JOLENE K. HANSON, RN
1810 North 56th
Street
Omaha, Nebraska 68104
(402) 301-6674 (Cell Phone)
Email: jhanson21@cox.net
SUMMARY OF QUALIFICATIONS
Organizational Development Training and Development Managed Care - Medical Management
Facilitation/Training Senior Leadership Consultation/Coaching Utilization Review/Case Management
Survey Management/Analysis Complex Project Management Staff Nursing – Med/Surg/Dialysis/Transplant
Quality Consultation/Auditing Leadership Development Home Health Recertification
_________________________________________________________________________________________________
CONTINUING EDUCATION
Accelerated Strengths Coaching Certification (Gallup) (2014) Recertified Strengths Coach (July 2016)
Edgerton Examiner (2008 and 2009)
Associate Degree – Nursing, University of Nebraska Medical Center, Omaha, NE (1986)
University of Nebraska, Lincoln (1982-1984)
Wayne State College (1980-1981)
_________________________________________________________________________________________________
EXPERIENCE
ALEGENT CREIGHTON HEALTH/CHI HEALTH, OMAHA, NE (2003-PRESENT)
With hospitals reaching from Kearney, Nebraska to Corning, Iowa and 15,900 employees, CHI Health is a network of 15 Acute-care
Medical/Surgical Hospitals, two psychiatric care facilities and two physician practice groups operating in a single clinically integrated
network.
HR TALENT COORDINATOR (DEC.2015 – PRESENT) - BASICALLY THE SAME POSITION, JUST NEW TITLE
♦ Collaborate and consult with senior campus leaders to identify their units/departments needing additional support in
education and service excellence. Facilitate training for leaders and staff.
♦ Observe and coach senior leadership to enhance professional coaching skills.
♦ Facilitate workgroups for General Orientation standardization project and was the lead facilitator for rolling out the new
content. Prepare for and facilitate General Orientation (GO) class every Tuesday for new hires. Class size is usually mid
forties.
♦ Assist with content changes and process maps to move independent general orientation (iGO) from Talent Acquisition to
HR Talent Development department. Facilitate any iGOs in the Omaha area.
ACCOMPLISHMENTS
♦ Did analysis of how AIDET/Communication and the Patient Experience was being taught to new hires (clinical &
nonclinical) and refreshed to all employees on all ministries.
♦ Successfully got sponsorship from senior leaders at CUMC to facilitate classes for past new hires from April 2015 to
present as they have not had this content. In process of developing a plan to continue to teach going forward.
♦ Successfully facilitated classes for senior leadership at CUMC on content that I would be teaching their staff as well as
MORE Coaching. Facilitated staff classes at all times of the day to accommodate all shifts resulting in approximately
200 CUMC staff being trained.
♦ Successfully have done the same for the surgery departments at CUMC and Bergan at the request of the surgery
director. The process again went from sponsorship to teaching leaders content and coaching, and then training
approximately 180 Bergan and CUMC surgery staff.
♦ Successfully led 5 workgroups for GO standardization project, was involved on main steering team around content
development and logistics. Was heavily involved in quality review of content, and facilitated the first classes with the
new content and made recommendations to the steering team for content changes and repositioning of sections.
♦ iGO process successfully transitioned from Talent Acquisition to the HR Talent Development department which was
done in June. This involved work on process maps and then the initial transition which occurred in June.
♦ Have successfully managed the first 5 iGOs, suggested and made changes to process maps and the facilitator worksheet
based on my experience with these iGOs.
HR TALENT FACILITATOR AND COACH (JAN. 2015 – DEC. 2015)
♦ Collaborate and consult with senior campus leaders to identify their units/departments needing additional support in
education and service excellence.
♦ Observe and coach senior leadership to enhance professional coaching skills.
♦ Project manage the Physician Insights survey across the entire MBO utilizing a new vendor for the survey.
♦ Project Manage the Performance Culture Assessment (PCA) survey across the entire MBO utilizing a new vendor for the
survey.
♦ Coordinate logistics and facilitate General Orientation class every Tuesday for new hires. Class size is usually mid forties.
Complete the process with finalizing paperwork and registering and grading the class in LEARN.
