2014 Dec Resume
- 1. MARY LISA CHRISTY R.N. 1230 S 3rd Rd SW Fairfield, Montana 59436 406-467-3153 406-868-5453 (cell) marychristy65@hotmail.com EXPERIENCE Referral Management Liaison United Healthcare Military & Veterans Malmstrom Air Force Base, Great Falls, Montana April 1, 2014 to present Interact with Military Treatment Facility (MTF): Serve as the principal point of contact for MTF staff on TRICARE operations to include all clinical, claims and administrative matters; Facilitate and maintain working relationships with MTF Commander, staff and providers on all matters pertaining to TRICARE; foster a strong collaborative working relationship with the TRICARE Operations and Patient Administration (TOPA) Flight and referral management center. Ensure efficient and accurate completion of all clinical and administrative activities with an emphasis on process improvement, utilization management, case management and condition management; Ensure operations are within the administrative and staffing budget; monitor various management indicators to evaluate the effectiveness of local operations. Complete referral and inpatient/outpattient authorization processing in accordance with United Healthcare Military & Veterans policies and procedures (myGuide), MCG criteria and TRICARE Policy Manual guidelines. Customer service:maintain a working environment focused on the provision of prompt, courteous and professional customer service, ensuring that all customer services are performed consistent with protocol and within the managed care support contract performance standards. Demonstrate the ability to independently identify, define and effectively resolve complex issues. Identify provider network problems/issues and correct or communicate these to the Director Market Operations (DMO) and network services Identify and report potential risk management and quality of care issues to the appropriate departments. Knowledge of TRICARE policies, procedures and claims processing, MCG criteria, ICD-9-CM, CPT-4 and HCPCS coding; various computer programs including Word, Excel, Power Point, Internet Explorer.
- 2. Manager, TRICARE Service Center United Healthcare Military & Veterans Malmstrom Air Force Base, Montana February 1, 2013 to March 31, 2014 Management TSC: Manage all aspects of operations in order to maintain a working environment focused on the provision of prompt, courteous and professional customer service, ensuring that all customer services are performed consistent with protocol in a caring, empathic manner and within the managed care support contract performance standards. Demonstrate the ability to independently identify, define and effectively resolve issues impacting operations in a timely fashion. Interact with MTF: Serve as the principal point of contact for MTF staff on TSC operations to include all clinical, claims and administrative matters; Interact, facilitate and maintain working relationships with MTF Commander, staff and providers on all matters pertaining to TRICARE and TSC operations; foster a strong collaborative working relationship with the TOPA Flight. Ensure efficient and accurate completion of all clinical and administrative activities with an emphasis on process improvement, utilization management, case management and condition management; Ensure the TSC operates within the administrative and staffing budget; monitor various management indicators to evaluate the effectiveness of TSC operations. Staff supervision: Prepares annual performance evaluations and provides staff feedback on a regular basis; ensure the staff appropriately implement United Healthcare Military and Veterans policies and procedures; develop TSC workflow processes to ensure maximum efficiency of assigned staff; monitor workload of employees to assure accuracy, timeliness, efficiency, and contract compliance; ensure that appropriate and timely coaching and performance counseling is provided to support staff performance improvement and provide DMO with recommendations for additional training; conducts and/or coordinates staff development activities. Ensure staff competencies are maximized through completion of all applicable new and annual refresher training. Identify provider network problems/issues and correct or communicate these to DMO and network services
