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Registered Nurse and Certified Case Manager with over 20 years of combined Case Management and Utilization Management experience.
Registered Nurse in Tennessee
Certified Case Manager
Western Kentucky University - Bowling Green, KY
Kentucky Baptist School of Nursing - Louisville, KY
Adventist Health System – Naperville, IL,
Facilitate optimal reimbursement through accurate certification and complete chart documentation. Conduct admission and continued stay reviews based on utilization review criteria. Refer and consult with the case manager and social worker to promote appropriate continued stay or discharge in the absence of definitive documentation and/or review criteria to support hospital stay. Experience with ICD 9 coding.
Blue Cross, Blue Shield Of TN – City, STATE,
On Site utilization review for acute hospital confinements for adults and pediatric members. Monitored utilization for HMO and PPO products, Utilized Milliman Criteria as management guideline
Case Manager for catastrophic cases for a managed Medicaid population, Coordinated health education and resources for members, Monitored and evaluated cost effectiveness and outcomes,
Home Technology Healthcare – City, STATE,
Implemented and managed a statewide central intake process for home care referrals, Managed growth of a referral base by an increase of 600% over 2 year period, Managed work flow of 13 staff members.
McFarland Hospital – City, STATE,
St Thomas Hospital – City, STATE,
Tristar Hendersonville Hospital – City, STATE,
University Of Louisville Medical Center – City, STATE,
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Resume Overview
School Attended
- Western Kentucky University
- Kentucky Baptist School of Nursing
Job Titles Held:
- Utilization Management Specialist
- Healthcare Assessment Nurse and Disease Management Specialist
- Director of Intake Coordination and Rehabilitation Nurse Coordinator
- Registered Nurse in the Post Anesthesia Care Unit
- Charge Nurse in the Emergency Department
- Charge Nurse in the Critical Care unit
- Registered Nurse in Post Anesthesia Care Unit
Degrees
- Bachelor of Science
- Diploma Degree
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