ACCOMPLISHMENTS
♦ Met all data timelines for pre-administration survey work with both the PCA and Physician surveys. (which that year
were happening simultaneously)
♦ Led subgroups for implementation around question selection, data collection and submission, communication plan,
and reporting from pre-administration to implementation of both surveys.
♦ Managed implementation phase of surveys, fielded questions, and managed participation reports, and ongoing
communication throughout the implementation phase of both surveys.
♦ Worked with the vendor to develop education for leaders and rollout of results for post phase of the surveys.
♦ Successfully facilitated general orientation every Tuesday from pre-class tasks (such as roster preparation,
communication to food and nutrition, communication to HR service center, communication to Talent Acquisition, and
the facilities for room arrangements, as well as actual room set-up) to post-class tasks (such as signing required
documentation and scanning to HR, entering the class completion into LEARN, and uploading documentation to the
Onboarding share point site.
ORGANIZATIONAL DEVELOPMENT CONSULTANT (MAY 2014-JAN. 2015)
♦ Collaborate and consult with senior campus leaders to identify their units/departments needing additional support in
improving patient survey results.
♦ Research and develop strategies for improving PatientsFIRST survey results.
♦ Serve as liaison with Studer Group personnel and Alegent Creighton Health/CHI Health leadership.
♦ Observe and coach senior leadership to enhance professional coaching skills.
ACCOMPLISHMENTS
♦ Selected to participate in the Gallup’s Accelerated Strengths Finder Coaching for Managers and Teams certification
course.
♦ Assisted with creation of and facilitation of evidence based education and skills lab for leaders and employees.
♦ Selected to work with nationally recognized Studer Group coaches to help implement evidence based practices within
Alegent Creighton Health/CHI system.
OPERATIONS ANALYST / ENGAGEMENT CONSULTANT (2009-MAY 2014)
♦ Initially functioned as a report specialist within the department focusing on the HCAHPS results for the system. Helped find
and manage a new vendor contract for patient surveys and maintained the relationship with the vendor (HealthStream).
Coordinated consulting visits and educated all leaders on use of the website and running data.
♦ Analysis of HCAHPS data and consultation with leaders around interventions and practices that could be implemented to
increase their scores and provide better quality and a better experience for the patient.
♦ Strategic goal setting with Executive Leadership Team for System Performance Measure(SPM) and Individual Performance
Measures(IPM) for Patient surveys, and SPM for Employee and Physician surveys.
♦ Project managed Employee Engagement survey for 5 years with Gallup and HealthStream, also created post survey reports,
presentations for data distribution, and education for leaders.
♦ Worked with Gallup to create a Business Impact Analysis (BIA) in 2012 and 2013.
♦ Project managed the Physician Engagement survey for 3 years with Gallup and PRC, also created post survey reports,
presentations for data distribution, and education. Involved in sharing results with medical staff across the system.
ACCOMPLISHMENTS
♦ All leaders throughout the system were knowledgeable and able to run customized reports from the HealthStream
website.
♦ Five cycles of the Employee Engagement survey were completed within all timelines with increasing system results.
♦ Successful transition of the Employee Survey process from Gallup to HealthStream.
♦ Three cycles of the Physician Engagement survey were completed within all timelines.
♦ Successful transition of the Physician Engagement survey from Gallup to PRC, and process started to transition to
HealthStream until the decision was made to not survey in 2014.
♦ Business Impact analysis was shared with the Executive Leadership Team and strategic decisions were made because of
the findings.
♦ System and Individual Performance Measures were developed and rolled out to leaders.
SYSTEM QUALITY IMPROVEMENT SPECIALIST FOR THE ONCOLOGY SERVICE LINE (2003-2009)
♦ Provided leadership to major projects and system performance improvement initiatives.
♦ Assisted campuses and specific service lines (Oncology & Orthopaedic) in performance improvement projects and activities.
♦ Utilized performance improvement methodologies, systems, and tools to support system quality initiatives.
♦ Project managed and co-wrote the application for the Edgerton Award.
♦ Worked as an Edgerton Examiner for 2 years, and have experience with the Baldrige criteria.
♦ Led several root cause analysis and failure mode effect analysis teams.
