Registered Nurse with a Bachelors of Science, with over 30 years of nursing experience. Areas of expertise include
developing, implementing and directing Clinical Documentation Improvement Programs in large hospital systems
including the Long Island Jewish Hospital System, New York University Medical Center, University of Chicago Medical
Center, Henry Ford and Beaumont Hospital Systems. My current position is Senior Consultant for Optun360. Previously I was the Director of Clinical Documentation
Programs at Accretive Health. I worked with the Physician Advisory Services (PAS) as an appeals author
handling Medicare and commercial coding and medical necessity denials for appeal. My nursing background includes
Adult and Child Psychiatry, Substance Abuse, Obstetrics & Gynecology, general medical-surgical, extended care units
and outpatient clinic management. I have expertise in Clinical Documentation Improvement Program development and
management, Utilization Review, Quality Improvement, Performance Improvement, Case Management, and Appeals
Management I am experienced in electronic medical records, multiple computer programs, including EPIC, Meditech, Midas,
Allscripts/ECIN, Microsoft Office, Excel and Access. I have extensive knowledge of ICD-10-CMS, Interqual Criteria,
Milliman Criteria and Joint Commission. I am experienced at instituting new programs as well as assessment and
revision of existing programs in need of update and change in order to stay abreast of current regulatory requirements,
formulating policies and procedures and management. I have extensive experience working collaboratively with medical
staff and medical coders in determining the most appropriate DRG assignment based on UHDDS/coding guidelines.
Certified Clinical Documentation Specialist Electronic Medical Record (EMR) software
CCDS ICD-10-CMS coding/DRG Assignment
Certified Professional of Healthcare Quality (CPHQ) Knowledge of HMOs, Medicare and Medicaid
Licensed RN in Ohio Relationship and team building
Master Trainer Veterans' Administration Staff training and development
Monitor In-depth claims knowledge
Experienced Appeals Author
Professional Registered Nurse, State of OH.
Certified Professional of HealthCare Quality (CPHQ)
Sigma Theta Tau International Honor Society of Nursing. RHO Chapter, University of Michigan
Association of Clinical Documentation Specialist (ACDIS) Certified Clinical Documentation Specialist (CCDS)
Published author of "To Appeal or Not to Appeal" presented for RAC Monitor Webinar Series in August, 2012.
Infused Management (Acting Supervisor/Manager of the Henry Ford Hospital System CDP team) responsible
for training interns, residents, physicians and nursing staff about ICD-9-CMS documentation requirements for a
period of one year.
Guest presenter at the Sigma Theta Tau International Honor Society of Nursing 36th Biennial Convention,
Guest speaker at the Michigan Nurse Association's Annual Convention, October 2002.
Veteran's HealthCare Administration Master Trainer of the "Treating Veteran's with C.A.R.E." program, a
mandatory education program for all new employees.
Responsible for selecting and training other instructors
within the VISN 11.
Developed an educational pamphlets to educate patients and families with regard to the use of restraints and
Responsible for a cultural change in nursing best practice involving the use of restraints in the hospitalized
Strengths include a proven ability to coordinate physician referrals, communication with physicians, third party
payers, communicate with a wide variety of outside agencies to determine length of stay, ensure appropriate
utilization of resources and reduce cost.
A proven ability as an independent problem-solver and negotiator, able to follow though and meet deadlines.
Skilled at interfacing well with people at all levels, administrators, medical professionals, outside vendors,
colleagues, subordinates and the public.
Exceptionally strong and effective written and verbal communication skills-able to listen, provide feedback and
creatively problem solve.
Advanced knowledge of Joint Commission standards, particularly as it pertains to Behavioral Health.
