Interim Director of Case Management | RN, MBA, CMAC, CPUR


Last Updated: March 7, 2020 (11 months ago)

Interim Director of Case Management | RN, MBA, CMAC, CPUR
Immediately
Leadership & Acute Care Experienced

Executive level clinical operations consultant with expertise in case management, utilization management, quality management, revenue management and compliance. Strong leadership skills with demonstrated success in problem resolution yielding greater efficiency, effectiveness, and profitability. Specializes in performance improvement activities to achieve effective utilization of hospital resources, ensure regulatory compliance, and support medical necessity to support appropriate reimbursement.

References & Reviews

• “She took over a department that had gone through turnover every year for multiple years. She was able to give the department a sense of structure and security that set them on a path to feeling like a valued member of the organization.”
• “She is very easy to work with, she’s very collaborative and works well at all levels of the organization. She is so knowledgeable that she builds instant credibility, and because she knows what she’s doing”
• “She was able to block and tackle really well, she came into a very dysfunctional department.”
• “She was able to cut to the chase, identify the core things to be done and she was able to help the staff understand the importance of getting things right.”

• Care Management
• Utilization Management
• Quality / Process Improvement
• Change Management
• Length of Stay Reduction
• Revenue Management
• Paralegal
• ACO Experience

Resume Content

Title:

Interim Director of Case Management | RN, MBA, CMAC, CPUR

Date Available:

Currently Available

Summary:

Leadership & Acute Care Experienced

Executive level clinical operations consultant with expertise in case management, utilization management, quality management, revenue management and compliance. Strong leadership skills with demonstrated success in problem resolution yielding greater efficiency, effectiveness, and profitability. Specializes in performance improvement activities to achieve effective utilization of hospital resources, ensure regulatory compliance, and support medical necessity to support appropriate reimbursement.

References & Reviews

• “She took over a department that had gone through turnover every year for multiple years. She was able to give the department a sense of structure and security that set them on a path to feeling like a valued member of the organization.”
• “She is very easy to work with, she’s very collaborative and works well at all levels of the organization. She is so knowledgeable that she builds instant credibility, and because she knows what she’s doing”
• “She was able to block and tackle really well, she came into a very dysfunctional department.”
• “She was able to cut to the chase, identify the core things to be done and she was able to help the staff understand the importance of getting things right.”

Qualifications & Achievements:

• Led a financial turnaround back to profitability, for 4 hospitals, within 6 months; reversing a $60M loss
• Salvaged $2.6M, $6M and $4.8M in claims for 3 hospitals
• Achieved a $41M cost savings to Medicare, over 3 years, for a 200-bed ACO
• Successfully overhauled an EMTALA process in 21 days in preparation for a federal survey
• Built or restructured over 25 Case/Utilization Management departments
• Led system wide standardization and reduced denials to 4-7 per month
• Reduced length of stay and readmissions
• Management experience of up to 60 FTEs
• Successfully build an observation program, Triad Model and ER CM program
• Rolled out a 2-Midnight Rule, 20-Day Certification Rule and Discharge Risk Factor Program
• Participates in professional affiliations and is published
• Successfully passed Federal OIG Inspections in nine facilities
• Set-up clinical quality programs at a top ten hospital

Expertise:

• Care Management
• Utilization Management
• Quality / Process Improvement
• Change Management
• Length of Stay Reduction
• Revenue Management
• Paralegal
• ACO Experience

Experience:

• Interim Director of Case Management | 150+ Bed Acute Care Hospital
• Interim System Level Director, Care Management | 300+ Bed Acute Care Hospital with Outpatient Clinics
• Interim Director of Care Management | 600 Bed Teaching Hospital
• Interim Director of Case Management/Clinical Revenue Management | 200 Bed Acute Care Hospital

Education:

• Master of Business Administration (MBA)
• Case Management Administrator Certification (CMAC)
• Certified Professional for Utilization Management (CPUR)

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Testimonials

"She has been perfect for us particularly since we are in our Joint Commission survey window for both our Disease Specific Care certification reviews and our triennial accreditation.  I also believe she is the one that’s helped us identify the root cause of some of our SSI’s.

Thank you for connecting us with [her]."

"[She] is an excellent addition to our team. She was able to hit the ground running, and I am very excited to be working with her. I believe with her positive attitude, we are really going to be able to turn our little home health ship around, and get it running well."

"[She] walked into a very challenging position - technically, politically, and operationally. She inherited a disorganized and unreliable credentialing history, records, and dysfunctional staff. She has a terrific work ethic, very pleasant interpersonal and leadership style, and great fund of knowledge. She has been incredibly reliable, dedicated, focused, and industrious. Thank you for sending her to us."

"[The Galileo Interim] was well received by our hospital staff members. She built relationships and was always in an "appreciative inquiry" mode. She quickly came up to speed on the transition of the retiring Quality Manager, and effectively transferred the necessary information to the new Quality Manager.

Many among our team have said they would like her to stay? We would like to have her come back for specific projects as needed."

"[He] spent an extended time at our hospital and lay the foundation of a strong infection prevention program. He assisted with program development (including training a new IP) and with policy development. He was well-received by everybody. Very adaptable to different audiences, always professional, and approached circumstances with a goal of providing support and guidance. In my experience, he was one of the strongest infection prevention professionals I've worked with, and he has my strongest recommendation."