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USHA VILLARREAL

Usha Villarreal
Certified Legal Nurse Consultant RN
Mission Viejo, CA
Email: spk@mindsource.org

Expertise - Key Words:

Highly experienced Certified Legal Nurse Consultant RN, with a unique background in Clinical and Administrative aspects of :

Home Health Care- Pediatrics and Geriatrics
Infusion therapy, Durable Medical equipment.

Adult and Pediatric Sleep Apnea

Medicare, Medi-cal and Managed Care

Quality Assurance, Utilization Review, Policies and Procedures

Extensive work in Pediatric/Neonatal / Labor and Delivery

Curriculum Vitae

SUMMARY OF QUALIFICATIONS

Highly experienced Certified Legal Nurse Consultant RN with a unique background in Clinical and Administrative aspects of :

Home Health Care- Pediatrics and Geriatrics

Infusion therapy, Durable Medical equipment.

Adult and Pediatric Sleep Apnea

Medicare, Medi-cal and Managed Care

Quality Assurance, Utilization Review, Policies and Procedures

Extensive work in Pediatric/Neonatal / Labor and Delivery

PROFESSIONAL BACKGROUND

4\99- LEGAL NURSE CONSULTING

Obtained Certification as Legal Nurse Consultant through The Medical- Legal Institute, Inc.’s National Certification Process

Providing Consulting Services on medical-related cases, screening cases, review and analysis of medical records, telephone consultation, case presentation for Attorneys, interviews with clients, depositions, attend independent medical examinations.

Types of Cases consulted on:

Wrongful Death

Heart Surgery

CABB foreign body left in lung

Lumbar Puncture procedure performed in the ER caused Brain Herniation

Neonatal Burns

Pain Suffering Post Car Accidents

Reflex Sympathetic Dystrophy Syndrome

Hernia Surgery Malpractice

Shoulder Dystocia delivery with damage to baby

Hellicocbacter Pylori misdiagnosed - Dental malpractice - HMO refusal of care issue- Product Liability - Damage to Spinal Nerve - Breech Delivery Injury

Attended IME’s

Locate Experts

4/99- Present- Elder Care Nurse Consultant- A professional service available for the geriatric client and their families. My services specialize in assisting the geriatric client with Living arrangements, Medical needs, Home Health Care, Medical Equipment needs, Pharmacy needs. After performing an evaluation assessment an appropriate care plan is recommended to the client and or family. I screen, arrange, and monitor in- home services Act as a liaison between clients and families. I assist the client in recognizing and defining their needs and then work towards creatively matching the clients needs with the best available resources available. I ensure that needed care and services are provided in a respectful and timely manner, promote a response to clients needs from other organizations. Maintain accurate clients records.

2/89- 4/99- Administrator/ Director of Patient Care Services

Founded ABC Childrens Home Care and ABC Home Care Specialists. Employed as Administrator full-time and also Program flexed under Title 22 by Orange County DHS to act as Director of Patient Care Services and filled in as Clinical Nurse Supervisor when needed.

ABC's objective was to manage and provide care, in the home, for both pediatric and adult patients in need of care after hospitalization. Also founded ABC Home Care Specialists for home infusion therapy and durable medical equipment. ABC provided skilled nursing, durable medical equipment and pharmaceuticals for the patients post hospitalization.

Administrator Responsibilities- Overall legal responsibility and authority for the operation of the Home Health Agency. Maintained compliance with Federal, State, and local laws and regulations, disclosure and ownership information and accepted professional standards and principals. Accomplished JCAHO Accreditation for ABC services, maintained ongoing accreditation. Responsible for organization, services furnished, administrative control, and lines of authority for delegation of responsibility down to the patient care level. Arranged for professional advice as required, adopted and periodically reviewed written by-laws or the excepted equivalent, and oversaw the management and fiscal affairs of the agency. Organized and directed the agency’s ongoing functions, maintained ongoing liaison among the governing body, the Professional Advisory Committee, Quality Assurance Committee, Utilization Review Committee and the Clinical Staff, overall responsibility to employ qualified personnel and ensure adequate staff education and evaluations; ensured the accuracy of public information materials and activities; and implemented an effective budgeting and accounting system.

