Designated member of specialty CM team delivering CM, DM, UR, DC planning to hospital systems in several states.• Provides case management/coaching to at risk clients including diagnoses of cancer, multiple co morbidities, chronic conditions, peds, and high risk OB/Gyn, Rehab and SNF patients.• Care coordination for home health, hospice, respite care, outpatient procedures and inpatient admissions. • Claims review for appropriate level of care review/medical neccesity review• Responsible for QA, UM, CM, DC planning for assigned patients.• Assists with managing high risk OB cases in the Maternity Management program.• Utilizes various guidelines for medical necessity including company and M&R guidelines.• Provided training for new employees for CM overview/policy and procedure.• Serves as mentor for CM staff in this role.• Written communication with insured groups providing medical narratives and updates.• Responsible for cost savings tracking, and estimated cost projections. • Role of CM referral analyst reviewing case appropriateness for CM involvement as well as case assignments based on patient needs, CM specialty and case loads.

• Case management team lead responsibilities and staffing assignment coordination• Served as CM resource for Joint Commission site visits• Hospital CM representative for The Center for Case management( New England) including site visit to New England• ON committee for the design and development of the case management program • Served as CM consultant in the development of the Asthma Disease Management program• Case management for all specialty areas. ICU, Pulm, Neuro, Plastics, GI, Renal, Cardiology and general pediatrics• Developed CM templates for ICU and general documentation • Development and presentation of “Introduction to CM” and delivery to various audiences, including, Nursing students, new employees, and community hhc agencies.• Served as CM representative for the Rehab/Trauma committees.• Provided orientation and education to new CM hires, and students from various clinical backgrounds• CM representative of redesign committee for patient care delivery Recipient of DFW Great 100 nurses award in 2003.

• Assisted with compilation of Prudential’s “National Neonatal Case Management Guidelines• Conducted various training programs, including Interqual Criteria to CM staffs in Dallas and Arizona• Assisted with development and implementation of Prudential’s mother/baby program• Oversight, participation, and implementation with the Asthma Disease Management program• Provided UR, QA ,CM, DM, DC planning for high risk OB, pediatric and adult rehab, palliative care, hospice and general adult/pediatric patients• Participated with Provider Relation department in the identification, contracting and orientation of specialized pediatric services

• Hiring and training field representatives in specialty DME company• Marketing in Dallas to area pediatricians/home health agencies• Oversight of Q&A process for equipment• CPR certification and education for caregivers• In Home assessments/care coordination