09/2014 to Current
Senior ConsultantOptum360 － Eden Prairie, MN
Assessment and Change Management plans for both large hospital systems and smaller community hospitals
Analysis and report building and submission to Executive Management
Revision/Update of Optum360 Training Manual yearly
11/2009 to 09/2014
DirectorAccretive Health － Chicago, IL
Director, Clinical Documentation Improvement Program - development and implementation of a Clinical
Documentation Improvement Programs including the training of clinical staff and physicians with regard to
ICD-10-CMS guidelines for appropriate capture of utilization of resources and DRG assignment.
Analysis and report building of CDI Initiative to hospital senior management.
Assessment of program success, development of standardized definitions with regard to those most problematic
for the facility.
Conduct thorough assessment reviews and ensure points clarified with physicians are recorded.
Education of HIM coding staff regarding clinical indicators related to disease process that lead to queries.
Expertise in Quadramed, WebStart Encoder, Allscripts, McKesson and 3M.
Revisions/update of Accretive Health CDI Training Manual, as well as assist in the development of the Accretive
DRG Integrity software.
Actively engaged in appeals management and authoring.
Setting for the Certified Coding Specialist () exam this summer.
04/2009 to 10/2009
Senior ConsultantDlitt & Touche LLP － Detroit, MI
Trained client personnel for positions as Clinical Documentation Specialists.
Realized over $650,000 captured revenue within the first 6 weeks of program implementation at New York City
Designed multiple tools for program implementation.
01/2006 to 01/2009
Managing ConsultantNavigant Consulting, Inc － Chicago, IL
Implemented and organized new CDI programs within major medical hospital systems including Long Island
Jewish Hospital System, and the University of Chicago Health Care System.
Trained and mentored client staff in program requirements.
Performed physician education regarding Federal Registry Medicare MS-DRG guidelines with regard to
documentation requirements and changes.
Developed change processes, forms, policies and procedures.
01/1999 to 01/2006
Performance Improvement CoordinatorVA Ann Arbor Healthcare System － Ann Arbor, MI
Responsible for Performance Improvements activities hospital wide, with special emphasis on the Behavioral
Health Care services and the Extended Care Center.
Analysis of hospital wide activity specific data for
presentation to hospital management, reported directly to the Chief of Staff on the utilization of hospital beds per
Development and revision of existing policies as pertaining to Joint Commission, included
hospital wide education and Joint "continuous readiness' preparedness.
Trained in Root Cause Analysis and Aggregate Review reporting quarterly on para suicidal events to the Patient
Safety Officer for VISN 11.
Chaired Performance Improvement teams, organized, developed and implemented a hospital wide training
seminar on the process change to a restraint free acute care policy.
Represented the Performance Improvement Department on hospital committees that analyzed problems,
developed new techniques, and implemented and revised policy.
01/1996 to 01/1998
Clinical Case Manager/ Case CoordinatorMercy Healthcare System － Toledo, OH
Tracking and management of all Outpatient Services for the Behavioral Health Care Division at St.Charles
Vincent Mercy Medical System.
Developed a previously non-existent position for a Behavioral Health Case Manager.
Dealt with quality assurance monitors, committee reports, utilization review, medical record review, insurance
review and certification of stay.
In-depth knowledge of requirements expected from all insurance carriers.
01/1991 to 01/1993
Registered Nurse-Case Management ConsultantMedical Mutual of Ohio － Toledo, OH
Performed medical necessity reviews on all patient cases admitted as inpatient to surrounding hospitals with
psychiatric or substance abuse diagnoses.
Responsible for making decisions with regards to approval or denial of benefits.
Education and Training
Bachelor of Science: Health Care Information ManagementUniversity of Toledo － Toledo, OHCum Laude Health Care Information Management
Associates of Applied Science: NursingUniversity of Toledo － Toledo, OhioNursing High Scholastic Academic Achievement Award
Certified Professional in Healthcare Quality (CPHQ)
Acute Care, Behavioral Health, Behavioral
Health Case Manager, CMS expertise, CDI staff training, senior management, forms, ICD-10, insurance, team building, medical record review, monitors, patient
safety, personnel, policies, process development, program implementation, coding, published author, quality assurance, reporting, trainer, author