ACCOMPLISHMENTS
♦ Went from having some Oncology units to all Oncology units in the system having performance measures for quality.
♦ Developed an Oncology scorecard for system Oncology measures.
♦ Audited and worked with the system Pathologists so that their pathology reports for staging were compliant with the
standards of accreditation.
♦ Successful Edgerton site visit
♦ Organized and led a cross-campus service line team of leaders which led to sharing of best practices across the system.
COMMUNITYCARE OF OKLAHOMA, TULSA, OK (2001-2003)
A for-profit company that provides health insurance products and related services to more than 250,000 members throughout the
state of Oklahoma. Its products include HMO and PPO health care plans, as well as Medicare supplemental insurance, and Individual
Health Plans for well individuals seeking health care coverage. One division also offers its subscribers online prescription refills. A
partnership consisting of Tulsa's Saint Francis Hospital and St. John Medical Center owns the company.
CLINICAL HEALTHCARE COORDINATOR (2001-2003)
♦ Developed and submitted quality studies to HCFA (now CMS).
♦ Led the Appeals Committee.
♦ Managed the Healthcare Employer Data Information Set Collection and Reporting (HEDIS) process.
♦ Worked with IT to develop an automatic data retrieval process.
ACCOMPLISHMENTS
♦ Submitted all studies to HCFA (now CMS) on or before scheduled due dates.
♦ Successful Appeals process.
♦ Successfully passed HEDIS audits for accreditation.
♦ Data retrieval was almost completely automated.
PACIFICARE OF OKLAHOMA, TULSA, OK (1994-2001)
PACIFICARE OF OKLAHOMA INC is in the Hospital and Medical Service Plans industry in TULSA, OK. This company currently has
approximately 150,000 to 200,000 employees and annual sales of over $1,000,000,000.
MEDICAL MANAGEMENT CONSULTANT (1997-2001)
♦ Successfully led 6 medical groups (including Hillcrest and Omni) through 3 major NCQA accreditation processes. Over a 4
year period, collected documentation, charted progress and coached group performance in the utilization management
area. The result was full compliance and an excellent rating.
♦ Audited medical groups to maintain compliance with PacifiCare standards. Quarterly TAT (turnaround time) and IRR (inter-
rate reliability) audits exposed areas needing improvement. Through coaching and education of the medical groups,
compliance was achieved and maintained.
♦ Conducted frequent (monthly or every 2 weeks) meeting with 6 medical groups to maintain high standards of quality
healthcare. The joint operations meetings, which included key management (Medical Directors, UM Directors), were
designed to identify problems, educate the staffs and offer patient care guidance. Part of my responsibilities included
developing action items and subsequent follow up.
♦ Investigated and processed Quality of Concern (QOC) issues for the medical groups. Issues could arise from members,
nurses or the Department of Health. Delved into hundreds of issues per month and assigned a level of concern to each.
Presented the most important concern to the Physician Advisory Committee (PAC).
♦ Coached medical groups to achieve compliance with the annual 36 page Utilization Management assessment. 5 of the 6
medical groups had scored below the required 90% level. To correct this situation, conducted individual group
assessments, developed policies, re-wrote program descriptions and submitted documentation. The result was that all 6
groups received scores of 90% or better.
ACCOMPLISHMENTS
♦ Full compliance and scores above 90% on annual Utilization Management assessment.
♦ Compliance with turnaround time, and inter-rater reliability audits.
♦ Since we were able to keep the medical groups compliant then PacifiCare was able to maintain its NCQA
accreditation.
MANAGED CARE CONSULTANT (1994-1997)
♦ Did utilization review of charts of hospitalized patients tied to the Medical groups that I was assigned. I managed two of the
larger groups, (Hillcrest and OMNI) which were tied to Hillcrest Medical Center and St. John’s Hospital. I rounded with the
lead physician, did follow-up from rounds, was involved in discharge rounds, coordinated patient discharges, and did data
analysis of bed days for the groups.
♦ Monitored the medical groups for over utilization and also under utilization since PacifiCare had a shared risk contract with
them.
ACCOMPLISHMENTS
♦ Readmissions were low for both groups.
♦ Bed days were within acceptable ranges for both the Medical groups and PacifiCare.
♦ Minimal out of network charges.
