Sally J Healy
Nursing in Buffalo, NY

Capella University
Masters of Science in Nursing Education D'Youville College - Buffalo, NY
BSN in Nursing with a minor in Health Services D'Youville College - Buffalo, NY
Bachelor of Science in Business Management

SKILLS AND QUALIFICATIONS: Medical Case Management, Worker's Compensation, and Utilization Review-responsible for aggressive and successful coordination of care and contact with provider, claimant, Attorney, claims examiner/adjustor; assessment of medical records for appropriateness of treatment and level of care being provided; Evaluate treatment requests and review clinical information received with treatment protocols and guidelines, identify medical necessity and refer to the Physician Advisor, if appropriate within the established timeframes; direct authorized medical treatment within the PPO, MPN or to strategic business partners whenever possible; Work with treating physicians and return to work contact for facilitating early return to work; utilize the established guidelines and documentation standards; prioritize and coordinate multiple responsibilities; maintain minimum billing standards; work closely with the Claims Adjustor to update and advise of case status and potential problems; Making outbound calls to assess members' current health status ; Identifying gaps or barriers in treatment plans; Providing patient education to assist with self-management; Coordinating care for members; Making referrals to outside sources; Coordinating services as needed (home health, DME, etc.); Educating members on disease processes; Encouraging members to make healthy lifestyle changes. Competent in organizational and multi-tasking skills, extensive experience with records review, analytical problem solving, research capabilities; Strong written and verbal communication skills; Effective team player, self-directed with pro-active management style; Strong computer skills including but not limited to Word, Outlook, Excel, internet search Most recently promoted to Medical Case Management Float Position, supporting nationwide jurisdictions temporary (90-120 day) assignments - thus far, experienced and competent supporting North and South Carolina, Kentucky, Michigan, Indiana, California (Northern and Southern), New York, Massachusetts, New Hampshire, Maine, Rhode Island, Vermont. Cardiac Intensive Care, Outpatient and surgical Ophthalmology, Orthopedic, Medical Surgical, ENT, Urology, Phlebotomy, Pediatric-Primary Care/ Specialty Clinics, Step-Down Neurology, Telemetry; Patient care, Vents, IV starts, phlebotomy (Adults and Pediatrics), Dobhoff tube insertion, Blood gases, Suctioning, medication administration (oral, IV, Subcutaneous, etc.); Treatments, Charge Nursing, Rehabilitation, allergy testing, Peak Flows; on-call and triage, home visits, death visits HMO Insurance Authorizations and Denials; Back-billing clean up, Home Care Case management; Staffing for HHA's for Homecare visits Nursing Informatics, Systems Analyst for Cerner and Eclipsys EMR, on-call triage of EMR (written/implementation); Involved in extensive build, planning, training and implementation of Eclipsys CPOE Project; Team Lead involved in planning and design for Cerner-Surginet and Surginet Anesthesia; Physician/Provider Training on Electronic Medical Record (Eclipsys); Workflow management (Eclipsys); Chart audits; resolving and addressing the support to the position; Provider Liaison for Electronic Medical Record (trained and supported staff CPOE project; Experience in planning and presentation to groups; Chart audits for EMR use/orders Physician and provider relations and training of the Electronic Medical Record for Renowned Cancer Center in Western NY Program Management: CPAP/BIPAP Compliance program; Nebulizer Program, Discontinue (D/C) Program while measuring and reporting sequential improvements; measures and outcomes; Data gathering/analysis and using Evidence Based results to adjust programs for better patient outcomes; Medent-medical record management

Buffalo/Niagara, New York Area

Hospital & Health Care