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Alice
allenafj6@yahoo.com
904-556-6257
861745 Worthington Dr.
Yulee, FL 32097
Supervisor, Clinical Health Services
15 years experience W2
0
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Average rating
8
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Summary

Experience
Supervisor, Clinical Health Services
Information Technology
Feb 2019 - Feb 2019
  • Oversee the implementation of post-acute (SNF, AR, LTAC) utilization management services for Southeast region (FL, GA, AL, MS, LA, TN, NC, SC).
  • Implement clinical policies & procedures (CMS, MCG, NCQA, state and federal standards and mandates as applicable).
  • Serve as a content model expert and mentor to a team of 26 utilization management nurse consultants regarding practice standards, quality of interventions, problem resolution, and critical thinking.
  • Develop, initiate, monitor, and communicate performance expectations through non-compliant report monitoring, quality audits, and productivity scores.
  • Acts as a single point of contact for providers, medical directors, and network team including participating in provider/network meetings.
  • Ensures the team understanding and use of system capability and functionality.
  • Participate in the recruitment and hiring process for post-acute utilization management nurse consultants in the Southeast region.
  • Participate in post-acute utilization management market leadership meetings.
  • Promote a positive workplace by embracing and advocating for necessary change.
  • Provide education & implementation to UMNC (utilization management nurse consultant) team on policy and procedure changes.
  • Manage assignment caseloads for a team of 26 nurses including time off, holiday, weekend coverage.
  • Facilitate Medical Director/RN rounds twice a week to discuss complex cases.
Health Services Administration
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Nurse Manager/MDS Coordinator
Medical Devices
Apr 2008 - Mar 2015
OF HILLIARD Nurse Manager/MDS Coordinator
  • Collaborate with all departments within the facility to ensure completion of MDS assessments and care plans in an accurate and timely manner.
  • Provides patient and family member education on current treatment plans, available resources, and follow-up care.
  • Negotiates for optimal level of contract level of care reimbursement and extension of services post admission and on-going.
  • Track Medicare residents and predict their RUG (resource utilization group) category to assure appropriate reimbursement for clinical services to the facility.
  • Develop individualized resident care plans, identifying the needs of the resident and projected outcomes as required by federal and state regulations.
  • Schedule care plan meetings with residents and families upon admission and quarterly to address any concerns or changes in resident's medical condition.
  • Direct and supervise professional and nonprofessional personnel.
  • Provide staff education, training, and in-services.
  • Review and audit resident's chart/documentation for appropriateness and accuracy.
  • Review quality measure/assurance reports to identify areas of concern, and create action plans for performance improvement.
  • Review CMS star rating on a monthly basis, and create action plans for areas of low rating.
Audit Medicare Nurse Management Nursing Utilization Review
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Med/Surg Staff Nurse
Medical Devices
Aug 2006 - Nov 2007
  • Assess, plan, evaluate, and document nursing care for multi-service patients on a 39 bed unit.
  • Monitor patients for abnormal vital signs, neurological deficits, cleared airways, bleeding, circulation, and pain control.
  • Interact and effectively communicate with multi-disciplinary staff, regarding patients condition, treatment, progress, and other imperative information.
  • Communicate with family members regarding patients plan of care and present condition.
  • Retrieve a brief history of patients.
Med-Surg Neurology Nursing
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Edit Skills
Non-cloudteam Skill
Education
Nursing
Jacksonville University 2006
Certifications
Registered Nurse
Skills
Nursing
2015
8
Audit
2015
7
Medicare
2015
7
Nurse Management
2015
7
Utilization Review
2015
7
Med-Surg
2007
1
Neurology
2007
1
Health Services Administration
2019
1