1. GINA ALLEN
2511 Lassen Lane,CastleRock,CO 80109| 720.333.2958| gina_renee_allen@yahoo.com
SUMMARY
To continuemy career in thehealthcareprofession,expand my knowledgein the
workforceand continueto havechallengingexperiences.
CERTIFICATIONS & MILESTONES
Certifications
· March 2016 - Accredited CaseManager certification fromtheNational Boardfor Case
Management.
· Certified with BasicLifeSupportwith theAmericanHeartAssociation
Milestones
· 1992 –Acquired RNlicensein thestateof Texas
· 1996 –Transitioned to CaseManagement
· September 23,2004 - licensed to practiceasa Registered NurseinColorado.
· Apr,May,June 2006 - Supervisorof thequarter (ParkmoorVillageHealthcareCenter)
EXPERIENCE
July 2013 –present Utilization Review–FulltimeRNCaseManager, CastleRock AdventistHospital
· Utilization review& dischargeplanning.Includingadmission,concurrent,and
retrospectivereviews.Familiarwith HMO plans,commercialinsuranceplans,and
Medicare/Medicaidregulationsfor covered benefits.
· Assess,plan,andevaluatethecareof a designated caseloadof patients so thatclinical
& financial outcomes areachieved.
· Maintained currentknowledge& skills necessary to providecare/services to theageof
the patients served in thehospital facility.
· Evaluatingquality careand effectiveutilization of hospital & community resources.
· Managingpatientcareto preventfragmentationandduplication of services.
· Participatein Daily(Monday Through Friday) interdisciplinary rounds
· Responsiblefor monthly Utilization reports including,increased lengthof stay,
readmission within 30 days,length of stay anddenials.Responsiblefor presentingthis
informationon monthlybasisto theUMcommittee.
· Computer skills:Word,Windows,Excel,internetexplorer,Interqual,CurrentMCG
super user,and Allscriptssuper user which isa softwareapplication thatenables the
casemanagersto enter the patients concurrentreview,authorizations,and discharge

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planningneeds identified.Meditech,which isan electronicmedical record application,
currently beingused atCentura hospitals.
May 2011 –July
2013
PRNRN CaseManager, Littleton AdventistHospital –Littleton,CO
· Utilization review& dischargeplanning.Including admission,concurrent,and
retrospectivereviews.Familiarwith HMO plans,commercialinsuranceplans,and
Medicare/Medicaidregulationsfor covered benefits.
· Assess,plan,andevaluatethecareof a designated caseloadof patients so thatclinical
& financial outcomes areachieved.
· Maintained currentknowledge& skills necessary to providecare/services to theageof
the patients served in thehospital facility.
· Evaluatingquality careand effectiveutilization of hospital & community resources.
· Managingpatientcareto preventfragmentationandduplication of services.
· Computer skills:Word,Windows,Excel,internetexplorer,Interqual,MCGand
Allscripts whichisa softwareapplicationthatenablesthecasemanagersto enter the
patients concurrentreview,authorizations,and dischargeplanningneeds identified.
Meditech,which isanelectronicmedicalrecordapplication,currently beingused at
Centura hospitals.
July 2010 –
December 2011
RN PartTimeOfficeAssistant, Boyd ChiropracticCenter–Castle Rock,CO
· Scheduleappointments
· Check in patientspriorto appointment,verify insurancebenefits and collectcopay if
needed.
· Assemblenewchartsfor newpatients.
· Placepatientson chiropractictherapies asordered per Doctor.
August2008 –July
2010
FulltimeRNCaseManager, ParkerAdventistHospital –Parker,CO
· Utilization review& dischargeplanning.Includingadmission,concurrent,and
retrospectivereviews.Familiarwith HMO plans,commercialinsuranceplans,and
Medicare/Medicaidregulationsfor covered benefits.
· Assess,plan,andevaluatethecareof a designated caseloadof patients so thatclinical
& financial outcomes areachieved.
· Maintained currentknowledge& skills necessary to providecare/services to theageof
the patients served in thehospital facility.
