SUMMARY:

Hospital and insurance registered nurse case manager with eight years of experience in evaluating and assessing high - risk members’ needs to achieve an optimal wellness state. Coordinate, guide, and facilitate members’ interactions toward appropriate resources, next level of care, or transition back into the home.

COMPUTER SKILLS:

MIDAS

STARR

SOVERA

Interqqual/Millman

Canopy

Quadramed

Pyxis

McKesson

CCMS

CGX/hCAT

Microsoft Windows, Word, Outlook, Excel, PowerPoint

MEDPROS/AVS/E-PROFILES

EXPERIENCE:

Case Manager

Confidential

Responsibilities:

• Collaborates with the interdisciplinary team participants in team rounds to: facilitate timely care; assure quality of care throughout the hospital stay; and minimize adverse outcomes.
• Provide Confidential navigation support for clinicians who are new to Confidential
• Troubleshoot problems within Confidential at point of service
• Suggest user-end feedback to enhance and optimize Confidential usage within the hospital
• Initiate appropriate referrals to the internal interdisciplinary team and outside provider network.
• Establish a working diagnosis on every patient at the time of admission to estimate the target length of stay or identify the date of discharge for planning and care coordination purposes.
• Screen every patient to identify need for further assessment of medical necessity or discharge planning.
• Participate in Quality and Performance Improvement Plan for the Care Management Department.
• Document all team, physician and patient/family communication and concerns pertaining to coordination of care and services.

Confidential

Care Manager/Mentor

Responsibilities:

• Participate in monthly super - user meetings and assist staff with current system upgrades
• Assess and evaluate member needs and requirements to achieve and/or maintain optimal wellness state.
• Guide members and their families toward and facilitate interaction with resources appropriate for the care and wellbeing of members.
• Work in collaboration with a multi-disciplinary team, employing a variety of strategies, approaches and techniques to manage a member s physical, environmental and psycho-social health issues.
• Proactive telephonic outreach to eligible Confidential members and engage participation in Confidential Cares Complex Care Management program.
• Complete physical, psychological, emotional and environmental assessments, for the purpose of providing appropriate, timely interventions to ensure provision of optimal care.
• Coordinate community care and services as deemed appropriate
• Works collaboratively with other members of the Confidential Cares Interdisciplinary team-to include; Confidential Cares Managers-Social Services, Field Care Managers and Community Health Educators
• Understand clinical program design, implementation, and management, monitoring and reporting
• Comply with performance and reporting standards as defined by Confidential

Case Manager

Confidential

Responsibilities:

• Responsible for the initial assessment of high - risk members, including evaluation of physiological, psychosocial, environmental, financial, and health related behavior domains
• Coordinating planned and unplanned transitions from members usual setting of care to the next setting as defined by individual member needs
• Participate with the attending physicians, primary care physicians, social workers, and discharge planners in transitioning patients to the most appropriate level of care
• Participates in UM case rounds, UM departmental staff meetings and QM studies as directed
• Establishes a plan of care with patients, providers, and family/significant others that identifies and continuously reassesses cost-efficient appropriate levels of care
• Enhance communication and collaborative relationships with multidisciplinary healthcare team members
• Emphasize continuity of care, thus reducing or eliminating fragmentation, duplication, and gaps in treatment plan
• Act as a patient advocate protecting privacy and confidentiality issues
• Provide patient education, monitoring of health needs, and coordination of community resources
• Prevent adverse patient occurrences when possible and intervenes quickly if prevention is not possible, thereby minimizing poor outcomes
• Collect quality review data to support outcome measurements and discuss admissions related to core measures
• Maintain a comprehensive working knowledge of community resources and network services for target population
• Identify opportunities for health promotion and illness prevention
• Performs retro, concurrent, initial, and precertification reviews
• Evaluate progressive conditions of critical care/acute/emergent care of patients
• Provide advanced nursing skills to many patients, assess patient conditions and acuity of vital signs
• Develop plans for treatments used and administer various medications and techniques in need of emergent care in fast paced / intense environment
• Discharge and educate patients/family on medications, follow up appointments, and plan of care
• Mentor new hire and graduates on into their role as ER nurses
• Subject Matter Expert in the flow and processes of a Level 1 ER trauma center

Care Coordinator

Confidential

Responsibilities:

• Perform daily utilization review on assigned units within acute care facility focusing on core measures
• Application of standardized InterQual criteria to assigned patients
• Assist in coordination of discharge planning
• Engage in ongoing communication with physicians regarding inpatient plan of care
• Participate in unit level patient rounding
• Review patient's clinical scenario to assess for appropriate status
• Communicate with insurance verification daily regarding insurance certification requirements
• Document clinical findings in MIDAS system
• Initiate referrals to quality improvement department
• Document clinical findings and application of standardized criteria into the Confidential AL web portal

Chief Nurse Administrator

Confidential

Responsibilities:

• Responsible for competency training of soldiers in Army standards medical skills
• Tracking and enforcing all professional credentials and verifying that all credentials are current
• Plan and conduct unit medical readiness events
• Review current vaccination/immunization records for all soldiers
• Teaching/Mentoring soldiers in techniques to enhance their knowledge and medical skills based on the Army principles and standards
• Brief Commander on current and anticipated events/issues and follow through to completion with assigned task
• Coordination of care with medical providers until soldiers are declared fit for duty, unfit for duty and/or at maximum medically improved
• Advise and support the unit Commander with all medical issues
• Monitor, advise, and facilitating medical readiness operations for over 4,000 soldiers
• Organize and supervise daily activities of the entire Surgeon’s section
• Supervise unit sick call procedures, providing individual health counseling, and conduct preliminary screening for profile requests
• Ensure proper documentation and archiving of all medical activities and records
• Assess patient conditions and acuity of vital signs
• Develop plans for treatments used, and administer various medications and techniques
• Evaluate progressive conditions of critical care/acute care patients
• Provide advanced nursing skills to many patients in need of immediate care in fast paced / intense environment
• Discharge and educate patients and family on medications, follow up appointments, and plan of care
• Part-time House Supervisor, HealthSouth Rehabilitation
• Assessed, planned, implemented, and evaluated nursing practices, quality and productivity programs, interdisciplinary clinical programs, fiscal budgets, employee relations, recruitments and retention, counseling, and customer service philosophy
• Controlled and directed activities during a designated shift
• Participated in activities to support departmental/hospital operations that may include call back as required
• Supervised and scheduled licensed and unlicensed nursing personnel as required.
• Participated with performance evaluations
• Conducted patient education and patient care