HEALTHCORE, INC. , TULSA, OK (1992-1994)
The company and subsidiaries provided home healthcare services to patients. It operated in three segments: nursing, respiratory
therapy/medical equipment (HME), and infusion therapy. As of 1999, HealthCore Holdings, Inc. went out of business.
QUALITY ASSURANCE NURSE (1992-1994)
♦ Reviewed staff documentation to determine that Medicare guidelines and quality standards were being met. This included
start of care documentation, concurrent review and monthly Quality Assurance monitors. Participated in quarterly
utilization review meetings, and assisted in monthly claims review for compliance with HCFA regulations.
♦ Managed the recertification process to keep patients on service.
♦ Educated home health staff on documentation needed to support admission or extension of homehealth services.
CLARKSON KIDNEY CENTER, OMAHA, NE (1990-1992)
Staff Nurse in 599 – Inpatient Dialysis Center
♦ Staff nurse in an 8 station acute kidney unit with rotations to ICU units at contracting hospitals. Used dialysis machines,
performed access of fistulas, grafts, femoral and subclavian lines. Team leader. On-call rotation for evenings and weekends.
UNIVERSITY OF NEBRASKA MEDICAL CENTER, OMAHA, NE (1988-1990)
Staff Nurse in Pediatric Bone Marrow Transplant Unit
♦ Staff nurse in a pediatric bone marrow transplant unit. Provided direct 1:1 patient care during the pre-transplant chemo
stage, through transplant and recovery. We were our own ICU when needed. Accessed catheters, used
ventilators/monitors and administered high dose chemo, blood products, bone marrow and multiple antibiotics. Skilled at
giving total care and building relationships with the patient’s family.
LDS HOSPITAL, SALT LAKE CITY, UT (1986-1988)
Staff Nurse – 56 Bed Medical Surgical Unit
♦ Designed and implemented care plans for a wide variety of internal medicine patients in a 56 bed med-surg unit. This
included administration of medications and treatments and assistance with the patient’s personal care. Variety of patients
ranged from stroke, to pre-heart caths, pneumonia, and HIV. Also had radiation rooms for implants.
REFERENCES PROVIDED UPON REQUEST

JOLENE HANSON 2016_updated 9_22_16

  • 1.
    JOLENE K. HANSON,RN 1810 North 56th Street Omaha, Nebraska 68104 (402) 301-6674 (Cell Phone) Email: jhanson21@cox.net SUMMARY OF QUALIFICATIONS Organizational Development Training and Development Managed Care - Medical Management Facilitation/Training Senior Leadership Consultation/Coaching Utilization Review/Case Management Survey Management/Analysis Complex Project Management Staff Nursing – Med/Surg/Dialysis/Transplant Quality Consultation/Auditing Leadership Development Home Health Recertification _________________________________________________________________________________________________ CONTINUING EDUCATION Accelerated Strengths Coaching Certification (Gallup) (2014) Recertified Strengths Coach (July 2016) Edgerton Examiner (2008 and 2009) Associate Degree – Nursing, University of Nebraska Medical Center, Omaha, NE (1986) University of Nebraska, Lincoln (1982-1984) Wayne State College (1980-1981) _________________________________________________________________________________________________ EXPERIENCE ALEGENT CREIGHTON HEALTH/CHI HEALTH, OMAHA, NE (2003-PRESENT) With hospitals reaching from Kearney, Nebraska to Corning, Iowa and 15,900 employees, CHI Health is a network of 15 Acute-care Medical/Surgical Hospitals, two psychiatric care facilities and two physician practice groups operating in a single clinically integrated network. HR TALENT COORDINATOR (DEC.2015 – PRESENT) - BASICALLY THE SAME POSITION, JUST NEW TITLE ♦ Collaborate and consult with senior campus leaders to identify their units/departments needing additional support in education and service excellence. Facilitate training for leaders and staff. ♦ Observe and coach senior leadership to enhance professional coaching skills. ♦ Facilitate workgroups for General Orientation standardization project and was the lead facilitator for rolling out the new content. Prepare for and facilitate General Orientation (GO) class every Tuesday for new hires. Class size is usually mid forties. ♦ Assist with content changes and process maps to move independent general orientation (iGO) from Talent Acquisition to HR Talent Development department. Facilitate any iGOs in the Omaha area. ACCOMPLISHMENTS ♦ Did analysis of how AIDET/Communication and the Patient Experience was being taught to new hires (clinical & nonclinical) and refreshed to all employees on all ministries. ♦ Successfully got sponsorship from senior leaders at CUMC to facilitate classes for past new hires from April 2015 to present as they have not had this content. In process of developing a plan to continue to teach going forward. ♦ Successfully facilitated classes for senior leadership at CUMC on content that I would be teaching their staff as well as MORE Coaching. Facilitated staff classes at all times of the day to accommodate all shifts resulting in approximately 200 CUMC staff being trained. ♦ Successfully have done the same for the surgery departments at CUMC and Bergan at the request of the surgery director. The process again went from sponsorship to teaching leaders content and coaching, and then training approximately 180 Bergan and CUMC surgery staff. ♦ Successfully led 5 workgroups for GO standardization project, was involved on main steering team around content development and logistics. Was heavily involved in quality review of content, and facilitated the first classes with the new content and made recommendations to the steering team for content changes and repositioning of sections. ♦ iGO process successfully transitioned from Talent Acquisition to the HR Talent Development department which was done in June. This involved work on process maps and then the initial transition which occurred in June. ♦ Have successfully managed the first 5 iGOs, suggested and made changes to process maps and the facilitator worksheet based on my experience with these iGOs.