· Evaluatingquality careand effectiveutilization of hospital & community resources.
· Managingpatientcareto preventfragmentationandduplication of services.
· Responsiblefor runningtheinterdisciplinary teammeetingthreetimes every week to
discussthepatient’s progressand dischargeplan.
· Computer skills:Word,Windows,Excel,internetexplorer,Interqual,Millimanand
ECIN,which is a softwareapplication thatenablesthecasemanagersto enter the
patients concurrentreview,authorizations,and dischargeplanningneeds identified.
Meditech,which isanelectronicmedicalrecordapplication,currently beingused at
Parker hospital.
August2008 –July
2010
FrontDesk, PlumCreek Medical – CastleRock, CO
· Schedulephysicianappointments
· Check in patientspriorto appointment=verify insuranceandcollectcopayif needed.
· Assemblenewchartsfor newpatients

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· Putnew patientinformationinto computer system
· Assistwith triagingphonecallsfor urgentcareneeds
· Assistin medical recordsasneeded
July 2005 –
November 2006
RN CaseManager, ParkmoorVillageHealthcareCenter- Colorado Springs,CO
· Utilization review& dischargeplanning.Includingadmission,concurrent,and
retrospectivereviews.Familiarwith HMO plans, commercialinsuranceplans,and
Medicare/Medicaidregulationsfor covered benefits.
· Assess,plan,andevaluatethecareof patientsintheskilled nursingunitsothatclinical
& financial outcomes areachieved.
· Maintained currentknowledge& skills necessary to providecare/services to theageof
the patients served in theskilled nursingfacility.
· Evaluatingquality careand effectiveutilization of thecommunity resources.
· Responsiblefor monthly reportsincluding,increased length of stay,readmission within
30 days,and length of stayper diagnosis.
· Responsiblefor runningtheinterdisciplinary teammeetingevery week to discussthe
patient’s progressand dischargeplan.
· Participatein weekly careplanmeetings to discusspatientprogress,clinical update
and dischargeplan.
· Supervisor of thequarter (Apr,May,June2006)
Dec. 2003 –Oct.
2004
RN CaseManager, TexSan HeartHospital - San Antonio TX
· Initiated thecasemanagementdepartmentatTexSan Hearthospital –opened in Jan.
2004.
· Developed casemanagerorientation checklistand oriented newcasemanagersto
hospital.
· Developed hospital community resourcemanuals.
· Responsiblefor monthly reportspresented atthePI (PerformanceImprovement)
committeeincludingavoidableand denied days,increased length of stay,readmission
within 30 days,and geometriclength of stay per DRG.
· Assisted with developmentand initiatingmultidisciplinary rounds.
· Utilization review& dischargeplanningusingtheMilliman careguidelines.Including
admission,concurrent,and retrospectivereviews.Familiarwith HMO plans,
commercial insuranceplans,and Medicare/Medicaid regulationsforcovered benefits.
· Assess,plan,andevaluatethecareof a designated caseloadof patients so thatclinical
& financial outcomes areachieved.
· Maintained currentknowledge& skills necessary to providecare/services to theageof
the patients served in thehospital facility.
· Evaluatingquality careand effectiveutilization of hospital & community resources.
· Computer skills:Word,Windows98,Windowsoffice2003,Excel,GroupWise,Milliman
careguidelines,and Midaswhichisa softwareapplication thatenablesthecase
managers to enter thepatient’s concurrentreview,authorizations,and discharge
planningneeds identified.Affinity/QuadraMed,which isa computerized medical
chartingsystem.
Aug. 2001 - Dec.
2003
RN CaseManager, NortheastBaptistHospital - San Antonio TX

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· Utilization review& dischargeplanningusingtheInterqual Criteriafor admission and
concurrentreview.Familiar with HMO plans,commercial insuranceplans,and
Medicareregulationsforcovered benefits.
· Assess,develop & implementcosteffective,alternativehealth careregimens.
· Workingin Collaborativepracticewith thephysiciansandother members of the
healthcareteamto meet the patient’s needs,linkingcostresourcemanagementand
quality to patientcare.
