Provides Opinion & Testimony In:
Oncology, Women92s Health, Behavioral Health, Telemetry, Med Surg, Case Management, Certified Case Manager Medicare Medicare Advantage Plans, HMO Self Funded Employer TPA UR UM, Focus on Catastrophic Case Management, Complex Case Management, Hospital Case Management, Insurance Telephonic Case Management Minor Telecommute Time, Concurrent Review Organ Transplants, Oncology, Concurrent Review, Medically Complex Patient Care, CM UM, UR, Appeals and Denials, Pre Determinations, Medical Claim Audit, Train Registered Nurses Licensed Vocational Nurses Insurance Clinical Software, Workflow Processes Procedures, Interqual Milliman,
Expert No. 748
Texas, Florida, California
SUMMARY OF QUALIFICATIONS
• Seasoned clinical nurse on several clinical units, including Oncology, Women’s Health, Behavioral Health, Telemetry, Med-Surg and more
• 10 years’ experience in Case Management, including training and development
• Certified Case Manager for Medicare and Medicare Advantage Plans (2001 – Present)
• HMO and self-funded Employer TPA groups.
• UR/UM, Focus on Catastrophic or Complex Case Management
• Hospital Case Management, insurance telephonic case management with minor telecommute time. Includes DC Planning functions. Focus on Concurrent Review.
• Experienced in organ transplants, oncology, concurrent review, general and medically complex patient care.
• Experienced in CM, UM, UR, Appeals and Denials, Pre-Determinations and Medical Claim Audit
• Train RN's and LVN's in the clinical and insurance setting on clinical software, workflow processes and procedures, and Interqual/Milliman
Lifespan Home Health – San Antonio, TX May 2016 – Present Field RN
• Admissions, discharges, ROC and Recerts
• PICC line care, IV Abx admin, wound care
• Patient and family education
The Forum at Lincoln Heights – San Antonio, TX December 2015 – Present
RN Supervisor and Floor RN, PRN
• Assist with RN Supervisor coverage on the weekends
• I handle emergencies in patient care
Buena Vida Nursing Facility – San Antonio, TX November 2014 – January 2015
• Handled emergencies and get patients out to ER
Caprock Home Health – San Antonio, TX August 2015 – September 2015
• OASIS Admissions
• Post Hospital visits. Discharges. Teaching. IV's, PICC Lines/Central lines, Wound Care, Antibiotics. Overseeing the LVN's who do intake and field work.
• Oversee the CLASS State of Texas DADS program
• Ensure that patient quality care, billing and operations are completed in a timely manner
• State and Federal guidelines are adhered to
• Oversee the Field RN that makes the supervisory visits, post hospital visits, annual visits and orientation for attendant visits for the CLASS program.
• Conduct assessments and supervisory visits
Interim HealthCare March 2015 – May 2015
Home Health RN, PRN
• IV Infusions and make home health visits in the San Antonio and New Braunfels area
• IVIG specialty infusions performed.
Trachmasters – San Antonio, TX July 2014 – January 2015
Clinical Instructor, PRN
• Teach IV Classes and EKG Class
• Assist in developing a CNA School
LifeCare Hospital – San Antonio, TX August 2014 – December 2014
RN Case Manager
• Inpatient RN Case Manager caring for 13-15 cases.
• Discharge planning, insurance reviews, CM assessments and Utilization Review and some social work type duties performed.
• Took care of very seriously ill patients and assisted them with transitioning to lower level or higher level of care from LTAC.
• Worked closely with nursing staff to help patient meet their goals of care at next level.
• Worked closely with family members and physicians also.
Careerpoint College – San Antonio, TX March 2014 – July 2014
• Maternal Child Clinical, Behavioral Health, Med Surg III
VIP Care Management Services, Caprock Health Group August 2013 – January 2014
Senior RN Case Manager
• Telephonic case management for the NICU, Hi Risk OB Moms, Pediatric, Adult, Geriatric, Oncology, Transplants, Autoimmune diseases.
• Caring for the ill population with A-Z demographics and diseases.
• Created all the forms and workflow processes that helped to develop this program.
• Personally eveloped the case management report forms and health maintenance program scripts Transplant checklist and Transition forms were created as well as Continuation of Care forms
Sunrise Nursing Facility – San Antonio, TX November 2011 – March 2013
RN Supervisor (weekends)
• Manage the building on the weekends 7am-7pm and assist working as a charge RN during the week if needed.
• Manage 20 employees every weekend and 100 patients.
• Conduct the wound care treatments and assist with IV antibiotic administration and care of the central lines and other tasks as needed.
• Supervise all employees and handle all clinical emergencies as they arise.
Restorative Health Care – San Antonio, TX June 2011 – June 2012
• Was full time RN doing OASIS admissions and clinical care in the home including IV Abx, pumps, CHF drips, Chest Tube Pleurex drainage in home
• Heavy Wound Care and Teaching.
• Teaching included the major chronic diseases CHF, Diabetes, COPD and other acute illness as well.
Web TPA, AMWins Group, Inc. 3/2011 – 5/2011
RN Case Manager
• 10 hospitals and 17,000 employees and their dependents
• Assisted in training other RN’s
Physican's Health Choice/ Well Med – San Antonio, TX April 2009 – March 2011
RN Case Manager, Temp
• Telephonic Case Manager, Transplant Coordinator and Prior Authorization RN
• Trained 13 RN Case Managers
• Served as UR nurse and followed URAC guidelines
• Assisted PHC with their UR/UM dept. as well at transplants of all types
• Assisted the Case Manager Department
St. Philip’s College – San Antonio, TX August 2006 – September 2011
Clinical Nursing Instructor
Benefit Planners – San Antonio, TX 2001 – 2006
Complex Case Manager
• Catastrophic case management for insurance companies and third-party administrators
Interim Healthcare (1993 – 1999)
Cleveland Regional Hospital, Staff RN
Memorial Hospital, Staff RN
Methodist Healhtcare, Staff RN: Telemetry, Med/Surg and Oncology 1993 – 1996