  • 2.
    HR TALENT FACILITATORAND COACH (JAN. 2015 – DEC. 2015) ♦ Collaborate and consult with senior campus leaders to identify their units/departments needing additional support in education and service excellence. ♦ Observe and coach senior leadership to enhance professional coaching skills. ♦ Project manage the Physician Insights survey across the entire MBO utilizing a new vendor for the survey. ♦ Project Manage the Performance Culture Assessment (PCA) survey across the entire MBO utilizing a new vendor for the survey. ♦ Coordinate logistics and facilitate General Orientation class every Tuesday for new hires. Class size is usually mid forties. Complete the process with finalizing paperwork and registering and grading the class in LEARN. ACCOMPLISHMENTS ♦ Met all data timelines for pre-administration survey work with both the PCA and Physician surveys. (which that year were happening simultaneously) ♦ Led subgroups for implementation around question selection, data collection and submission, communication plan, and reporting from pre-administration to implementation of both surveys. ♦ Managed implementation phase of surveys, fielded questions, and managed participation reports, and ongoing communication throughout the implementation phase of both surveys. ♦ Worked with the vendor to develop education for leaders and rollout of results for post phase of the surveys. ♦ Successfully facilitated general orientation every Tuesday from pre-class tasks (such as roster preparation, communication to food and nutrition, communication to HR service center, communication to Talent Acquisition, and the facilities for room arrangements, as well as actual room set-up) to post-class tasks (such as signing required documentation and scanning to HR, entering the class completion into LEARN, and uploading documentation to the Onboarding share point site. ORGANIZATIONAL DEVELOPMENT CONSULTANT (MAY 2014-JAN. 2015) ♦ Collaborate and consult with senior campus leaders to identify their units/departments needing additional support in improving patient survey results. ♦ Research and develop strategies for improving PatientsFIRST survey results. ♦ Serve as liaison with Studer Group personnel and Alegent Creighton Health/CHI Health leadership. ♦ Observe and coach senior leadership to enhance professional coaching skills. ACCOMPLISHMENTS ♦ Selected to participate in the Gallup’s Accelerated Strengths Finder Coaching for Managers and Teams certification course. ♦ Assisted with creation of and facilitation of evidence based education and skills lab for leaders and employees. ♦ Selected to work with nationally recognized Studer Group coaches to help implement evidence based practices within Alegent Creighton Health/CHI system. OPERATIONS ANALYST / ENGAGEMENT CONSULTANT (2009-MAY 2014) ♦ Initially functioned as a report specialist within the department focusing on the HCAHPS results for the system. Helped find and manage a new vendor contract for patient surveys and maintained the relationship with the vendor (HealthStream). Coordinated consulting visits and educated all leaders on use of the website and running data. ♦ Analysis of HCAHPS data and consultation with leaders around interventions and practices that could be implemented to increase their scores and provide better quality and a better experience for the patient. ♦ Strategic goal setting with Executive Leadership Team for System Performance Measure(SPM) and Individual Performance Measures(IPM) for Patient surveys, and SPM for Employee and Physician surveys. ♦ Project managed Employee Engagement survey for 5 years with Gallup and HealthStream, also created post survey reports, presentations for data distribution, and education for leaders. ♦ Worked with Gallup to create a Business Impact Analysis (BIA) in 2012 and 2013. ♦ Project managed the Physician Engagement survey for 3 years with Gallup and PRC, also created post survey reports, presentations for data distribution, and education. Involved in sharing results with medical staff across the system. ACCOMPLISHMENTS ♦ All leaders throughout the system were knowledgeable and able to run customized reports from the HealthStream website. ♦ Five cycles of the Employee Engagement survey were completed within all timelines with increasing system results. ♦ Successful transition of the Employee Survey process from Gallup to HealthStream. ♦ Three cycles of the Physician Engagement survey were completed within all timelines. ♦ Successful transition of the Physician Engagement survey from Gallup to PRC, and process started to transition to HealthStream until the decision was made to not survey in 2014.
