President and Legal Nurse Consultant

• Own and operate a Legal Nurse Consultant company that provides powerful, simple solutions to attorneys and insurance companies for their complex medical-legal-insurance needs. 

• For the legal industry, I have participated in Medical Mal-Practice, Personal Injury, Workers Compensation, Toxic Torts, Product Liability and Class Actions suits. The services have included in-depth medical record review with multiple and specific medical chronology of facts, advanced case analysis including weakness and strengths of case, medical literature review, standards and protocol identification, trending of data for analysis benefit, graphic presentation of trends, trial presentation graphics, juror packets, expert identification and qualification, future medical cost projections, and assistance with affidavit allegations, deposition questions, mediation and IME. I have also acted as a fact witness at trial.

• For the insurance industry, I have participated in PI cases, Workers Compensation, General Liability, and all types of Bodily Injury claims. The services have included nurse review of all medical records, physician and chiropractic review of medical records, analysis for pre-existing events and their effects on the case, injury causation, medical necessity and appropriateness of care, related versus unrelated issues and charges, future medical cost projections, and assistance with reserve setting. 

• For insurance, government or home health care review, I have done extensive auditing and quality assurance tracking for home health for HCFA compliance, State Certification and JACHO accreditation. Have assisted with these audits in Home Health specifically with Skilled Nursing, Physical Therapy, Infusion Therapy and DME.

• For education and standards and protocols to the Home Health Industry, I have previously written, published, implemented, oriented, and audited for compliance on all major disease processes standards and protocols for the home health industry. I have also designed, implemented and taught a large number of courses to nurses, therapists, social workers, aides, and management personnel in the past. I have designed, implemented, certified and taught Home Health Aide Certification Classes. I have been in charge of producing all monthly continuing education classes for nurses and aides. I have assisted many Home Health Agencies to meet the unique challenges they face in education, continuing education, standard and protocol development, quality assurance and accreditation. 
  

1997-2002 CorVel Corporation Columbia, MO

• Legal Nurse Consultant
  Consultation and review for defense and plaintiff attorneys for medical malpractice, workers compensation, auto and general liability legal files. Included obtaining, organizing and arranging medical records in chronological order for easy review by attorneys and physicians. Preparation of in-depth chronology timeline events, summary of medical events, screening for merit and exposure, report analysis including breach of medical standards and recommendation production. Services included timeline graphics, trend analysis, and graphic exhibit development for trial. Have assisted with affidavit allegations, deposition questions, mediation and IME. Identified and acquired expert witnesses, literature and Internet searches. Have acted as expert witness in the scope of cardiac nursing. 

• Peer Review Auditor:
  Concurrent and retrospective medical/legal file and peer review for claims examiners for workers compensation, auto and general liability insurance files. Record/file review included identification of injury onset, pre-existing conditions, area of exposure, pertinent witnesses, causality, and related versus non-related issues. File management included organization of medical records/bills, development of report to physician including accident description, treatment rendered and questions posed, and summary and cost analysis report to examiners.
  Outcomes savings per case ranged from $3,000 to $3,500,000 with $20,271 being the average savings.

• Certified Utilization Review Nurse:
  Retrospective review of inpatient hospital bills and multiple surgical bills for duplication of costs/services, medical necessity, appropriateness of care/costs, unbundling/global pricing issues, usual and customary charges, fee schedule and PPO providers. Corporate on site audits also performed.
  Average savings per hospital bills/surgical bills ranged from $100 to $4,800, and went as high as $64,000.

• Home Care Connection, Inc.Columbia, MO
  Vice President of Patient Services:
  Responsible for all departmental patient services (Nursing, Physical Therapy, Occupational Therapy, Speech Therapy, Medical Social Workers, Home Health Aides, Infusion Therapy and Durable Medical Equipment).
  Responsible for all third party payer decisions regarding patient coverage, meeting rules/guidelines, and utilizing resources appropriately.
  Performed and analyzed all quality improvement audits for company, as well as dealing with HCFA State Audits, HCFA Focused Review Audits, and JACHO Accreditation.
  State Certification and JACHO Accreditation achieved during my tenure without deficiencies. Only 4 visits out of 16,000 denied when reviewed for HCFA Focused Review.
  Assisted CEO in budgetary process, marketing strategies, and decisions for direction in which agency was to grow. 
  Revenue for agency grew from $1,000,000 to $10,000,000 during my tenure.
  Responsible for all agency education of staff, program development in-services and staff meetings.
  Orientated 100 new professional employees during my tenure.

