Therese M Toms Email & Phone Number

Chicago, Illinois, United States

Nonprofit Community Health Provider with 35 clinics throughout Chicago, Cook and DuPage Counties. Access delegated to manage Blue Cross Blue Shield HMO commercial employer and ACA products for UM/CM. Establish processes and workflows for UR in coordination with clinic providers for necessary patient referrals to established In Network providers and assure.

Greater Chicago Area

Formerly FAMILY HEALTH NETWORK / COMMUNITY CARE ALLIANCE OF ILLINOISNon profit health plan for Government contracts for State of Illinois Medicaid HMO and Medicare Advantage. Conduct training, oversight and monitoring of clinical and non clinical staff activities. Establish and implement processes and work flows to meet NCQA and CMS requirements.Prepare.

Downers Grove, Illinois

Greater Chicago Area

Performed UM/CM/DM under the Primary Nurse Model Performed initial and concurrent review for emergency and elective hospitalization to determine medical necessity. Coordinated with facilities for discharge planning and assist in identifying alternate treatment programs that provide the safest discharge for patient and promote best outcomes for recovery..

Telephonic assessment of medical condition, behavior, and lifestyle choices to assist in managing acute and chronic disease, encourage behavioral changes and to promote optimal wellness. Determine if patient is receiving appropriate care from his health care providers or whether they need more intensive treatment or immediate intervention. Utilizing.

Contracted Nurse in Level II Medical and Surgical ICU.Implemented total patient care through a team nursing process covering 18 high acuity patients, assigned 2-3 patients providing clinical skills including emergency care.Respiratory monitoring including O2, ventilator support and trach care, cardiac monitoring with EKG, Swan Ganz, CVP, and appropriate.

Staff Nurse in Coronary/Medical/Surgical ICU for 8 years for 18 bed unit, 1 year in Med/SurgServed on Rapid Response Team for 1 year, emergency response to patients throughout hospitalAssessed patient status and notified physician of clinical changes, and implemented ordered treatments and tests.Implemented total patient care through a team nursing process.

Implemented total patient care through a team nursing process covering 18 high acuity patients, providing clinical skills including emergency care, IV insertions and infusions, injections, phlebotomy, respiratory treatments, cardiac monitoring, assist with procedures at bedside, transport for critically ill patients and facilitate patient/family teaching..