PROFESSIONAL EXPERIENCES

Certified Nurse Life Care Planner
Certified Legal Nurse Consultant
Licensed Registered Nurse
Coordinator – Clinical Resource Management
Manager – Physician Peer Review
Coordinator – Quality Assurance/Quality and Resource Management
Coordinator – Utilization Review and Quality Assurance
Director, Patient Care Services
Head Nurse Level II Nursery
Assistant Manager – Birthing Unit
Staff Nurse ll – Labor and Delivery, Ante-partum, Post-partum, Nursery, NICU

 

 NURSING EXPERIENCES

 

Reviewed and entered all Acute Myocardial Infarction (AMI) Data into National Core Studies Program, Joint Commission on Accreditation of Healthcare Organizations, and National Medicare Program for Major Medical Center

 

Participated in Congestive Heart Failure (CHF), Pneumonia, Surgical Infection, and Cesarean Section data collection for National Core Studies Program, Joint Commission on Accreditation of Healthcare Organizations, and National Medicare Program for Major Medical Center

 

Performed Physician Peer Review and Quality Assurance duties for Obstetrics and Gynecology, Pediatric, Surgery, Psychiatric, Emergency, Radiology, and Medicine Departments of Major Medical Center

 

Established and Implemented Physician Peer Review Program to interface with Physician Credentialing for all departments of a Major Medical Center

 

Conducted extensive Chart Review for Standards of Care, Policy and Procedures, Sentinel Events, and Compliance for all departments of a Major Medical Center

 

Developed and Implemented Utilization Review and Quality Assurance Program for Health Maintenance Organization (HMO) and Independent Physician Association (IPA)

 

Developed Medical Appropriateness Guidelines Manual and Policy and Procedure Manual for HMO/IPA

 

Responsible for Single Source Contract for Home Health Care, Home IV Therapy, and Durable Medical Equipment for HMO/IPA

 

Case Management of Catastrophic, High Cost, and Long Term Care situations for National Insurance Company and HMO/IPA

 

Interpretation of Benefits/Claims Adjudication for National Insurance Company and HMO/IPA

 

Developed and Implemented Policy and Procedure Manual for Level ll Nursery of new Home Birthing Unit

 

Participated in development and implementation of Policy and Procedure Manual for Labor and Delivery, Ante-partum and Post-partum units of new Home Birthing Unit

 

Patient Care in all areas of Labor and Delivery, Ante-partum, Post-partum, Well-Baby Nursery and Neonatal Intensive Care Units

 

 

SKILLS AND PROFICIENCIES

·     Fetal Heart Tracing Interpretation for “Bad Baby” Litigation
·     Computer literate – Outlook, Microsoft Word, Internet Research
·     Medical Record Data Collection and Interpretation
·     Hospital, Health Care, and Insurance Ethics
·     Life Care Planning
·     Life Care Plan Critique and Rebuttal
·     Medicare Set-Asides
·     caMRSA and haMRSA course work

 

SPECIAL CERTIFICATES AND LICENSES

Registered Nurse – California - License #905454 – Active
Certified Legal Nurse Consultant
Certified Nurse Life Care Planner

PROFESSIONAL MEMBERSHIPS

American Association of Nurse Life Care Planners
American Association of Legal Nurse Consultants
National Alliance of Legal Nurse Consultants

 

PROFESSIONAL SUBSCRIPTIONS

Journal of Legal Nurse Consulting
The Medical-Legal News
Journal of Nurse Life Care Planning
ADVANCE for Nurses Magazine
Legal Nurse Consulting Ezine
NurseWeek Magazine

 

EDUCATION

 

NURSE LIFE CARE PLANNING
MEDICARE SET-ASIDES

Certification
Kelynco
Salt Lake City, Utah
8/2007

 

LEGAL NURSE CONSULTING

Certification
Vickie Milazzo Institute
Houston, Texas
3/2007

 

Merritt Hospital School of Nursing

Registered Nurse
Diploma Degree
Oakland, California
9/1976 – 6/1979

 

San Diego State University

Major: Health Sciences
San Diego, California
9/1974 – 6/1976

 

PROFESSIONAL EXPERIENCE

2007

CEO, KRISTEN JONES CONSULTING, LLC
ALAMO, CALIFORNIA
Certified Nurse Life Care Planning and Certified Legal Nurse Consulting
Life Care Planning and Legal Nurse Consulting Services, including Medical Case Screening for Merit, Comprehensive Medical Case Review, IME Attendance, Expert Witnessing, Life Care Planning and Life Care Plan Critique and Rebuttal.