Present at all unannounced Department of Health Services/ Medicare Surveys onsite and at the patient’s home, responsible for all communication with plans of correction and follow when necessary. Assumed twenty four hour back-up call for clinical and administrative issues.

Responsible for securing HMO/PPO contracts for ABC, developed relationships HMO/PPO referral staff by providing free educational in-services. Overall responsible for the Agency PR and Business Development. Negotiated a NICU Sleep Lab Contract with QVH to perform 13-22 channel sleep studies, ABR’s for the high risk neonate. Responsible for purchasing sleep lab equipment, hiring and training staff and attending NICU grand rounds every week.

Developed and implemented Pediatric Home Phototherapy Program, Early Discharge Preemie Program and Pediatric Hospice Care at Home.

Director of Patient Care Services responsibilities- Responsibly for quality and safe delivery of Home Health Care Services. Responsible for coordination and provision of Home Health Care Services that reflected the Home Health Care Agency’s philosophy and Standards of Home Health Care. Developed, documented, and implement home health care agency policies and procedures reflect quality and safe delivery of Home Health Care Services. Developed and implemented nursing standards and evaluated on an annual basis. Developed Client Plans of care, implemented and evaluated every sixty days after case conferencing with field staff and patients MD. Responsible for Home Health Care Staff member nursing practice in the field, made unannounced field visits to review standard of care being delivered to patients in their homes. Reviewed patient records every sixty days for quality of care and medical necessity prior to billing for care. Conducted patient care conferences on a weekly basis. Assessed clients when necessary for appropriateness of Home Health Services. Documented Staff job performances for sixty day and annual reviews. Responsible for staff educational programs including a monthly inservice to staff. Responsible for development patient, patient family and community education, participated with field staff in blood pressure clinics at local senior and residential care facilities. Responsible for maintaining compliance with Title 22 ( State Regulations), Medicare and Medi-cal, JCAHO, MSDS and other applicable regulations.

Responsible for interviewing, hiring, orientating field and office staff and counseling when necessary. Supervisory visits conducted for supervision of home health aides. On-call back to the Clinical Nurse Supervisor. Responsible for all MD telephone orders regarding changes in patient care, lab results received reviewed and reported to patients MD coordinated changes in medications via communication with pharmacist. Coordinated patient equipment needs, telephone communication regarding authorization from HMO for continued services. Responsible for ADR review prior to submission to Medicare Blue Cross. Other duties as necessary

2/96-8/98 RN Nurse Consultant/ Home Health Care.

Founded Allied Home Health Consultants Inc., a California Corporation.

Functioned as a RN consultant to Home Health Agencies outside the State of California.

Consulting project experiences include:

Adding a quality Managed Care Pediatric Home Care program to an existing home health agency in Dallas, Texas.

Implemented a psychiatric Home Care program for a Dallas based Home Health Agency.

Assisted a home health agency to acquire JCAHO accreditation status in New Orleans. Restructured, orientated, developed and implemented a Quality Assurance program for a company in Baton Rouge. Worked with the Agency and the Fiscal Intermediary to get the Agency off 100% Focused Medical Review, project completed over a one year project. Focused review project entailed detailed review of Medical records, nursing standards of care, utilization of services retrospect, concurrent and prospective. Educator to Casemanagers and Management staff. Developed and implemented Medicare billing audit tools to avoid billing errors.

2/88-2/89 STAFF NURSE/CHARGE NURSE

Neonatal Intensive Care Unit Level III, Saddleback Hospital, Mission Viejo, California Worked with this first team nurses when the hospital opened the Women’s Center Assisted with setting up the unit, stocking meds, supplies, implementing policies and procedures.

Staff Nurse/Charge Nurse on a rotating basis as per schedule. Set up and managed apnea program and pulmonary follow-up for Dr. Cunningham . Entailed setting up appointments an discharged babies with pulmonary problems, evaluated and coordinated home care needs and services, implemented educational programs and served as resource person for discharged families until they were seen in the Pulmonary Apnea Clinic.

2/88-2/89 Childrens Hospital of Orange County Home Health Department.

Completed two weeks of intensive orientation, then one year providing direct patient care to the homebound child, focusing on developmental needs and family education.

