Nursing experience to implement appropriate Plan of Care for our members. 7years Case Management experience, 28years ICU experience. Involve the Hospitalist or Medical Director for Peer to Peer review as needed.
Best in Class Case ManagementCase ManagementLas Vegas, NV, USAContinuing Ed class by Catherine Mullahy.
University of CaliforniaMedical Case ManagementRiverside, CA, USACertificate Program.
El Camino CollegeNursingTorrance, CA, United States
Molina HealthcareSeptember 2014 to CurrentConcurrent Review Clinician Long Beach, CA
EMERGENCY DEPARTMENT SUPPORT UNIT, remote position. Determine appropriate level of care. Create and issue authorizations for admission, transportation, or home health. Assist in the collaboration of SNF placement if clinically indicated. Coordinate placement into case management when appropriate.
Speak with ER physicians re: continued care post DC, arrange for followup appointments.
and advise hospital Case Managers of options.
Interact with Medical Directors re:
identification of member needs and appropriate utilization of covered care.
Discharge planning. Utilize criteria met via InterQual, and most recently educated on Milliman Care
Determine insurance responsibility via use of DoFRs.
PromedAugust 2012 to August 2014Inpatient Case Manager Pomona, CA
Daily review utilizing Milliman for justification of stay.
Identify and evaluate member's needs.
Discuss cases with Primary Care Physicians, Specialists during morning rounds.
Spoke with patients and their families regarding plan of care. References given.
Montclair HospitalNovember 2009 to June 2012Inpatient Case Manager Montclair, CA
DC Planning upon admission. Daily reviews inpatient utilizing Interqual, Milliman, DRG.
Consult with patient care team, PCPs
regarding Discharge Plan.
Educate patient/family regarding diagnosis and Plan of Care.
Montclair HospitalJune 2005 to November 2009ICU Relief Charge Nurse, Preceptor Montclair, CA
Oriented, educated current staff and new hires to the ICU.
Developed and implemented a Plan
and Schedule for orientation, and continued education for staff.
Actively involved in QA and day
to day functioning of the ICU.
Participated in Joint Commision surveys when present in the Unit.
Assess inpatient services for members to ensure optimum outcomes, cost-effectiveness, and compliance with all state and federal regulations and guidelines.
Conduct inpatient reviews, re-evaluations. Currently being trained in Appeals and Grievances.
Access to variety EMR systems to conduct reviews.
Activities and Honors
Member: American Association of Critical Care Nurses (1981- current)