KATHLEEN BRANIA

29W 371 EMERALD GREEN DR #G

WARRENVILLE, IL. 60555
630 836 7559
630 890 3388
Nurse Reviewer, Clincal One, June to July 2010.Contract assignment at Swedish A
merican Hospital reviewing employee health records to meet Joint Commission stan
dards.
Nurse Reviewer, Clinical One, 03/2010 to 06/2010. Contract assignment collectin
g HEDIS data from physician offices, scanning files, and downloading. Audit inv
olved Aetna members.
Nurse Reviewer, Managed Care Staffers, Park Ridge, IL. 03/09 to 9/09. Tempor
ary position at a Chicago health network PHO office facilitating transfer of pat
ients to network facilities when members were outside their network. Required w
orking knowledge of Blue Cross of Illinois, Humana, Unicare and Family Health Ne
twork HMO plans.
Nurse Reviewer, American Imaging Management, Westchester, IL. 07/06 to 02/09.Rev
iewed imaging studies including CT scans, MRI scans, PET scans, and cardiac nucl
ear studies for various Blue Cross health plans in Illinois, Texas, Michigan, Ge
orgia and the Eastern Seaboard, following the health plan
or AIM guidelines.
Concurrent Review Nurse, Unicare Health Plan, Chicago, IL.10/04 to 01/05, 06/05
to 12/05
Reviewed individual and small group plan PPO hospital stays using Milliman crite
ria. Review was for both concurrent and retrospective hospital stays.
Concurrent Review Nurse 01/04 to 09/04.Through local agencies I had short-term a
ssignments performing concurrent and retrospective review for a large urban hosp
ital and a suburban PHO.
Hospice Nurse, Hospice Partners, Hillside, IL. 04/03 to 12/03. Provided hospice
care to terminally ill patients in private or nursing home settings. Care incl
uded pain assessment and management, symptom control, psychosocial support, and
education related to the dying process.
.
Home Health nurse, American Home Care, Aurora, IL. 11/02 to 02/03. Provided hom
e health care for a 17-year old male with muscular dystrophy, including daily as
sessment, hygiene, feeding, medication, suctioning, transfers, and ventilator mo
nitoring.
Care Reviewer Nurse Staffers, Skokie, IL. 11/01 to 10/02. Reviewed physical the
rapy and chiropractic services for medical necessity, certified DME, home health
, negotiated rates for equipment and services, and pre-screened candidates for l
arge case management.
Pre-cert Nurse, Cigna Health Services, Chicago, IL. 07/00 to 11/01.Processed ref
errals for specialist services, out-of-network services, surgeries, orthotics, p
rosthetics, home health, chiropractic and physical
therapy, DME, and coordinated benefits for HMO patients in four areas of the Mid
west.
Referral Nurse, Accord Health Plan, Westmont, IL. 08/99 to 06/00. Processed refe
rrals, reviewed surgical cases, hospital stays, approved home health, DME, and o
ther ancillary services, and coordinated benefits for five HMO products for Chic
ago area PHOs.
Pre-cert Nurse, Managed Care Staffers, Park Ridge, IL. 10/98 to 06/99.Served as
referral coordinator for PHO office that included processing referrals to specia
lists, pre-certifying surgeries and outpatient tests
using InterQual criteria, approving DME and other ancillary services.
Utilization Review, Methodist Hospital, Chicago, IL. 07/95 to 06/98. Reviewed ch
arts for admission or continued stay, and performed retrospectivereviews as need
ed for Medicare and privately insured patients. Communicated with managed care
organizations to provide clinical information for inpatient stay approval and di
scharge planning.
Case Manager, United Behavioral Systems, Itasca, IL. 02/93 to 09/94.
Reviewed inpatient and outpatient admissions for medical necessity, performed co
ncurrent review, reviewed outpatient treatment plans from providers, explored al
ternate levels of care, and monitored health benefits for HMO clients to ensure
optimum behavioral health care.
Charge Nurse, Charter Barclay Hospital, Chicago, IL. 04/92 to 02/93.Completed ad
mission assessments, administered medications, facilitated. psychosocial groups,
provided assistance restraining aggressive or agitated patients, developed and
revised treatment plans, and communicated with multidisciplinary team members to
provide adequate discharge planning and follow-up care.
Mental Health Coordinator, Health Chicago, Lisle, IL. 03/90 to 11/90. Provided
HMO members with referrals to inpatient and outpatient levels of care, reviewed
treatment plans, monitored inpatient hospitalizations to ensure appropriate inte
nsity of services, and monitored utilization of health benefits.
Staff Nurse, Alcoholism Treatment Center, Winfield, IL. 05/88 to 05/89.Complete
d admission assessments, gave medication, facilitated psychosocial groups, devel
oped care plans, monitored behavior, provided disease education to families, and
provided interventions based on 12 Step principles.
Staff nurse, Illinois State Psychiatric Institute, Chicago, IL. 11/86 to 05/87.
Completed admission assessments, gave medication, managed aggressive or psychot
ic patients, maintained a safe milieu, and developed treatment plans.
Staff Nurse, Chicago Lakeshore Hospital, Chicago, IL. 12/85 to 10/86 Performed
assessments, managed aggressive patients, facilitated groups, developed treatmen
t plans, gave medication, and participated in
multi-disciplinary staffing.
Staff Nurse, Elgin Mental Health Center, Elgin, IL. 11/83 to 11/85. Completed ad
mission assessments, administered medication, restrained aggressive patients, pr
ovided a secure milieu.
Education: B.A. English Education, University of Illinois, Urbana.
A.A.S. Nursing, College of DuPage, Glen Ellyn, IL.