Professionally trained Registered Nurse licensed in Illinois withsolid clinical, utilization reviewand case management experience within an inpatient setting. Ensures high standards of culturally competent care for a wide variety of patients with diverse needs. Varied skill set in nursing specialties which encompass:quality improvement initiatives/inspections, health education/disease management, revenue cycle/denials management and most recent clinical expertise,11 yearsutilization/hospital case management. Looking for a position that involves significant work in quality of care initiatives whereI can continue to assess patient\'s health care needs while evaluating patient progress andbe a continued advocate forpatients and families.
Strong clinical judgment
Patient and family advocacy
Thorough p hysical assessments
Professional bedside manner
Problem resolution capability
Grant writing ability
Occupational Health Nurse Administrator, 11/2015
to Current United States Postal Service – 433 W. Harison Street Chicago,
IL 60601 Assists in implementing and participates in programs to support total resource management services for Postal Service health and safety goals and objectives.Serves as medical resource for the Chicago District on issues such as: absence management, return to work, fitness for duty, district reasonable accommodation and serious accident reviews. Assists in conducting applicant pre-employment medical evaluations.Analyzes medical reports and updates confidential employee health records.Case manages: injured employees, and employees on medical leave/absent from work due to non-occupational injury or illness when appropriate. Monitors light duty assignments.Serves as medical resource to review and interpret medical documentation on work related injuries for Chicago District.
Nurse Case Manager, 04/2012
to 10/2015 John Stroger Hospital – 1900 West Harrison Street Chicago,
IL 60612 Worked with interdisciplinary team members/physician practices and inpatient teams to promote the effective utilization of services and coordinated care for the adult and geriatric population.Case managed clinically complex patient case load for: homeless, sheltered and underserved population. Coordinated discharge planning services and plan continuity of care.Assessment of patient\'s psychosocial, financial, cultural and family situation. Coordinated social services for patients and families.Participated in the development, implementation and evaluation of clinical pathways and process improvement plans.Reviewed and applied criteria to admissions and inpatient stays with respect to the medical necessity, appropriateness and quality of care.
Healthcare Utilization Review Coordinator II, 03/2005
to 12/2011 University of IL. Hospital and Health Science Center – 1740 West Taylor Chicago,
IL 60612 Provided initial, concurrent and retrospective clinical reviews (to include plan of care and discharge plan) of all inpatient, urgent/emergent admissions for commercial, Medicare/Medicaid insurers. Utilized EqHealth System to perform initial reviews for Medicaid admissions while utilizing Interqual criteria to assure the inpatient status was at the appropriate level of care. Participated in multidisciplinary rounds while serving as patient advocate to achieve high standards of patient care and quality outcomes.Worked with Revenue Cycle Department on denied claims to negotiate payment. Over turned a single claim in the amount of 1.8 million dollars.Served as resource and mentor to other RN staff in precertification department.
Clinical Team Leader-Internal Medicine Department, 02/2004
to 03/2005 Advocate Health Care – 9800 South Western Ave. Chicago,
IL 60643 Clinical team leader in Internal Medicine Department for staff of 10 RN, LPN and medical assistants.Served as clinical resource for nursing staff, made daily assignments and overall supervisory responsibility of daily flow.Provides triage services as needed and direct patient care to health plan members.Counseled and educated patients on health maintenance and disease management. Handling all aspects of treatment from medication administration to wound care.Assisted physicians with non-invasive procedures, communicated lab results to patients on behalf of physicians and provided necessary follow-up instructions related to treatment.
Consumer Safety Officer, 08/2002
to 02/2004 U.S. Food & Drug Administration – 550 West Jackson Street Chicago,
IL 60601 Conducted annual, investigatory and quality inspections on firms regulated by the Food & Drug Administration (including food, pharmaceutical and medical device companies) to determine compliance with federal guidelines and regulations.Evaluation of firms manufacturing processes, equipment design, analytical data and written standard operating procedures.Preparation of reports that document deficiencies and level of compliance.Daily meetings with upper management to identify deficiencies while allowing an opportunity to present additional data.
Private Duty Registered Nurse, 05/2000
to 08/2003 Melmedica Children\'s Healthcare – 17500 South Pulaski Rd. Country Club Hills,
IL 60476 Provided skilled nursing care to medically complex pediatric children in home care setting. Primary care, assessment and evaluation of new born and pediatric patients. Instructed families on proper procedures and medication administration. Monitored patient reactions to drugs and carefully documented progress.Trained new staff on treatments and procedures.Extensive experience working in homes with disabled children.
Nurse Consultant (Federal Surveyor), 08/1999
to 06/2000 Centers for Medicare and Medicaid – 233 North Michigan Ave. Chicago,
IL 6-601 Conducted federal oversight surveys of long-term facilities,investigatory surveys/inspections andquality surveys in the Midwestregion to determine compliance with state licensure and federalcertification requirements.Provided guidance and support to state surveyors (on federal oversight surveys) to evaluate the state\'s process in identifying quality issues, non-compliance of long-term care facilities, abuse and issues affecting the daily care of residents.Met with senior management of long-term care facilities to identify areas for process improvement.Prepares written reports documenting findings and deficiencies for upper management.Demonstrated ability to lead and motivate as a team member during the survey process.
School Nurse, 02/1994
to 08/1999 Chicago Board of Education – 1819 West Pershing Rd. Chicago,
IL 60609 Nurse case manager for students in grades K-12 with chronic diseases. Disease management/wellness education for students and faculty on illnesses such as : diabetes, asthma, meningitis, hypertension, and substance abuse.Promotes immunization compliancy by partnering with local agencies to bring immunization fairs to local schools.Provides first aid care as needed, administers prescription medication as directed.Participates in annual individualized evaluation plan (IEP) on behalf of students requiring nursing services.
Staff Nurse/Research Specialist, 01/1990
to 03/1998 University of IL. Hospital and Health Science Center – 1740 West Taylor Street Chicago,
IL 60612 As a staff nurse, provided primary care and assessment of adult/geriatric population with chronic medical-surgical disorders. Handling of all aspects of treatment from medication administration to wound care and monitoring of 7-19 patients per shift.Rotating charge nurse duties for medical-surgical unit of 30 patients.Research Specialist-Department of HematologyParticipated in successful grant writing for two studies: Hydroxyurea in the use of Sickle Cell Disease, Acute Chest Syndrome in Sickle Cell Disease. Decreased the number of Emergency Room admissions forsickle cell patientsby 50% through the implementation of approved clinical trials, extended clinic hours and case management team of RNs and social workers.
Master of Arts: Public Administration,
2000 Roosevelt University - 430 S. Michigan Ave. Chicago IL. 60601 Obtained Master of Pubic Administration with concentration in Health care Administration. Pursued graduate studies with emphasis in Health Administration in order to stay current with trends in managed care organizations and to better understandfinancial initiatives usedby organizations tostay viable in theever changingbusiness of health care.
Bachelor of Science: Nursing,
1/1990 Lewis University - Rt. 53 Romeoville,
Worked with Revenue Cycle Department at the University of IL. Hospital and Health Science Center to over turn a single denied claim and secure financial payment for the hospital in the amount of 1.8 million dollars. Trained team of staff nurses in department on denial\'s management techniques to secure financial payments.
Registered Nurse , Illinois, active license.State Minimum Qualified Test (SMQT) certification as a federal surveyor for the Centers for Medicare and Medicaid,(1999).