This document provides a summary of Gina Allen's experience and qualifications as a registered nurse and case manager. She has over 25 years of experience in healthcare, including current roles as a full-time RN case manager and previous roles in hospitals, skilled nursing facilities, and insurance companies. She holds certifications in case management and basic life support.

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