1995 -1996 Physicians Home Health Network/HealthCor 
Columbia, MO

• In charge of 7 person continuous quality improvement committee for large national (80 agency) corporation. Conducted audits of each agency to ensure compliance with State, HCFA and JACHO accreditation. Assigned deficiencies to agencies when necessary, helped staff develop and implement deficiency plan of actions, and implemented and designed education programs to deal with deficiency areas, Audits included Nursing, Rehab, Pharmacy & IV Infusion, and DME. 

• All agencies passed State and HCFA Certification and JACHO Accreditation during my tenure.

• All policies and procedures, standards and protocols, operating procedural manuals changes and managed care contracts went through the committee for approval prior to implementation.

• Responsible for incorporating new agency acquisitions into the corporate structure. 

• Developed Patient/Provider Satisfaction Surveys for corporation for nursing, pharmacy and infusion, and DME. Required extensive computer and Scantron technology.

• Helped develop outcomes and clinical pathways to meet all managed care contracts, specialized in cardiac care and IV therapy infusion.

1992-1995 Physicians Home Health Network Columbia, MO

• Developed and implemented 32 class modules for Nursing Staff, Management Staff, Aide Certification and Third Party Payer Rules and Regulations.

• Required extensive needs analysis, knowledge base of third party payer rules and regulations and nursing protocols.
  Educated all new employees, developed all remedial courses and helped design and implement all standards of care (from cardiology to oncology, etc.).

• Did yearly nursing skills evaluation and testing on all nursing personnel.
  Orientation increased the staff retention rate from 85% to 99.8% for 3 years. Visit denial reimbursement decreased to .001% and workers compensation premiums decreased by 60% with implementation of these training programs.

Primary Nurse Case Manager/Third Party Payer Supervisor

• Required ongoing assessment, education, and coordination of care by a multidisciplinary team for cardio-pulmonary, neurologicaly impaired, oncological, diabetic, orthopedic and IV infusion types of home health care patients. 

• Specialized in cardiology and IV Infusion Therapy
  Required extensive knowledge base of third party payer regulation.
  Supervised, scheduled all private duty staffing and Insurance/Medicaid patients for agency.

1998-1992 Independent Legal Nurse Consultant Columbia, MO

Legal Nurse Consultant:

• Organized medical files, perused litigation documentation for areas of exposure, made recommendations for further medical reports, questions to be answered during depositions, and further follow-up studies on a case by case basis.

• Specialized in defense malpractice cases.

1986-1987 Intracorp Columbia, MO

Catastrophic Nurse Case Manager

• Handled catastrophic nurse case management for end-stage cardiology patients, especially for those waiting for heart transplants. Also handled acute oncology and neurology patients.

• Utilized all duties of a case manager to obtain the best, most effective care for the patient in a cost oriented basis.

1984-1985 University of Missouri Hospital Columbia, MO

Staff Nurse for Cardiac and Neuro Intensive Care Units

• Took primary care of all types of cardiac patients from Myocardial Infarction, Congestive Heart Failure, Cardiomyopathy, Implantable Ventricular Defibrillators, Coronary Artery Bypass Graft, Heart Valve Surgery, and Arrhythmia patients.

• Took primary care of all types of neurological patients from intensive closed head injuries, TIA/CVA, Brain Tumors and Blood Brain Barrier Disruption for Chemotherapy patients. 

1983-1984 St. Mary's Hospital Decatur, IL

Cardiac Staff Charge Nurse:

• Staff charge nurse for 62 bed cardiac and surgical step down units.
  Team care of all cardiac patients (post CABG, post MI, CHF, arrhythmias, etc.) to all surgical patients requiring a semi-intensive care setting. 

1980-1983 St. John's Regional Hospital Springfield, MO

Staff Nurse/Senior Nursing Aide:

• Staff nurse for orthopedic unit that specialized in total hip replacement and total knee replacement surgery. Handled full range of orthopedic patients.
  Senior Level Nurses Aide in Cardiac Intensive Care during all of my nursing school period. 
  
  
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