1722 Miriam Street ~ Pittsburgh, PA 15218 Home: [Send email to request phone number] 31.2085
Cell: 321.537.9097
OBJECTIVE
Clinical Administration/Healthcare Management/Consultant position encompassing
promoting, directing, conceptualizing and economizing skills in a varied,
consumer oriented environment, in hospitals, healthcare, or health services.
QUALIFICATIONS
* Provide Leadership * Corporate Compliance * Contractual Compliance
* Cost Effective, Quality Alternatives * Disease Management * Continuity of
Care
* Clinical Process Management * Presentations/Education * Critical Thinking
* Business Development * Family Nurse Practitioner * Provide Home Health
Services
Spent twenty-plus years at the same hospital participating in a variety of
clinical / administrative roles.
ACHIEVEMENTS
DIRECTED/ORGANIZED the closure/replacement of a management department from one
office (in another state) to the Pgh. Market for a for-profit company;
restructured/reorganized the cost-effective, quality control philosophy of the
Utilization Case Management team. Results: Utilizing years of clinical experience
and diagnostic acumen; improvement in the documentation and medically necessary
care preventing negative risk outcomes.
ECONOMIZED by initiating 24/7 Utilization/Quality/Clinic Management Hotline.
Facilitated customer interviews; obtained knowledge of contractual agreements;
and coordinated care across state lines. Results: Improved decision capabilities
at site-level; saved company over $150+K annually; averted admissions from
non-contracted hospitals; avoided delays in treatment; promoted corporate
compliance.
CONCEPTUALIZED customization of clinical decision-making based on customer
needs; stimulated organizational change following identification of problematic
areas. Results: Realized Clinical Process Management through shared knowledge
among settings and practices; varied treatment/procedures based on customer
preferences.
PROMOTED hospital-wide services for 200+ bed hospital. Developed/implemented
plan of action for development department, established budget; facilitated
customer interview; recruited physicians; increased volume of patient customer
use in hospital. Results: Monitored and provided positive outcomes and overall
enhancement of the hospital's ability to provide cost-effective quality care
while staffed with specialty physicians supporting the delivery of best
practices; increased revenue 30+%.
PRESENTED/COORDINATED daily acquisition of predetermined critical indicators,
hospital-wide; analyzed and reported researched data of adverse outcomes,
sentinel events and priority conditions; presented information using statistical
guidelines; stimulated discussions amongst and between the medical staff.
Results: Improved quality and coordination of care between disciplines; developed
systematic approach to the Management of a condition, i.e. Disease Management;
designed care that included services across the entire continuum of care;
developed improved protocols, guidelines and clinical pathways adhering to
federal and state regulations; saving $2,7MM in the performance of unnecessary,
invasive procedures; reduced exposure to liability; met HMO requirements.
INITIATED/RESEARCHED/DEVELOPED progressive Utilization Management concept for
Independent Physicians' Organization that included membership clarity about team
goals. Researched tests/procedures pertinent to each body system and criteria to
be met when physician could proceed to the next level without prior
authorization. Results: Maintained Physicians' autonomy; improved decision making
capabilities within clearly defined goals; increased customer satisfaction by 50%
as measured by phone and written survey.
EDUCATION
Masters in Nursing/FNP Duquesne University Pittsburgh, PA
Masters in Health Education Pennsylvania State University Pittsburgh, PA
Bachelor of Science in Nursing Duquesne University Pittsburgh, PA
PROFESSIONAL EXPERIENCE
SELECT SPECIALTY HOSPITAL Director of Clinical Services 05/08 - Present
Pittsburgh, PA
Organizes and administers the Department of Clinical Services by implementing
standards of care, policies, and procedures established by the company ensuring
timely, accurate, complete documentation and that regulatory requirements are
met. Position responsible for implementing Pulmonary-Ventilator Weaning, complex
Wound Care, complex Medical including Infectious Disease, Renal, and Brain Injury
Recovery Programs.
HOUSE CALLS OF CENTRAL FLORIDA Family Nurse Practitioner 06/05 - 05/08
Dr. Oscar Jenkins ~ Merritt Island, FL
Per Diem house calls. Skilled nursing and assisted living visits made as an
Advanced Registered Nurse Practitioner. Diagnose illness and initiate treatment
plan. Work closely with case workers and home health services to ensure treatment
is carried out that meets Medicare guidelines and State Survey protocals for
these medically necessary home health orders. Quality improvement initiatives
utilized in identifying best practices in the design of care processes.
