Deborah H. Email and Phone Number

-Perform as staff development coordinator for Care Coordination and Nurse Case Management for onboarding and training. -Supervisor of Case Management Team for 8 FTE Care Managers. -Serve as a nurse resource with focus on Medicare Advantage population in implementation of Nurse Case Management and in the Utilization Review Process. -Drove increased performance through the Care Management team. -Implemented the use of InterQual criteria for review of prospective, concurrent, and retrospective criteria to evaluate medical necessity for hospital admission and hospital observation status through access to 28 hospitals that serve the patient populations in over 30 MSO Primary Care entities used in the discussion of denials with designated plans. -Monitor length of stay, discharge disposition in the hospital, inpatient rehab, and Long-Term Acute Care and kept track of long and complex admissions that may require additional interventions and engagement from Care Manager, Social Worker and Providers assigned. -Created training material for the new corporate team for all Care Managers including educational material for patient care. -Direct Coordination of Care with UM and CM staff along with leadership, medical directors, and external hospital/facility clinical staff to ensure that all patients have the correct admission status (inpatient, outpatient short stay, observation, and ED) to ensure the most appropriate clinical setting and interventions. -Serve as a nurse consultant with focus on patient care and utilization trends that impact on HEDIS, Stars and Quality Ratings. -Served as a subject matter expert for developing a Corporate Care Management Guide used for New Hire Orientation and staff development.

Transitions of Care Management Discharge Planning Utilization Management using MCG guidelines. Participated in appeals.

• Repeatedly recognized for top performance.• Serve as a Subject Matter Expert in the implementation of Case Management Workflow for effectively managing the complexities of certain populations with multiple complex comorbidities.• Focus primarily on patient engagement and assessment through collaboration and telephonic outreach to member, caregiver, facilities, and care providers facilitating effective transitions of care in all areas. • Provided support and education to members. Connected members to resources provided within plan to include Pharmacist, Social Worker, Registered Dietician and Behavioral Health to help members have the tools to increase their health.• MCG guidelines used to collaborate with and assist member, care giver, providers, facilities, and Medical Director in appeals process to assess benefit eligibility.

• MCG Guidelines used to determine the appropriateness and cumulative effectiveness based on documentation of care and permit payment and utilization of funding to pay for services ordered by medical doctor as determined by a multi-faceted system for determination of payment authorization.• Coordinates the care and services of selected member populations across the continuum of care, promotes effective utilization and monitoring of health care resources, and assumes a collaborative role with all members of the healthcare team to achieve optimal clinical and resource outcomes.

• Provided pre and post procedural nursing care to patient population for same day PCI and non-PCI cardiac catheterization, cardiac procedures, peripheral vascular, cerebral vascular, endovascular, and radiological interventions. • Prepare patient for admission in the event of planned and emergent occurrences. Focus on patient and caregiver education concerning safe recovery and transition to the community by educating the patient on self-care.

• Provides nursing care on an 8 bed Burn ICU critical care unit and level 2 trauma 12-bed stepdown burn and plastics unit with proficiency concerning burn dressings, muscle flaps, necrotizing fasciitis, decubitus ulcers, burn debridement, fasciotomy and escharotomy. • Experience with vasopressor drips, managing cardiogenic shock, septic shock, ECMO, ventilator care and Swans-Ganz Catheters for pediatric and adults.

• Provided care to the acutely ill patient population for up to four patients on a 36-bed monitored cardiac telemetry progressive care unit in collaboration with other members of the health care team environment through application of the nursing process. • Served in a leadership role on Magnet Committee overseeing many reward programs also working to prepare the hospital in reapplication of the 2014 Magnet Certification through the American Nurses Credentialing Center. Served on Committee for Career Ladder application requirements and presented awards for Career Ladder Awards recipients. • Served as unit leader representative on many committees in the hospital. Facilitated employee policy amendments to increase employee retention thus decreasing budget for new hire expenses. • Responsible for nursing policy revision due to hospital acquired conditions to increase the safety of the patient through incident investigations and presentation of evidence-based practice to decrease future events. Planning for many functions of the Magnet Committee including Nurse's Day Celebration, BSN & MSN Celebration, Certified Nurse's Day, and the Great 100 Nurses Celebration just to mention a few.

• Assumed direct and indirect responsibility for up to two patients on a forty-five-bed unit receiving also patient overflow from other intensive care units and the intermediate care environment. • Served on the CODE BLUE team and Rapid Response throughout the hospital system with other ICU team members to provide critical care to patients.• Provided care for patient at risk for actual or potential life-threatening health problems including a variety of complex life threatening unstable critical vascular and cardiac patient including but not limited to acute congestive heart failure, potentially lethal arrhythmia’s, acute myocardial infarction, post code in community, complex unstable post-percutaneous, coronary artery, and other vascular interventions. • Float experience to Neurological ICU, and ICU stepdown.