SUSAN M.

KARLSEN, RN, CCM

996 GREEN POND ROAD, NEWFOUNDLAND, NJ 07435
HOME: (973) 697-2657 * E-MAIL: sk39d6ce@westpost.net
SUMMARY OF QUALIFICATIONS:
* Certified Case Manager; solid experience with all types of disability, auto li
ability and worker's compensation.
* Diverse clinical background includes hospice care, rehabilitation, home health
care and acute care settings.
* Proven record in obtaining high quality care outcomes and implementing medical
cost control programs.
* Diligently analyze medical documentation in order to make determinations of el
igibility for benefits.
PROFESSIONAL EXPERIENCE:
Hospice of New Jersey, Bloomfield, NJ
Staff Nurse - Hospice Services 12/05 - 4/08
* Assessed and met palliative, educational and supportive care needs of terminal
ly ill patients and their families.
* Coordinated home services with DME suppliers, pharmacists and community resour
ces for continuity of care.
* Supervised, oriented and provided on-site training of HHA's; focused education
on pain assessment, comfort, safety, grooming, wound, ostomy, decubitus care, m
aintaining skin integrity and accurate reporting.
* Played a key role in pain management; collaborated with physicians to ensure e
fficacy of drug choices.
* Provided grief counseling and support to families; encouraged follow-up with p
astoral and social services.
Total Claims Review & Management, Inc., Montclair, NJ
Acute Care Case Manager 2005
* Conducted concurrent reviews of medical claims for union local members and the
ir families.
* Pre-determined appropriateness for acute care/ surgical procedures and granted
approvals.
* Reviewed medical records in the appeal and dispute process.
JEC Disability Management (formerly Med-One Case Management, Inc.), Valhalla, NY
Field Case Manager 2003 - 2004
* Contracted by major insurance companies to review worker's compensation and no
-fault claims.
* Managed a caseload between 25-35 claims; opened new cases and followed them th
rough to final settlement.
* Interviewed physicians and claimants; insured adherence to the treatment plan,
thus reducing work loss time.
* Worked closely with adjusters; reported misuse of resources and potential frau
d for further investigation.
Hospice of New Jersey, Bloomfield, NJ
Hospice Case Manager 2001 - 2002
* Made initial visit to patient homes/ long term care facilities to assess appro
priateness for hospice admission.
* Performed detailed evaluation of social, family, environmental and safety fact
ors.
* Collaborated with physicians and other professionals to insure continuity of t
reatment planning.
* Orchestrated and mobilized resources, including home care agency services, hom
e health aides, medications, DME supplies, respiratory and other therapies to en
sure quality care management.
National Healthcare Resources, Inc., Woodbridge, NJ
Field Rehabilitation Manager 1999 - 2001
* Conducted field visits to review worker's compensation and auto liability clai
ms.
* Role entailed aggressive negotiation of vendor prices and early return to work
targets.
Pinnacle Health Enterprises, Clifton, NJ
Acute Care Case Manager 1998 - 1999
* Telephonic review of acute care services for group members of HIP NJ and Blue
Cross HMO.
* Educated consumers regarding policy coverage and enforced strict adherence to
benefit limits.

SUSAN M. KARLSEN, RN, CCM ~2~

PROFESSIONAL EXPERIENCE: (cont'd)
AIG Claims Services, Parsippany, NJ
Telephonic Case Manager 1997 - 1998
* High volume review of compensation claims for acute care and catastrophic illn
ess in the non-directed states of New York, Pennsylvania and Illinois.
NYNEX Absence Benefit Center, White Plains, NY
Telephonic Case Manager 1996 - 1997
* Reviewed short-term disability cases and tracked medical absence cases involvi
ng NYNEX employees.
* Knowledge of evidence-based Official Disability Guidelines (ODG).
* Analyzed histories and patterns of absence; reviewed medical documentation sub
stantiating illness and injuries.
Med-One Management, Inc., Valhalla, NY
Field Case Manager 1992 - 1996
* Contracted by NYS Dept. of Labor and various insurers to review worker's compe
nsation and no-fault claims.
* Negotiated vendor prices for durable equipment, all therapies, home care and o
ther approved services.
* Same duties as described under JEC Disability Management, the company's curren
t name.
Worldwide Rehabilitation, Inc., Lansdale, PA
Field Rehabilitation Case Manager 1991 - 1992
Morris Home Care, Morristown, NJ
Alliance Nursing Services, Morristown, NJ
Home Health Care Nurse 1988 - 1992
* Skilled care visits included IV therapy, wound care, ventilator management and
general health maintenance.
Riverside Hospital, Boonton, NJ
Staff Nurse - Telemetry Unit 1981 - 1986
EDUCATION:
County College of Morris, Randolph, NJ Degree: June 1981
Associate in Applied Science - Nursing
LICENSURE/ CERTIFICATES:
* New Jersey State Registered Professional Nurse
* Certified Case Manager, Commission for Case Manager Certification (1997-Presen
t)
COMMUNITY ACTIVITIES:
* Health Education/ Health Screening Coordinator, Holy Trinity Lutheran Church,
Rockaway, NJ (2003-Present)
* Member, Social & Health Ministry, Holy Trinity Lutheran Church, Rockaway, NJ (
2003-Present)
ADDITIONAL SKILLS:
* Windows XP/ VISTA, MS Word, Internet Explorer, Outlook Express; Reed Medical D
isability Adviser.