rn care coordinator population health hybrid resume example with 8+ years of experience
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Experienced Certified Nurse Case Manager. Consistently rewarded for success in planning and operational improvements following NCQA and Milliman Care Guidelines (MCG). Successfully able to work remotely. Team lead in collaborative program with DaVita Kidney Care overseeing 15 nurses. Direct care experience serving patients with commercial insurance and government health plans including Medicare, Medicare Advantage, Medicaid, and DSNP populations in community settings. Proficient in quality metrics for value-based payment models using Managed Care Coordination. Excellent reputation for multitasking, resolving problems, identifying and closing gaps in care, and driving overall operational improvements. Proven leadership focused on increasing and enhancing patient care and satisfaction and closing gaps in care. Streamlined safety protocols for comprehensive patient care. Dedicated and compassionate Registered Nurse (RN) with progressive career history in direct patient care, triage and care coordination in fast-paced environment in addition to patients on hospice, home health, sub-acute rehabilitation, and assisted living. Success providing individualized patient care. Committed to delivering best-in-class patient care through effective education and counseling. Proven to remain calm under pressure and skillfully handle difficult patients and high-stress situations. Consistently developed strong relationships with patients and families through empathetic communication, respectful attitude and excellent customer service. Willing to grow and learn, accept new challenges and opportunities, contribute to company's overall growth, and help build a strong team. Successfully completed second undergraduate and master's degrees; with two certifications in nine years.
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- Team lead overseeing 15 nurses in collaborative program sharing patient care coordination services with DaVita Kidney Care to address root cause of repeated missed treatments, gaps in care, managing social health needs, navigating health plan resources and scheduling external healthcare provider appointments, and facilitating end of life services. Responsible for producing monthly and quarterly reports for senior management to review clinical scorecard, discuss success stories, opportunities, and readmission rates.
- Assess physical, functional, social, psychological, environmental, learning and financial needs of patients for Commercial insurance, Medicare, Medicaid, DSNP, Special Needs and Behavioral Health patient through Managed Care Coordination.
- Participate in monthly case rounds with Medical Director, Pharmacy and Population Health team, LSW, RD and Senior Management presenting high-risk patients for review.
- Facilitate disease prevention and health promotion with patients and families.
- Educate patients, families and caregivers on diagnosis and prognosis, treatment options, disease process and management and lifestyle options.
- Identify problems, goals and interventions designed to meet patient's needs, including prioritized goals that consider patient/caregivers goals, preferences and desired level of involvement.
- Consistently meet departmental productivity levels of 100 - 150 active patient cases.
- Utilize motivational interviewing skills to build patient engagement.
- Provide education, information, direction and support related to patient's care goals.
- Act as patient advocate and assist with problem solving and address any barriers to care or compliance with care plan.
- Mentor and train new associates.
- Manage care from admission to discharge to post discharge.
- Instruct patients to improve lifestyle choices and dramatically reduce chance of symptom reoccurrence.
- Managed, educated and assisted high-risk members with complex co-morbidities.
- Assigned special project to support increased cost savings.
- Interacted with Utilization RN to assess patient's clinical needs against NCQA and Milliman Care guidelines and standards to ensure that level of care and length of stay of patient are medically appropriate for inpatient stay.
- Managed over 35-40 calls per day.
- Evaluated care by problem solving, analyzing variances, and participating in quality improvement program to enhance member outcomes.
- Coordinated with patient, family, physician, hospital, and other external stakeholders regarding appropriateness of care from diagnosis to outcome.
- Monitored patient's medical care activities and outcomes for appropriateness and effectiveness.
- Advocated for member/ family and coordinate resource utilization and evaluation of services provided.
- Encouraged member participation and compliance in case and disease management program.
- Interacted and communicated with multidisciplinary teams telephonically and/ or in person striving for continuity and efficiency while managing member along care continuum.
- Successfully understood fiscal accountability and impact on utilization of resources.
- Coordinated with interdisciplinary professionals to develop plans of care, administer tests and monitor patient status.
- Member of Shared Governance hospital-based Informatics committee.
- Conducted needs analysis for company-wide implementation of API Self-Scheduling web application.
- Defined and prioritized system requirements.
- Set-up test environments & created test scenarios based on each department/unit needs.
- Implemented unit specifications in live environment.
- Performed end-to-end system testing.
- Trained and educate hospital staff.
- Provided on-site support during roll-out.
- Collaborated with system analysts and nursing Informatics teams.
- Proved successful working within tight deadlines and fast-paced atmosphere
- Functioned as charge nurse and precepted new RN graduates.
- Audited patient charts and documentation.
- Managed team of 6 for hospital-wide 2-year research study to identify process improvements for oral care and decrease aspiration risks.
- Demonstrated ability to lead and motivate employees.
- Led annual CNA competency training program.
- Liaison between patients, patient families, case managers, social workers, and physicians to ensure comprehension of treatment and discharge plans.
University of Washington - Seattle, WA
William Paterson University - Wayne, NJ,
- CMGT-BC: Nursing Case Management Certification
- CMSRN: Certified Medical-Surgical Registered Nurse
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Resume Overview
School Attended
- University of Washington
- William Paterson University
Job Titles Held:
- RN Care Coordinator Population Health - Hybrid
- RN II Complex Case Manager - Remote
- Nursing Informatics Engineer
- Staff Nurse- Stroke/Neurology/Medical-Surgical
Degrees
- Master of Science
- Bachelor of Science
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