SHONNA MACAULAY, RN, BSN, CCM

101 Shady Trail * San Antonio, TX 78232 * (210) 386-7593

sm611928@westpost.net
OBJECTIVE:
Position where my public relations and managed
care background can be effectively utilized to improve client services.
CORE COMPETENCIES
Team Building & Leadership * Client Relations & Retention *Training & Education
* Case Management * Utilization Review * Medical Auditing * Quality Improvemen
t * Compliance * Health Care Network Administration
JURISDICTIONAL
COMPLIANCE:
Wrote Barron Risk Management's utilization review plan and obtained certificatio
n with the Texas Department of Insurance. Was on the team that achieved certifi
cation of the SouthWest Medical Provider Network. Developed the initial draft t
o certify the San Antonio office to do utilization review for Texas workers' com
pensation networks. Managed complaints, compliance and disputes for the San Ant
onio office. Prevailed in four out of five medical disputes filed with the Texas
Department of Insurance.
MANAGED
CARE:
Supervise a team of nurses performing multi-jurisdictional workers' compensation
utilization reviews and telephone triage services. Was on the team that develop
ed the plans for Sedgwick CMS's proprietary managed care software program. Work
with nurses, claims examiners, health care providers, and injured workers to fa
cilitate cost-effective medical care and integrated injury management. Medical
bill auditing resulting in savings between 30-60% off billed charges.

PRESENTATION:
Marketed managed care services to clients and potential clients. Developed semin
ars to educate clients and health care providers about changes and trends in the
workers' compensation system. Assisted with the re-design of marketing materia
ls for Barron Risk Management. Devised and taught a fund-raising workshop for no
n-profit volunteers and board members. Created an educational brochure for a bu
sy downtown hospital about pre and post-op expectations.

LEADERSHIP:
Planned and implemented a variety of special events earning $1 million annually.
Directed a diverse team of volunteers, clerical staff, an assistant and intern
s. Frequently acted as Charge Nurse for an OB-GYN unit. Oversaw care provided
by non-licensed staff, students, and LVNs. Lead a cub scout pack with 100 boys
and approximately 20 adult leaders. Served on the Vestry of a 1,500 member chur
ch. Serve on the Board of the Texas Medical Auditor's Association.

COMMUNICATIONS:
Developed a medical cost containment training manual for the San Antonio office.
 Established a public relations program for a local United Way agency. Managed
communications for a 55-branch non-profit organization. Negotiated sponsorship
contracts for special events. Recruited celebrity spokespersons. Developed pr
int and broadcast media publicity materials.

SHONNA MACAULAY, RN, BSN, CCM

101 Shady Trail * San Antonio, TX 78232 * (210) 386-7593
sm611928@westpost.net
WORK EXPERIENCE

2007 - present Sedgwick CMS, San Antonio, TX

Utilization Review/Clinical Consultation Management Supervisor
2001 - 2007 CMI Barron Risk Management Services, Inc., San Antonio, TX
Senior Nurse Consultant/Compliance Specialist
1995 - 2001 Barron Risk Management Services, Inc., San Antonio, TX
Nurse Consultant
1993 - 1995 Metropolitan Methodist Hospital, San Antonio, TX
Staff RN, OB-GYN and Newborn Nursery
1989 - 1993 South Texas Children's Habilitation Center, San Antonio, TX
Director of Public Relations
1987 - 1989 Children's Hospital Branches, Inc., Oakland, CA
Public Relations Coordinator

EDUCATION

University of Texas Health: B.S.N., May 1993

Science Center at San Antonio Magna cum laude
Texas Tech University: B.A., Advertising/PR
Lubbock, Texas Minor -- Marketing
Cum laude
University of Phoenix Currently enrolled in MBA program

CERTIFICATIONS
Certified Case Manager since April 2006
PROFESSIONAL AFFILIATIONS
Texas Medical Auditors' Association Board of Directors
Sigma Theta Tau