Denise Cree

I am genuinely passionate about continuous learning because I believe Healthcare needs individuals that look for new and innovative ways to serve the community. 

Manager, Case Management Dept.  Inova Fairfax Medical Center, Falls Church, VA |May 2023– Current 

My role involves leading a team of case managers, social workers, and support staff to ensure compliance with regulatory requirements, improve patient outcomes, and enhance care coordination. I ensure strong collaboration with clinical teams, physicians, and external partners to optimize patient flow, reduce length of stay, and manage readmissions

Developed training documents and trained Inova Fairfax Case Management Department in Insurance Authorization SNF submission. 

• Initiated the use of “TEAMS” within the department bullet point here. Trained Staff on submitting tasks via “TEAMS” for weekend handoff. 
• Created and maintained a safe and growth mindset with the entire case management department. here. Offering support and education to all staff asking for help without hesitation. 
• Maintained 100% retention of all direct support staff. 

Travel Case Manager, Host HealthCare, San Diego CA July 2022 – April 2023

Inova Fairfax hospital and Del Sol Medical Center in El Paso Tx, respectively.  

My duties required assessing the patient’s needs post-discharge and arrange appropriate services such as home health care, rehabilitation, or long-term care, ensuring a smooth transition from the hospital to the next care setting. I worked with insurance companies to confirm coverage, handle authorizations, and resolve potential issues related to the patient’s care and length of stay.

• Responsible for daily discharge planning in assigned area, Observation, Step-down, ICU, Stroke, Oncology and NICU, Med-surg, Cardiac, and Comprehensive. 
• Effectively completed InterQual utilization reviews and second level reviews at Del Sol Medical Center. 
• Collaborated with providers on all “Observation” patients reaching 30 hours or more to assist in removing discharge barriers. 

Inpatient Case Manager, Pittsburgh PA |2021– 2022

Evaluate and optimize the use of hospital resources, ensuring that care is provided in a cost-effective manner while maintaining high standards of care. Advocated for patients and their families, ensuring they understand the care plan, treatment options, and next steps after discharge Participated in daily multidisciplinary rounds to ensure patient care aligns with hospital policies, governmental regulations, and accreditation standards.

• Proficient in discharge planning and understanding and researching community resources. 
• Expert knowledge of healthcare regulations, insurance processes and utilization review. 
• Ability to work with diverse patient populations and healthcare teams. 

Complex Case Manager, Highmark Inc, Pittsburgh PA |2015– 2022  

 Responsible for managing and coordinating care for members with complex medical needs, often involving multiple chronic conditions or high-risk situations. My role involved in managing the top 1% spend on national commercial plans and all commercial plan LTACH requests. Managing over 100 accounts monthly, assessing the member’s needs, developing personalized care plans, and working closely with healthcare providers to ensure that members receive appropriate, timely, and cost-effective care. The Complex Case Manager also serves as an advocate for members, helping them navigate the healthcare system and insurance benefits.

• Trained multiple case managers around the organization footprint and area of concentration. 
• Collaborated with insurance utilization nurse to develop an efficient and quality discharge plan. 
• Worked with multiple patient populations, high-cost NICU, Adult Trauma, Complex cancer patients, LTACH referrals, and patients requiring high-cost medication management.

Hospice Care Transition Coordinator, Amedisys, Morgantown WV| 2014-2015

As the transition coordinator for hospice care services I met with terminally ill patients, ensuring compassionate and high-quality end-of-life care. My role involved working closely with patients, their families, healthcare providers, and hospice staff. As the coordinator for multiple care sites, I also ensured that all hospice services are delivered in compliance with state and federal regulations, hospice policies, and patient care standards.

• Met with patients in the hospital setting, provided hospice philosophy education and coordinated the discharged to home.
• Collaborated with local hospital leadership and implemented the first GIP program at the facility. 
• Increased hospice admission volumes and supported the local hospital in decreasing readmissions. 
• Built a strong relationship with Hospitalist group in the local hospital and promptly supported requests to meet both the hospital and patient needs. 
• Created a supportive relationship with bedside staff and set up all hospice transportation, acquired all necessary documentation and communicated all updates to family and bedside staff. 

RN to MSN in Nursing Leadership, University of Phoenix 

RN Washington Hospital School of Nursing

B.A. Communication/Public Relations, California University of PA