· Managingpatientcareto preventfragmentationandduplication of services.
· Computer skills:Word,Windows98,Excel,GroupWise,Interqual,and Midaswhich isa
softwareapplication thatenablesthecasemanagersto enter the patient’s concurrent
review,authorizations,anddischargeplanningneeds identified.
Aug. 1999 –Aug.
2001
Senior CaseManager, Quality CareNetwork - San Antonio TX
· Preceptor for newcasemanagers –involved with thedevelopmentof a new
orientation guidefor thecasemanagers.
· Responsiblefor makingon-call scheduleandvacation schedules.
· Assistcasemanagerswith preparing for monthly board meetings.
· Involved with theinterviewprocessand hiringof newcasemanagers.
· Responsiblefor runningtwicea week casemanager meeting.
· Continueto beresponsiblefor oneIPAgroup and monthlyBoard meetings.Including
the on-sitereviewof chartsasexplained below.
· Continueto bethe firstresourcefor all casemanagerswith anydaily problemsor
concernsregardinga certainpatientand/or physician.
· Computer Skills:Word,Windows98,MicrosoftOutlookExpress,Excel,and EZCap
which isan Quality CareNetwork softwareapplicationthatenablesthecasemanagers
to enter the patients concurrentreviewfor each inpatientrecordandauthorizations.
Sept. 1997 –Aug.
1999
CaseManager, Quality CareNetwork - San Antonio TX
· DailyOn-siteUtilizationreview& dischargeplanningusingtheInterqual Criteriafor
admission andconcurrentreviewfor HMO members with Humana,Humana Gold,
PacifiCare,SecureHorizons,Community FirstMedicaid & Community Firstcommercial
insuranceplans.Familiarwith all planscoverage,and Medicareregulationsfor covered
benefits.
· Dailyextensivetelephoneand individual communicationswith Primary carephysicians
& specialistsregardingpatientscontinued plan of care& dischargeplanof care.
Quality CareNetwork has approximately 150 Primary CarePhysicians.Responsiblefor
managementof all PCP’s managed caremembers.
· Responsiblefor presentingutilization information,Feefor Servicereferrals,and
opportunity daysatthemonthly Board meetingswith thePrimary Carephysicians&
specialists.Each casemanager isassigned oneor two IPA’s (IndependentPhysicians
Association).Quality CareNetwork hasa total of seven IPA’s.
· Assess,develop and implementcosteffective,alternativehealthcareregimens.
· Develop and maintain relationshipswith hospitals,physiciansand healthcare
providers.
Sept. 1996 –Sept.
1997
Nurseconsultant- Utilization Management, Aetna US Healthcare - San AntonioTX
· Precertificationfor inpatientand outpatientmedical services includingoutpatient
psychiatricreviews.
· Concurrentandretrospectiveinpatientreviews.

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· Assess,develop and implementcosteffective,alternativehealthcareregimens.
· Develop and maintain relationshipswith hospitals,physiciansand healthcare
providers.
· Evaluatemedical claims and provideprofessional opinionsasto medical necessity with
supportfromphysician consultants.
· Extensivetelephonecontactwith patient,hospitalsand other healthcareproviders.
· Computer Skills:Word,Windows95,Email,and Healthlinewhich isanAetna software
application thatenablesthenurseto enter thepatient’s medical historyfor each
inpatientand outpatientservice.
May 1991 –Sept.
1996
RN Staff Nurse, SWTMethodistHospital - San Antonio TX
· IntermediateMedical and Surgical CareUnit/ General Surgery.
· Preceptor for newnursesto unit - involved indevelopmentof newpreceptor plan for
unit.
· Involved ineducation council.
· ResourceRole- TeamLeader for agency nursesor LVN’s.
· Relief Chargenursefor 3-11shift- involved in triageof patients,nurseassignments,
reportto oncomingchargenurse,resourcerole,and communicatingwith thehospital
shiftsupervisorregardingavailability of beds on unit.
EDUCATION
1988 - 1992 Associates Degreein Nursing., San AntonioCollegeSchool Of Nursing