  • 3.
    ♦ Business Impactanalysis was shared with the Executive Leadership Team and strategic decisions were made because of the findings. ♦ System and Individual Performance Measures were developed and rolled out to leaders. SYSTEM QUALITY IMPROVEMENT SPECIALIST FOR THE ONCOLOGY SERVICE LINE (2003-2009) ♦ Provided leadership to major projects and system performance improvement initiatives. ♦ Assisted campuses and specific service lines (Oncology & Orthopaedic) in performance improvement projects and activities. ♦ Utilized performance improvement methodologies, systems, and tools to support system quality initiatives. ♦ Project managed and co-wrote the application for the Edgerton Award. ♦ Worked as an Edgerton Examiner for 2 years, and have experience with the Baldrige criteria. ♦ Led several root cause analysis and failure mode effect analysis teams. ACCOMPLISHMENTS ♦ Went from having some Oncology units to all Oncology units in the system having performance measures for quality. ♦ Developed an Oncology scorecard for system Oncology measures. ♦ Audited and worked with the system Pathologists so that their pathology reports for staging were compliant with the standards of accreditation. ♦ Successful Edgerton site visit ♦ Organized and led a cross-campus service line team of leaders which led to sharing of best practices across the system. COMMUNITYCARE OF OKLAHOMA, TULSA, OK (2001-2003) A for-profit company that provides health insurance products and related services to more than 250,000 members throughout the state of Oklahoma. Its products include HMO and PPO health care plans, as well as Medicare supplemental insurance, and Individual Health Plans for well individuals seeking health care coverage. One division also offers its subscribers online prescription refills. A partnership consisting of Tulsa's Saint Francis Hospital and St. John Medical Center owns the company. CLINICAL HEALTHCARE COORDINATOR (2001-2003) ♦ Developed and submitted quality studies to HCFA (now CMS). ♦ Led the Appeals Committee. ♦ Managed the Healthcare Employer Data Information Set Collection and Reporting (HEDIS) process. ♦ Worked with IT to develop an automatic data retrieval process. ACCOMPLISHMENTS ♦ Submitted all studies to HCFA (now CMS) on or before scheduled due dates. ♦ Successful Appeals process. ♦ Successfully passed HEDIS audits for accreditation. ♦ Data retrieval was almost completely automated. PACIFICARE OF OKLAHOMA, TULSA, OK (1994-2001) PACIFICARE OF OKLAHOMA INC is in the Hospital and Medical Service Plans industry in TULSA, OK. This company currently has approximately 150,000 to 200,000 employees and annual sales of over $1,000,000,000. MEDICAL MANAGEMENT CONSULTANT (1997-2001) ♦ Successfully led 6 medical groups (including Hillcrest and Omni) through 3 major NCQA accreditation processes. Over a 4 year period, collected documentation, charted progress and coached group performance in the utilization management area. The result was full compliance and an excellent rating. ♦ Audited medical groups to maintain compliance with PacifiCare standards. Quarterly TAT (turnaround time) and IRR (inter- rate reliability) audits exposed areas needing improvement. Through coaching and education of the medical groups, compliance was achieved and maintained. ♦ Conducted frequent (monthly or every 2 weeks) meeting with 6 medical groups to maintain high standards of quality healthcare. The joint operations meetings, which included key management (Medical Directors, UM Directors), were designed to identify problems, educate the staffs and offer patient care guidance. Part of my responsibilities included developing action items and subsequent follow up. ♦ Investigated and processed Quality of Concern (QOC) issues for the medical groups. Issues could arise from members, nurses or the Department of Health. Delved into hundreds of issues per month and assigned a level of concern to each. Presented the most important concern to the Physician Advisory Committee (PAC). ♦ Coached medical groups to achieve compliance with the annual 36 page Utilization Management assessment. 5 of the 6 medical groups had scored below the required 90% level. To correct this situation, conducted individual group assessments, developed policies, re-wrote program descriptions and submitted documentation. The result was that all 6 groups received scores of 90% or better.
