Population Health Care Coordinator RN Resume Example Mount Carmel Health Systems

POPULATION HEALTH CARE COORDINATOR RN

Summary

Skilled Case Manager experienced in coordinating care for Medicare, Medicare Advantage, and ACO members. Proactive and resourceful professional able to make appropriate decisions for high-quality and cost-effective care.

Skills

Healthcare management
Healthy learning environments
Healthcare facility coordination
Healthcare delivery systems management
Strong clinical judgement

High level of autonomy
Extensive knowledge of Medicare, Medicare Advantage Plans, and ACO's.
Ability to work as a team and independently per job requirements.
20 years plus in the nursing field.

Experience

Mount Carmel Health Systems | Columbus, OHPopulation Health Care Coordinator RN03/2019 - Current

Earned reputation for good attendance and hard work.
Provided excellent service and attention to customers when face-to-face or through phone conversations.
Performed site evaluations for SNF patients under our ACO (NEXT GEN), BPCI Medicare Bundle patients, and Medicare advantage lives to facilitate a smooth transition to the next level of care.
Worked with assigned skilled nursing facilities to reduce SNF length of stays.
Performed Transition of Care calls ensuring that all services were in place and appointments were made within a timely manor.
Provided patient education to reduce the need for rehospitalization.
Linked patients with resources to assist with their success at home. Including but not limited to social services and medication financial assistance.
Developed strong professional relationships with assigned skilled nursing facilities.

Altercare of Canal Winchester | Canal Winchester, OHMDS Coordinator06/2014 - 03/2019

Verified quality of assessments in accurately reflecting physical, mental and psychosocial status of each resident.
Trained and supervised health care workers conducting resident assessments.
Helped develop comprehensive resident assessment and care plans for 72 bed facility.
Managed comprehensive, interdisciplinary assessments for patient admissions and annual reviews.
Coordinated completion of resident assessments in accordance with current federal and state regulations.
Reviewed and validated care plan reports and monitored follow-up actions to identify systemic deficiencies.
Completed all Managed Care continued stay updates to insurance companies.
Completed Medicare appeals on behalf of company.
Assess and determine if clients meet CMS skilled nursing criteria for continued stay.
Responsible for managing facility quality measures and maintaining our 5 star through CMS.

Aetna | New Albany, OHUtilization Management Nurse Consultant10/2012 - 06/2014

Utilized computerized Resource and Patient Management System (RPMS) and Electronic Health Record (EHR) system.
Reviewed inpatient hospital, SNF, and LTACH cases to determine if patient met criteria for medical necessity.
Performed triage to maximum team productivity and effectiveness.
Answered patient calls, identified issues and determined how best to provide assistance within parameters established by facility and supervisor.
Assisted with retro review cases as needed.
Precepted new staff.
Assisted with preauthorization cases as needed.
Worked cases up to be sent to Medical Director as needed.
Communicated with providers on case determinations in a timely fashion.

AlterCare | Canal Winchester, OHLPN/RN/MDS Coordinator06/1996 - 01/2012

Educated clients, patients and caregivers on medical diagnoses, treatment options, chronic disease self-management and wound management.
Managed wound care, gave respiratory treatments and helped with non-invasive procedures.
Documented patient intake information, including medical histories, current symptoms and vitals such as height and weight.
Collected biological specimens and packaged for laboratory transport to complete important diagnostic tests.
Documented patient intake and dietary requirements and assisted with feeding.
Promoted patient satisfaction by assisting with daily living needs such as bathing, dressing, toileting and exercising.
Cleaned and sanitized rooms and equipment using aseptic technique to prevent infection and cross-contamination.
Examined and addressed lacerations, contusions and other physical symptoms in need of further attention.
Responded to patient alarms and needs-assessment requests to identify course of treatment.
Delivered high-quality direct and indirect nursing care to up to 72 patients per day.
Trained new staff on quality control procedures.
Participated in unit based Quality Assurance Program
Developed, implemented, and updated nursing care plans
Filled in for DON as needed
Completed MDS assessments

Education and Training

Hocking College | Nelsonville, OHAssociate of Applied Science in Nursing12/2006

Hocking College | Nelsonville, OHLPN Certificate12/1996

Resume Overview

Companies Worked For:

Mount Carmel Health Systems
Altercare of Canal Winchester
Aetna
AlterCare

School Attended

Hocking College

Job Titles Held:

Population Health Care Coordinator RN
MDS Coordinator
Utilization Management Nurse Consultant
LPN/RN/MDS Coordinator

Degrees

Associate of Applied Science in Nursing
LPN Certificate

Population Health Care Coordinator RN Resume Example

Resume Score: 80%

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