career profile

 

accomplished nursing and case management professional with more than 20 years experience in hospital and medical group settings. possess excellent team leadership, program administration, quality assurance, and patient care skills. acls and pals certified. licensed rn in california and xxxxxx.

professional experience

 

ppmc/vantage medical group, riverside, ca                                                       06/2008-11/2009

concurrent/discharge planner, case manager

     led patient care programs and case management for all 250,000 health net members including an 85-hospital system.

 

case manager

     oversaw case management for 33,000 members with a medical group in fountain valley hospital.

     conducted chart and concurrent reviews, planned discharges, devised methods to avoid additional bed days, and processed denial of hospital days.

 

bright medical group, whittier, ca                                                                         01/2006-06/2008

case management supervisor

     administered hiring processes and scheduling for all personnel and conducted annual reviews to determine assignments for case managers.

     assessed physician performance for review by the community to resolve problems with patient care or length of stay in the hospital. 

     performed case management for hospital members in the er and oversaw patient transfers to various hospitals in-network.

     scheduled follow up appointments for patients being discharged who needed to see specialist soon after leaving the hospital. 

     presented cases during utilization review meetings at the corporate office.

     facilitated case management initiatives by helping on the floors when the census was up and a case manager called in. 

 

managed care resources, whittier, ca                                                                  01/1999-01/2006

rn case manager

     led case management and discharge planning for medical groups, hospitals, and health plans. 

     collaborated with pacificare/secure horizons by performing expedited and standard appeals for kindred an ltac hospital, as well as 20 hospitals.

     monitored patients in er, icu/ccu, peds, med/surg, telemetry, nicu, ortho,rehab units to ensure optimal and timely patient care by staff. 

     served as a prior authorization nurse by reviewing requests for surgery, durable  medical equipment, specialist care, and second opinions. 

 

los angeles community hospital, los angeles, ca                                                    1999-2001

house supervisor

     supervised bed boards, transfers, and attended all code blue situations.

     managed staff scheduling and located replacement staff for shifts that weren t covered.

     served as recovery room nurse when an emergency surgery situation occurred late at night or or staff or recovery room staff couldn't arrive in time.

     i relieved staff for breaks and other time off in er, icu/ccu, and telem. 

     retrieved medications from the pharmacy and communicated with mortuary staff who came in to collect deceased patients. 

     reviewed patient care to assess quality management and developed processes and forms to review physicians on surgery, transfusions, rate of infections.

     ensured all charts and forms were ready for survey. 

                                                                                             

 

 

 

additional work history

 

1990-1999- director of nursing for many skilled nursing facilities

     developed new programs to ensure safety of all patients. 

     conducted hiring processes for cna, lvn, and rn staff. 

     performed all staff reviews and incorporated disciplinary action as needed.

     reviewed all medicare charts for accuracy, completed all tars for medical patients, and attended rehabilitation meetings to discuss and review progress of patients.

     resolved any issues the state questioned after the facility was surveyed.

education

 

mt san antonio, walnut, ca

licensed vocational nurse, 1979

 

golden west college, huntington beach, ca

associates of nursing (rn), 1989

 

acls and pals certification

 

licensed rn in california and xxxxxx