2/86-2/87 REGISTERED NURSE/PART TIME REGISTRY

Medical help, Dannebergs Kids Kare Home Health Agency, Orange, California Medical help to other facilities as staff worked NICU, PICU and Pediatrics. Dannebergs Kids Kare Neonatal and Pediatric home shift care for BDP, congenital abnormalities, multiple births, renal patients, and ventilator-dependent patients. One complete year with Kids Kare.

2/86-12/87 STAFF NURSE/ROTATING CHARGE NURSE

Neonatal Intensive Care Unit Level III, UCI Medical Center, Orange, California Staff Nurse/Rotating Charge Nurse as determined by schedule in Neonatal Intensive Care Unit Level III. Extremely busy 40-bed capacity with a petite suite for low weight preemies. Also responsible to cover LDRP for trauma births and C-Sections. Part of UCIMC transport team and discharge planning of infants. Primary nursing practiced.

7/85-2-86 STAFF NURSE/CHARGE NURSE

Neonatal Intensive Care Unit, Garfield Medical Center, Los Angeles, California staff

Responsible for coordinating other members and was present at deliveries for resuscitation and transports. On a part-time basis available to evaluate and help coordinate home care needs for babies near discharge, to provide a smooth transition from the hospital to home. Also required to work with Utilization Review Nurses and physicians on an on-going basis.

8/84-4/85 CHARGE NURSE

Level III Unit, Dhahran Medical Center, Saudi Arabia.

Responsible for management of the unit and directed the staff nurses toward optimal neonatal care. Role included being present at deliveries to resuscitate infant as necessary. Also responsible for transport team for both neonatal and pediatrics. Coordinated and personally transported several neonatal and pediatric patients by air to King Fiscal Hospital in Rriad, Saudi Arabia.

6/83-7/84 STAFF NURSE/MIDWIFE

Neonatal Intensive Care Unit Level III

Successfully completed neonatal certification. After certification, was charge nurse on night shift for a 30-bed Level III Neonatal Intensive Care Unit.

2/83-6/83 STATE CERTIFIED MIDWIFE

Derby City Hospital, Derby, England

Practiced as a State Certified Midwife at Derby City Hospital. Delivered 56 babies successfully.

1/82-2/83 STUDENT MIDWIFE

Derby City Hospital, Derby, England

Intensive course to become certified as a State Certified Midwife. Training involved completing 20 births supervised by a State Certified Midwife and 3 months of community training delivering in the home, newborn assessments and jaundice therapy. Final examination included two days of written testing and then an oral examination in front of the physician who scored the test.

6/81-12/81 STAFF NURSE

Neuro-Surgical Ward, Derbyshire royal Infirmary, Derby, England

Staff Nurse at the Neuro-Surgical Ward. Busy 40-bed ward.

EDUCATIONAL BACKGROUND

1985 Registered Nurse (California)

1999 Certified Legal Nurse Consultant

1981 State Registered Nurse (England)

1982 Neonatal Intensive Care Certified (England)

1983 State Certified Midwife (England)

CREDENTIALS

Registered Nurse in the State of California-Active

Completed the Medical-Legal Consulting Institute, Inc.’s National Certification and Successfully obtained Certification.

Member of CAHSAH (California Association of Health Services at Home)

Member of Health Professionals in Sales of Southern California (1991)

Accredited by the Joint Commission on Accreditation of Healthcare Organizations

CONTINUING EDUCATION

Ethical Conflicts in Legal Nurse Consulting

Report Writing for the Legal Nurse Consultant

Strengthening the voice of Women

Future Trends in Products Liability Cases

Lopez, Hodes, Restaino, Milman & Skikos

Medical- Legal Nurse Consulting Certification

Medicare fraud and abuse/ Corporate Compliance Plan

Oasis implementation

Stress Management

Quality Assessment and Quality Improvement

Changes in Health Care, Case Management

Medicare fraud and Abuse Laws

Ten Steps to a Profitable Hospice

Home Health Standards and Documentation

PROFESSIONAL ORGANIZATIONS

Orange County Chapter of Legal Nurse Consultants/ Secretary Board Member.

Member of Medical Legal Institue/ Certified Nurse Consultants.

CASAH- California Association of Services at Home

NAHC- National Association of Home Health Care

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