THE LITTLE CLINIC ~ Rockledge, FL Regional Director of Operations 12/05 - 2007
Responsible for opening 11 clinics for start-up organizations; hiring and
retaining Nurse Practitioners (NP) to position themselves in clinics to provide
care to customers/patients with minor illnesses. Accomplished systematic
monitoring and evaluation of services provided with the sole purpose of improving
quality of care provided. Acted in the role as each clinic's Medical Supervisor
working closely with collaborating physicians. Responsible for overseeing
documentation in an electronic medical record (EMR). Duties of the NP included:
obtaining insurance information, diagnosing and treating walk-in customers, and
collection office for service.
Leon Cohen, MD, PA. ~ Merritt Island, FL Family Nurse Practitioner 2004 - 2005
Full-time Family Nurse Practitioner functioning as an independent Healthcare
Provider who works in a collaborative fashion within the healthcare team.
Provides comprehensive care to all clinic patients. Demonstrates a high degree of
clinical expertise in caring for patients with acute and chronic illnesses.
Educate patients and families on treatment plans and intervenes in emergent
situations and participates in educating co-workers. Participates in learning
opportunities for nursing; participating in quality control, quality assurance
and quality improvement. Emphasis is on preventive medicine. Provides
Anticipatory Guidance associated with each illness or problem.
WUESTHOFF HEALTH SYSTEM ~ Merritt Island, FL Director of Operations 2002 - 2004
Director of practice operations acts as an agent in the development, management,
and administration of the practice. Insures compliance with established
objectives and realization of quality, economical, and practice. Insures
compliance with established objectives and realization of quality, economical,
and comprehensive services. Directs and coordinates activities of all practice
operations for a group of 9 cardiologists and 45+ employees, between 5 offices,
maintaining efficient flow of work by evaluation/modification of office
procedures.
WEXFORD HEALTH SOURCES, INC. ~ Pittsburgh, PA 1998 - 2002
Director of Clinical Services 2001- 2002
Overseen system-wide clinical performance of 1400+ employees. Defined domains of
clinical performance and focus measure(s). Directed 65 Health Care units, lined
to area hospitals, in the provision of Correctional Health Care. Maintained
regulatory and organizational compliance through well-developed standards.
Participated in strategic planning. Measured outcomes by monitoring/auditing
predetermined quality indicators using statistical guidelines. Instituted
Morbidity/Mortality Committee. Introduced feedback, mechanism, communicated
analyzed data, supporting and promoting best practices. Developed practice
guidelines, reducing variations in care. Extensive travel required.
PROFESSIONAL EXPERIENCE - (continued)
Director of Utilization Management 1998 - 2001
Analyzed program organizing transition/closure of one Utilization Review Office
to the Pittsburgh market. Recruited, hired, and mentored Pittsburgh staff in
correctional health care. Evaluated contracts, educated staff in ICD/CPT coding
and Medicaid State specific regulations. Initiated review of claims. Incorporated
Medicare regulations. Developed Alternate Plan Concept. Approved medically
necessary care using HEDIS, NCQA, JCAHO, and URAC to introduce NCCHC standards.
Developed and implemented policies and procedures. Reviewed 100% of consults
written against Integral criteria.
CARDIO-PULMONARY RENAL ASSOCIATES ~ Pittsburgh, PA Practice Administrator 1993 -
1998
Directed operations for a Cardiology/Internal Medicine Practice.
Responsibilities included fiscal management, healthcare operations, business
ethics, information technology, human resources, credentialing, risk management,
clinical operations, and long term strategic planning for a group of 7
physicians, 35+ employees with large customer base. Acquired and maintained two
family centered practices and opened up and made operational a
stress/testing/drug-testing laboratory.
CERTIFICATES AND PROFESSIONAL AFFILIATIONS
Certified Professional Healthcare Quality (CPHQ) of National Association for
Healthcare Quality (NAHQ)
Certified Correctional Health Professional (CCHP) of National Commission on
Correctional Health Care (NCCHC)
Registered Nurse, Commonwealth of Pennsylvania
Certified Registered Nurse Practitioner, Commonwealth of Pennsylvania
Registered Nurse, Florida Board of Nursing
Advanced Nurse Practitioner, State of Florida
Advanced Registered Nurse Practitioner, State of Florida
~ References and Additional Information Furnished Upon Request ~
|
