skilled nursing floors.
Dates of work: 6-95 through present *currently file is inactive. Have not worked

5-98 to 7-3-98
Director of Nursing
Senior Services- Covenant Care Center 100 bed facility
Job Title: Temporary
Duties: To "watch" facility for Director while on honeymoon. Managed about 50 nursing employees and did all of the
hiring, counseling, scheduling, terminations and oversaw all of the operations of the nursing department. Functioned
as the Clinical RN Supervisor for the mostly LVN staff.

11-97 to 5-98
Senior Services- Care Center 120 bed facility
Job Title: Temporary, Medicaid Nurse, Clinical RN Supervisor
Duties: Worked as the TILE nurse and recovered $1,000,000 in lost TILE/Medicaid revenue for the facility in 5 months and got the facility off corrective action with the state. Functioned as the MDS nurse coordinator and assisted the facility with keeping in state regulatory compliance standard for long term care.

Assisted in overseeing a staff of about 50 employees and also assisted with the infection control/wound and skin programs. Was a clinical RN Supervisor for a mostly LVN staff.

Job Title: Nurse Educator, QA Nurse, Infection Control Nurse,
Clinical RN Supervisor, Charge RN prn Subacute Rehab
Job Duties: Supervised 289 bed facility as Clinical RN Supervisor. was the Nurse Educator and conducted all orientation training for new employees and did special training on equipment with new hires and nurses. Arranged all of the inservices for the CEU's and continuing education for nurse's RN's and LVN's. Was the CQI Chairman and was in charge of the monthly CQI meetings. Created audit tools and used audit tools to bring the documentation necessary to achieve JCAHO Accreditation with Honors to the facility. Also, functioned as the Infection Control Chairman and oversaw the monthly meetings and did in services and teaching with the nurse's to bring infection control problems under control. Worked in a 16 bed Subacute Rehab prn as a Charge Nurse when needed. Assisted medically complex patient'�s on ventilators and telemetry on completing their physical rehab. Was responsible for keeping this entire facility within state long term care and acute care licensure regulatory requirements. Was the clinical resource for RN'�s and LVN's at the facility. Used to supervising more than 50 employees at any given time. Had to give employee inservices. Handle distribution of the paychecks to employees. Responsible for destruction of drugs and control over supplies and inventory. Was required to make high level nursing decisions independently regarding patient care and needs as they arose in emergency situations.

Rehabilitation Hospital
12 Bed Specialty Hospital
Job Title: Charge Nurse 7a-7p 9-95 to 5-96
Job Duties: Was the day charge nurse 3 days a week for the
small medically complex rehab population that stayed in this facility. Many stays averaged at minimum 29 days. Worked
with a variety of rehab patient'�s ranging from orthopedic injuries to neuro injuries. Was the clinical supervisor for LVN's.
Had to administer blood and handle emergencies as occurred.

Denotes that I worked at all 3 of these jobs simultaneously the year I lived in Hunstsville, Texas prior to moving to San Antonio, Texas.

Nursing Center
Job Title: Weekend Clinical RN Supervisor
Job Duties: Weekend supervisor for mostly LVN staff.

Memorial Hospital
Job Title: Charge RN 3-11pm ,Per Diem
Job Duties: Was a Charge RN for RN'�s and LVN's on a 45 bed medical/surgical floor that also included 7 pediatric beds. Would float to other floors prn.

Regional Hospital Supervisor
Job Title: PRN nurse- mostly weekends 7a-7p
Job Duties: Worked on the large medical/surgical floor with heavy pulmonary and cardiac patient population. Approximately 40-50 bed medical/surgical floor. Worked as charge RN prn on the surgical floor -16 beds. In Houston, worked at the following places prior to moving to Huntsville, Texas in 5-94. The following places are:

10-93 to 5-94
Hospital
Job Title: Med- Surg Float Pool RN
Job Duties: Worked as an RN on the seven medical and surgical floors. This includes Neuro, Neuro IMC, Renal, Renal IMC, Orthopedics, Rehab, Oncology, Special diseases, Medical, and Surgical floors. Worked with renal patients undergoing dialysis, orthopedic patient's postop, the oncology patients undergoing chemotherapy, surgery patients on the GI floor, a wide array of neuro patient's including those postoperatively from spinal surgery caring for them on the neuro floor. AIDS patient'�s on the oncology floor portion for special diseases. The stroke and spinal cord injured patient'�s on the rehab floor. Also worked in the intermediate units.

9-90 to 7-93
Cancer Center
Job Title: Per Diem RN
Duties: Worked on the Leukemia/Lymphoma inpatient service with full time hours. I also floated to the transplant floor as needed and the leukemia clinic as needed when a nurse called in. Moved to the emergency room - Station 19A the last few months I worked here before going on maternity leave in 7-93. Was responsible for caring for cancer patient's of all types who required drug protocols, chemotherapy, blood products and immunobiologic administration as well as catheter care for the many different central lines. Was required to do a lot of teaching with the cancer patients. Gave experimental drugs and experimental combination of drugs. Acted as a charge nurse prn. Was responsible for handling emergency situations frequently as this patient population has fragile health and requires very frequent and urgent nursing care. Handled end of life issues. *denotes: I came here as an agency RN and was asked to sign a one year contract and at the end of that year went on to become Per Diem RN. Total time= 3 years.

Languages

English. I speak, read and write a little Spanish and French. Not fluent.I speak a few words in Arabic and can communicate light conversation.

References

Available Upon Request

Other Experience

I have worked as a nursing expert in the areas of medical/surgical nursing, rehabilitation nursing and oncology nursing for many years. Please see my management resume'� for my management experience the last
16 out of 18 years.

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