  • 4.
    ACCOMPLISHMENTS ♦ Full complianceand scores above 90% on annual Utilization Management assessment. ♦ Compliance with turnaround time, and inter-rater reliability audits. ♦ Since we were able to keep the medical groups compliant then PacifiCare was able to maintain its NCQA accreditation. MANAGED CARE CONSULTANT (1994-1997) ♦ Did utilization review of charts of hospitalized patients tied to the Medical groups that I was assigned. I managed two of the larger groups, (Hillcrest and OMNI) which were tied to Hillcrest Medical Center and St. John’s Hospital. I rounded with the lead physician, did follow-up from rounds, was involved in discharge rounds, coordinated patient discharges, and did data analysis of bed days for the groups. ♦ Monitored the medical groups for over utilization and also under utilization since PacifiCare had a shared risk contract with them. ACCOMPLISHMENTS ♦ Readmissions were low for both groups. ♦ Bed days were within acceptable ranges for both the Medical groups and PacifiCare. ♦ Minimal out of network charges. HEALTHCORE, INC. , TULSA, OK (1992-1994) The company and subsidiaries provided home healthcare services to patients. It operated in three segments: nursing, respiratory therapy/medical equipment (HME), and infusion therapy. As of 1999, HealthCore Holdings, Inc. went out of business. QUALITY ASSURANCE NURSE (1992-1994) ♦ Reviewed staff documentation to determine that Medicare guidelines and quality standards were being met. This included start of care documentation, concurrent review and monthly Quality Assurance monitors. Participated in quarterly utilization review meetings, and assisted in monthly claims review for compliance with HCFA regulations. ♦ Managed the recertification process to keep patients on service. ♦ Educated home health staff on documentation needed to support admission or extension of homehealth services. CLARKSON KIDNEY CENTER, OMAHA, NE (1990-1992) Staff Nurse in 599 – Inpatient Dialysis Center ♦ Staff nurse in an 8 station acute kidney unit with rotations to ICU units at contracting hospitals. Used dialysis machines, performed access of fistulas, grafts, femoral and subclavian lines. Team leader. On-call rotation for evenings and weekends. UNIVERSITY OF NEBRASKA MEDICAL CENTER, OMAHA, NE (1988-1990) Staff Nurse in Pediatric Bone Marrow Transplant Unit ♦ Staff nurse in a pediatric bone marrow transplant unit. Provided direct 1:1 patient care during the pre-transplant chemo stage, through transplant and recovery. We were our own ICU when needed. Accessed catheters, used ventilators/monitors and administered high dose chemo, blood products, bone marrow and multiple antibiotics. Skilled at giving total care and building relationships with the patient’s family. LDS HOSPITAL, SALT LAKE CITY, UT (1986-1988) Staff Nurse – 56 Bed Medical Surgical Unit ♦ Designed and implemented care plans for a wide variety of internal medicine patients in a 56 bed med-surg unit. This included administration of medications and treatments and assistance with the patient’s personal care. Variety of patients ranged from stroke, to pre-heart caths, pneumonia, and HIV. Also had radiation rooms for implants. REFERENCES PROVIDED UPON REQUEST