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GRACE A. KOCH BSN, RN, CPDM, CCMPO Box 2098, Corvallis, OR 97339P 541-753-1524 , F 541-738-0524

STATEMENT OF QUALIFICATIONS

Experienced health care professional with extensive and progressive experience in utilization review, regulatory requirements, auditing and analysis of employergroup health plans, quality assurance, workers' compensation, personal injury,insurance claim reviews, documentation and advocacy process; medical/legal educator.

PROFESSIONAL EXPERIENCE

GRACE A. KOCH RN, CONSULTING, Corvallis, Oregon.Regional healthcare consulting firm specializing in clinical audit review to facilitate health plan beneficiary advocacy programs and stratagems for profit recovery.Medical Consultant, 2007-Current* Manage Oregon DHS TANF/Temporary Assistance for Needy Families and SSP/Self Sufficiency Program clients whose medical issues may hinder their ability to be employed and self sufficient, for Lincoln and Benton Counties.* Communicate with medical professional providers to help identify the validityof the client's medical condition, as well as provide clarification for DHS cas

e managers to facilitate the appropriate recommendations for services to aid theclient in becoming self-sufficient.* Trained Leader: Stanford Chronic Disease Self-Management Program.

SAMARITAN HEALTH PLANS, Corvallis, Oregon.A state licensed regional Third Party Administrator insurance company with fourspecialized plans which include Medicare and Medicaid serving 250,000 people in3 counties and employing 100.Utilization Review RN, 2006-2007* Perform prospective and retrospective reviews utilizing McKesson/Interqual Acute Care Criterion for Inpatient Admissions, Imaging and other Procedures, all plans as appropriate andmake decisions for acceptance or referral for Physician Review.

* Perform Utilization Review for specialized health plans for Home Health, Skilled Nursing, Intermediate Care Facility Therapies, Occupational Therapy and Physical Therapy benefit requests in a like manner.* Initiated advocacy process on behalf of infant member requiring compounded cardiac medication which resulted in a company policy change to provide safe discharge, improved services, integrated care, and contain costs.* Facilitate and promote Education, Quality and Performance Improvement Programs.* Participate as part of the Managed Care Team.

MERCY MEDICAL CENTER, Roseburg, Oregon.Community based medical center with a 174 bed capacity, owned by the Catholic Health Initiatives focusing on well health care and community outreach employing 1

,000 people.Clinical DRG Management Specialist, 2005-2006* Planned, and Implement DRG Management.* Performed prospective reviews utilizing McKesson/Interqual Acute Care Criterion for patient admission, and retrospective reviews for appellate purposes.* Data established empirical justification for establishment of a new hospitalunit for Clinical Decision/Observation Status.* Facilitate and promote the work of the Utilization Management Team.* Participate as part of the Clinical Strategy Team & Decision Support Group.

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OREGON PATIENT SAFETY COMMISSION, Portland, Oregon.Semi-independent state agency charged with improving patient safety by reducingthe risk of adverse events occurring in Oregon's health care system and by encouraging a culture of patient safety in Oregon.Researcher, 2004-2005* Provide research as asked for the Principal Contributor and Commissioners.

WMCI PRIME EVALUATIONS, Portland, Oregon.Privately owned medical consulting firm founded in 1985 which offers physical examination services for insurance companies in Oregon with offices in Portland, Salem, Eugene, Grants Pass, and the states of Washington, Arizona, Colorado and Utah with annual sales of $500,000-$999,000, and employing 57 people.Quality Assurance Program Supervisor & Legal Nurse Consultant, 2001-2002* Supervised specialists in Medical Records and Quality Assurance Departments,concurrently performing Legal Nurse Review for attorney clients.* Aided physicians to identify issues of concern under Medicare, ADA, FMLA, long and short term disability, workers' compensation and other employer group health plans.* Planned and implemented improved Quality Assurance procedures which stratagems reduced addendum reports, administrative costs and a decrease in product turnaround time to the client.

CAMBRIDGE MANAGED CARE, Genex, Kemper, Portland, Oregon.Major national healthcare organizations utilizing registered nurses to facilitat

e recommended treatment plans to assure appropriate care is provided to disabled, ill, or injured individuals.Case Management Nurse, 1996-2001* Coordinated medical care services to disabled individuals under Medicare, ADA, FMLA, workers' compensation, group health, long & short term disability and other employer benefit plans.* Identify gaps in the standard of care in regard to issues related to documentation, necessity of treatment, negotiating contracts, resulting in improved patient safety, medical services and client satisfaction.* Facilitated employer return to work programs using creative disability case management case specific techniques to contain indemnity and medical costs. Maintained 108% production with lower per case costs.* Achieved Kemper's highest corporate rating for field case management.

AMERICAN INTERNATIONAL GROUP, Portland, Oregon.A world leader in insurance and financial services with operations in 130 countries serving commercial, institutional, and individual customers in life, property and casualty insurance, title and mortgage networks.Divisional Legal Nurse Consultant, 1993-1996* Provided written analysis of complex medical-related insurance claims issuesencompassing appropriateness of treatment, injury causation, missing records, medical malpractice, product liability, disease or treatment process research, andtoxic tort.* Reviewed complex medical claims using innovative Legal Nurse Processes and providing written recommendations for further investigation and case resolution and resulted in defense counsels' ability to use clinical analysis as part of tria

l preparation.* Created medical-legal educational programs using knowledge of adult learningneeds. Achieved accreditation from the Oregon Bar, NARPPS, and the Recertification Program for Claims Examiners for Oregon and featured by the CEO in the newsletter, "AIG Claims Chronicle."

RELIANCE/UNITED PACIFIC INSURANCE COMPANY, Portland, Oregon.Major national property and casualty insurance operation with developing subsidiaries in real estate and international group subsidiaries in energy, environmentand natural resources consulting.

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Senior Claims Representative, Workers' Compensation., 1986-1991* Processed claims from inception to conclusion including Board's Own Motion.* Utilized nursing knowledge of disease processes in processing claims resulting in lower litigation incidence, reduced claim indemnity, medical and legal costs.

Clinical Nurse, 1976-1993* Relief Charge Nurse, Team Leader, and Residential Manager.* Clinical Areas: Includes Acute Care, Ortho/Neuro, Med/Surg, and Community Health.

EDUCATION

BSN/Oregon Health Sciences Center,1976, Portland, ORCCM/ Commission for Case Manager Certification, Portland, Oregon 2002.CPDM/ Insurance Education Association, Portland, Oregon 1999.

MEMBERAmerican Society for Healthcare Risk ManagementOregon Society for Healthcare Risk ManagementAmerican Association of Legal Nurse ConsultantsOregon Nurses AssociationOregon Medical Case Manager's GroupCase Management Society of America