- 3. Identify and report potential risk management and quality of care issues to the appropriate departments. Knowledge of TRICARE policies and claims processing, InterQual/Milliman Criteria, ICD-9-CM, CPT-4, HCPCs and American Dental codes; various computer programs including Word, Excel, Power Point, Internet Explorer. Clinical Liaison Nurse TriWest Healthcare Alliance - Malmstrom, Great Falls, Montana May 7, 2001 to February 15, 2013 Supervision TSC: Manage all aspects of the TSC to maintain a working environment focused on the provision of prompt, courteous, and professional customer service, ensuring that all customer services are performed consistent with protocol, and within the managed care support contract performance standards. Demonstrate the ability to independently identify, define and effectively resolve issues impacting day-to-day TSC operations. Interact with MTF: Serve as the principal point of contact for MTF staff on TSC operations to include all clinical and administrative matters; Interact with MTF Commander and staff on all operational and clinical issues concerning the operation of the TSC; Facilitate and maintain working relationships with MTF Commander, staff and providers on all matters pertaining to TRICARE and TSC operations; foster a strong collaborative working relationship with the Contracting Officer Representative (COR). Ensure efficient and accurate completion of all clinical activities with an emphasis on process improvement, utilization management, case management and condition management; Complete referral and inpatient/outpattient authorization processing in accordance with company policies and procedures, InterQual criteria and TRICARE policy manual guidelines. Complete clincal packets for medical director review. Provider guidance/supervision to staff on completion of referrals and clinical authorizations. Staff supervision: Prepare annual performance evaluations and provide staff feedback on a regular basis; ensure the staff appropriately implements policies and procedures; develop workflow processes to ensure maximum efficiency of assigned staff; monitor workload of employees to assure accuracy, timeliness, efficiency, and contract compliance; ensure that appropriate and timely coaching and performance counseling is provided
- 4. to support staff performance improvement and provide Service Area Director (SAD) with recommendations for additional training; conducts and/or coordinates staff development activities. Ensure TRICARE Service staff competencies are maximized through completion of all applicable new and annual refresher training. Identify network provider problems/issues and correct or communicate these to SAD and network subcontractor Identify and report potential risk management and quality of care issues to the appropriate corporate office. Knowledge of TRICARE Policy Manual, InterQual Criteria, ICD-9-CM, CPT-4, HCPCs and American Dental codes and coding conventions; various computer programs including Word, Excel, Power Point, Internet Explorer. Internal Case Management Supervisor Spectrum Medical, Inc., Great Falls, Montana January 10, 2000 to May 2001. Internal Case Manager (home health, private duty, durable medical equipment, oxygen services, rehab services) relations. Coordination of care of clients using multiple services. Daily review of current clients hospitalized. Research and perform customer service call backs for quality assurance. Home Health: Receiving referrals from Benefis Healthcare, physicians and clients for skilled nursing, physical therapy, occupational therapy or speech therapy. Create admission packet for staff. Scheduling of nursing staff to meet plan of care for each client. Admit clients and provide nursing care on an as needed basis. Maintain daily census statistics. Maintain home health utilization statistics. Data entry of Home Health client data into Haven. Employee Health: Coordinate and maintain current employee health files on all employees. Administer tuberculosis testing, Hepatitis B vaccinations, flu shots, latex allergy questioning and other necessary screenings keeping accurate records for all tests/vaccines administered. Provide monthly education to all employees on mandatory topics i.e. infection control, blood born pathogens. Private Duty: Receiving referrals from Benefis Healthcare, physicians and clients for personal care, nursing care. Complete EPSDT application for pediatric nursing care. Receive physician orders and schedule phlebotomist for at home blood draws. Admit clients and provide nursing care on an as
- 5. needed basis in absence of Private Duty Coordinator. Home and Community Based Services (HCBS) Case Management Team: case manager responsible for 21 HCBS clients. Pediatric Staff Registered Nurse Benefis Healthcare, Great Falls, Montana - October 1987 to December 1989. Full-time nurse on 20-bed unit that included pediatric nursing and education for children and families Office Nurse Mark A. Kelly, D.O., Cut Bank, Montana - March to November 1986. Office nurse with miscellaneous office duties including nursing, laboratory, ordering supplies, filing, dictation, scheduling. Shift Supervisor Toole County Hospital & Nursing Home, Shelby, Montana - August to December 1985. Full-time supervisor for a 45-bed long-term care facility. Staff Registered Nurse Toole County Hospital & Nursing Home, Shelby, Montana - January to March 1986. Full-time staff at a 23-bed rural hospital.