Carol Ann Plain has over 30 years of experience in nursing and case management. She currently works as a telephonic ER case manager for HealthNet, Inc., where she screens cases and manages follow-up care for members with multiple ER admissions. Previously, she was a telephonic nurse care manager at Healthways, Inc., managing care for high-risk adult patients. She also served as a lead care manager and client resource specialist for a Medicare care demonstration project. Plain holds nursing licenses in California, New York, and Arizona and is certified as a case manager.

1. CAROL ANN PLAIN RN, BSN, CCM
plaincarol@gmail.com | www.linkedin.com/pub/carol-plain/91/884/4a5
PROFESSIONAL EXPERIENCE
5/2015 – present HealthNet, Inc., Woodland Hills, CA
Telephonic ER Case Management –Care Coordinator (Pilot Program) in San Diego, CA
• Case screening and case management follow-up for HN members from centric reporting with multiple ER admits.
• Training in process for COCA/TOCA/COC for appeals and denials.
2/2001 - 12/2014 Healthways, Inc., Nashville, TN
(formerly StatusOne which merged with Healthways, Inc.
Telephonic Nurse Care Manager in San Diego, CA
• Care management of complex high risk adult patients via a telework home-based setting for multiple insurance clients
including Gateway, Harvard Pilgrim, Medicare/CMS, and Oxford/United Healthcare.
• Collaborated with patients and physician to assess needs, identify or assist to develop a support or social network, improve
self-care function, and prevent hospitalization with development and follow up of a proactive care plan.
Lead Care Manager and Client Resource Specialist – MCCD in San Diego, CA (09/2002 – 03/2006)
• Medicare Coordination of Care Demonstration (MCCD) Project for Healthways, Inc. and Washington University in
St Louis. Worked directly with fragile geriatric patients developing hospitalization prevention care plans.
• Managed a Team of Telework Nurse Care Managers and acted as a liaison between Healthways, Inc., Washington
University, and CMS.
02/2000 - 6/2001 Scripps Health, La Jolla, CA
Hospital Case Manager
• Coordination of care with Physicians, Therapists, and other hospital clinicians from admission through discharge to ensure
optimal care, and appropriate discharge while promoting fiscal responsibility.
03/1989 - 02/2000 Sharp Healthcare, San Diego, CA
Home Health Coordinator / Marketing Representative; Telephonic Case Management; Transitional Care
Unit/Assistant Manager
• Hospital liaison completing assessment and planning of patient care for cardiac and transplant patients with Discharge
Team and Physicians.
• Educate, support, and provide self-care guidance for heart failure research project.
• Assisted in the establishment of first Palliative Care Unit and Short-Term SNF for Sharp Healthcare.
EDUCATION & CERTICATIONS
1965 – present California State Licensed Registered Nurse
1964 – present New York State Licensed Registered Nurse
2015 pending Arizona State Licensed Registered Nurse
2007 – present CCM – Certified Case Manager
1992 – present PHN – Public Health Nurse Certification
University of Phoenix, Phoenix, Arizona Bachelor of Science in Nursing
Millard Fillmore Hospital School of Nursing, Buffalo, New York RN Diploma
University of Buffalo, Buffalo, New York Major in Science, Nursing