 

1998 – 2007

COORDINATOR
CLINICAL RESOURCE MANAGEMENT
ALTA BATES SUMMIT MEDICAL CENTER
BERKELEY, CALIFORNIA
Reviewed the charts of all the patients with a diagnosis of Acute Myocardial Infarction (AMI) averaging 125 to 150 charts per month, 1500-2000 chart reviews per year.  Also reviewed the charts of patients diagnosed with Congestive Heart Failure (CHF), Pneumonia, Surgical Infections, and Caesarian Sections.  This data base, specific to the hospital, was then sent to the National Core Studies Program, the Joint Commission of Healthcare Organizations, and the National Medicare Program.  The data is used to compare outcomes, rate hospital compliance, and set standards at national levels.  On the hospital level, it indicates areas and systems needing performance improvement.   

 

1995-1997

MANAGER
PHYSICIAN PEER REVIEW
ALTA BATES MEDICAL CENTER
BERKELEY, CALIFORNIA
Developed a Peer Review system for all departments of Alta Bates Medical Center that provided the physicians with statistical feedback regarding performance.  It identified specific individual, departmental, and hospital indicators and then provided individual and departmental feedback, which was presented monthly to the Medical Director and CEO.  This system also interfaced with the Credentialing Department to provide data for Physician Recredentialing every 2 years.  The Peer Review System also investigated and documented situations with serious or egregious outcomes.  These situations happened in every department and needed thorough investigation.  Due to a very large Obstetrics department and large volume of maternity patients, Fetal Heart Tracing interpretation and knowledge of Labor and Delivery systems was essential to the investigation of “bad baby” cases.  Other specialized areas needing investigation provided intense, and often abrupt, learning experiences.

Participated in Alta Bates Medical Center Ethics Committee in Case Review and Evaluation. 

 

1991-1995

COORDINATOR
QUALITY ASSURANCE/QUALITY AND RESOURCE MANAGEMENT
ALTA BATES MEDICAL CENTER
BERKELEY, CALIFORNIA
Performed general quality assurance duties, reviewed charts, assisted at monthly departmental quality assurance meetings, supported department quality assurance chairmen.  The Quality Assurance System was outmoded and needed complete revision to the more advanced system soon to be required by the Joint Commission.  The QA Department also needed to interface with the Credentialing Department to decrease duplication of duties and provide data at recredentialing.  Indicator identification, surveillance methods for problem indicators, and all assessment systems inadequate.

  

1990-1991

COORDINATOR – UTILIZATION REVIEW AND QUALITY ASSURANCE
PACIFIC HEALTHCARE
PLEASANTON, CALIFORNIA
Established and implemented Utilization Review and Quality Assurance Program for a new Health Maintenance Organization (HMO) and Independent Physician Association (IPA).  Case management of catastrophic, high cost, and long term care situations.

Interpretation of benefits for claims adjudication.  Responsible for single source contract for Home Health Care, Home IV Therapy, and Durable Medical Equipment.

Established Medical Appropriateness Guidelines Manual, Policy and Procedure Manual, and Standards of Care Manual.

 

1989-1990

COORDINATOR – UTILIZATION REVIEW AND QUALITY ASSURANCE
CIGNA HEALTH PLAN
OAKLAND, CALIFORNIA
Case management for high cost, catastrophic, long-term, and HIV cases.  Provided interpretation of benefits for claims adjudication.  Renegotiated contracts for Home Health Care, Home IV Therapy, Durable Medical Equipment, and Prosthetics/Orthotics.  Subscriber and Provider teaching regarding HMO procedures.

 

1988-1989

DIRECTOR, PATIENT CARE SERVICES
MARTIN LUTHER KING JR. FAMILY HEALTH CENTER
RICHMOND, CALIFORNIA
State MediCal Program Clinic.  Responsible for all LVNs and Aids working in patient care areas.  In charge of Standards of Care, Policy and Procedure guidelines, and scheduling of LVNs and Aides.  Supervised Medical Record Department and MediCal/Medicare billing.  Troubleshooting problem interactions between MDs, PAs, nurses and patients.  Responsible for all Obstetrical Intake and inpatient hospital utilization. 

 

1985-1988

HEAD NURSE, LEVEL II NURSERY
ASSISTANT MANAGER, BIRTHING UNIT
PROVIDENCE HOSPITAL
OAKLAND, CALIFORNIA
Participated in starting a new Home Birthing Unit with Level ll Nursery at major hospital.  Developed and Implemented Policy and Procedure Manual for Level ll Nursery.  Responsible for all special equipment needed in Level ll Nursery and Birthing Suites.  Assisted with development and implementation of Policy and Procedure Manuals for Labor and Delivery, Ante-partum and Post-partum areas.  Registered Nurse duties in all areas.

 

1981-1985 

STAFF NURSE ll - BIRTHING UNIT
MARSHALL HOSPITAL
PLACERVILLE, CALIFORNIA
Registered Nurse duties in Labor and Delivery, Nursery and Post-partum units.

 

1979-1981

STAFF NURSE ll - NEONATAL INTENSIVE CARE UNIT
CHILDREN’S HOSPITAL MEDICAL CENTER
OAKLAND, CALIFORNIA
Registered Nurse duties in Neonatal Intensive Care Unit, working with very premature infants, compromised newborns, or newborns needing surgery.