Treva Powers Email & Phone Number

Atlanta, Georgia

Nashville,Tn

Responsible for case managing members experiencing complex health issues, disease management. • Acts as a member advocate, seeking and coordinating creative solutions to member's healthcare needs without compromising quality of outcomes. • Obtains an accurate member history• Assesses clinical information to develop care plans including a member support system • Establishes short and long term goals in collaboration with the member that meet the member's needs and the referral source's requirements • Establishes working relationships with referral sources and community resources• Communicates care objectives to appropriate individuals/departments /referral sources• Assesses bio-psychosocial factors• Identifies members with potential for high risk complications and coordinates the appropriate treatment in conjunction with the member and the health care team.• Conduct field visits• Performs pre-certification duties and responsibilities as assigned and required• Acts as an advocate for an individual's health care needs• Reviews benefit systems and cost benefit analysis. • Evaluates the quality of necessary medical services• Utilizes criteria for authorizing appropriate clinical services• Identifies members that would benefit from an alternative level of care.• Acquires data and evaluates necessary health services for cost containment• Documents effectiveness of case management services• Identifies the need for assistive devices/adaptive equipment needed for members• Conducts skills assessment, ,planning, ,implementation, coordination, monitoring and evaluation• Request directions from appropriate supervisor(s) on complex issues• Utilizes leadership skills for non-clinical team members• Collaboratively works with other departments• Participates in Quality Improvement processes• Serves on internal and external committees• Maintains member confidentiality•

My responsibilities include case managing Medicaid population which entails coordination of services, collaboration, and communication with providers, members, and interdepartmental associates. Also, submitting referrals to the Choice Program, Quality and Fraud and Abuse when necessary.

Greater Atlanta Area

• Responsible for managing a team of nurse case managers, social workers and non-licensed associates in assessing, developing, implementing, ,coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum and ensuring member access to services appropriate to health needs. • Primary duties may include, but are not limited to: Responsible for process improvement, quality assurance, and adherence to appropriate medical policy, care management best practices, relevant clinical standards, and member contract. • Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Nashville, Tn

• View clinical from provider to determine medical necessity and intensity of service. • Participate in medical rounds with medical director to discuss cases. • Train new employees on systems and applications and review process. • Train new employee on InterQual Review process.

Nashville, Tn

Case Manager May 2006 to July 2006, Team Manger- August 2006 to March 2007 Provide supervision to a team of case managers, access case managers, utilization review nurses, and discharge planner. • Evaluate staff’s performance of managing length of stay, avoidable days, and denials. • Educate staff regarding use of InterQual and M&R• Inform staff of Medicare regulations, and identifying proper inpatient versus observation status, including compliance to Medicare requirements accordingly.• Evaluate and implement new processes to improve performance of department and meet corporate goals. • Manage scheduling of PTO, On-Call and Payroll • Utilization of Power Point Presentations to conduct meetings with staff.• Evaluate staff’s performance and adherence to department and hospital policies• Assist Director of Case Management with presentations and meeting with physicians on documentation, GLOS, ALOS, and Health grades etc...• Attend interdepartmental meeting to problem solve issues relating to access bed management, case management, utilization review • Meet with Physician Liaison weekly to address and monitor denials and appeals. • Monitor UR Nurses management of uninsured, charity pending, Medicare and commercial insurance cases.• Coordinate and Manage meetings with vendors.

Medical Surgical And Critical Care

• Effectively and efficiently manages the care of patients coordinating both financial and clinical aspects of service to promote achievement of quality outcomes. • Coordinates and maximizes the positive benefits of the interdisciplinary team approach to the delivery of services. • Promotes guidance and education to key clinicians related to optimizing resource management, decreasing average annual percentage of payer denials, decreasing length of stay and unnecessary costs, coordinating discharge planning and evaluating appropriateness of admissions. • Collaborates with physicians and key clinicians to develop physician order sets and clinical pathways and continually monitors these activities for analysis and recommendation for improvement.• Initiates and implements discharge planning and arranges services such as DME, HHC, SNF, ICF, LTAC admissions.

California Co., Traveled To Various States.

• Company alleviated this department. Traveled to various hospitals in and out of state to train and teach staff on utilization and implementation of new biomedical technology products such as Beckon Dickinson needless systems, posi-flush etc...

Tennessee Christian Acute Inpatient - Prn Status, Nashville, Tn

Provided hemodialysis to acute and chronic renal failure patient, usually end stage renal patients. Worked as needed, usually worked in addition to full-time critical care. Second job to primary job.

Nashille, Tn

Provide nursing care to critically ill patients which included those on ventilators.

Nashville, Tn

• RN medical-surgical, Progressive Care Unit, Critical Care, Acute hemodialysisWorked as second job.

Various Middle Tennessee Hospitals (Centennial, General, Springfield, Etc. )

Worked for agency in meeting critical care needs of local hospitals. Worked in ICU, CCU.

Nashville, Tn

• Evaluated contestable claims utilizing nursing education and skills• Performed Chronological Reviews• Assess applications for misrepresentation of facts• Made recommendations to medical committee for approval or rescinding payment after viewing medical information• Processed payments or letters of rescission to claimant

Nashville, Tn

• Supervised technicians whose responsibilities were to set up hemodialysis treatment, and assess and perform hemodialysis on chronic end-stage renal failure clients. Attend medical rounds with Medical Director.

Hendersonville, Tn

• Performed preliminary case reviews for attorneys • Prepared Chronological Reviews and input regarding cases.• Expert Witness if necessary

Madison, Tn

• Medical surgical nurse for 1 year then ,• Progressive Coronary Care Unit: provided nursing care for Coronary Artery Bypass Graft patients, preop, post op teaching, and care including ventilators• ICU, CCU, PCU, Neuro ICU, Orthopedics, Pediatric Nurse

Bsn, Registered Nursing/Registered Nurse

Activities and Societies: Delta Epsilon Sigma Graduate May 16, 2015

Certiifed Critial Care Nurse, Critical Care Nursing

Activities and Societies: Nashville Critical Care Certification

Associate'S Degree, Registered Nurse

Activities and Societies: Gamma Beta Phi Associate Degree from Volunteer State and Tennessee State University.

Certified Computer Programmer, Computer Programming

Activities and Societies: Cobol, Basic, Advanced Basic. Little Fortran. Computer Programming -Basic, Advanced Basic, Cobol and little.

Education record