Nursing and medical case management expert witness and has more than 40 years of experience in medical assessment, coordination of care, cost containment of medical care, payment sources, critical care delivery and supervision, nursing and paramedic education, hospital department administration, risk management, quality assurance, and major medical and workers’ compensation case management. Her background includes provider bill auditing, retrospective appeals of Medi-Cal and other payment denials, telephonic case management, early intervention medical case management, utilization review, discharge planning, quality improvement, and critical care supervision. She holds an R.N. designation and a B.A. in Healthcare Administration, with nursing education completed through a hospital-based nursing program. Her professional background also includes inactive CCM, CPDM, and WCCP certifications.

She has performed case management activities for senior and commercial members, reviewed requests for referrals with medical directors and committees, managed quality improvement activities, and helped assure compliance with health plan requirements. Her workers’ compensation experience includes medical chart review, bill audits, negotiated settlements with providers, claims analysis, assessment and coordination of cost-effective medical care, and return-to-work coordination for injured workers. She has also trained, mentored, and managed professional staff, worked with employer and client protocols, and participated in quality assurance projects designed to evaluate and streamline telephonic case management performance. Her hospital-based experience includes utilization review, discharge planning, risk management, quality assurance, continuity-of-care planning, post-discharge services, facility transfers, and coordination with physicians, patients, family members, outside agencies, and facilities. She has also worked in critical care supervision and coronary care consulting. Her experience supports evaluation of care coordination, utilization review, medical billing disputes, payment denial appeals, cost containment, discharge planning, risk management, quality assurance, and nursing standards of care.