Highly competent Case Manager with passion for coordinating quality care for patients. Offering 29 years of experience in various nursing roles. Exemplary interpersonal skills and commitment to helping patients receive effective care in line with preferences and standards.
Skills
Case Management
HIPAA Compliance
Discharge Planning
Insurance Knowledge
Education
Indiana Wesleyan UniversityMarion, INExpected in 01/2001 ā āBachelor of Science:Nursing - GPA:
Indiana University NorthwestGary, INExpected in 06/1992 ā āAssociate of Science:Nursing - GPA:
Work History
Country Manor - RN Case Manager Sartell, MN, 03/2008 - Current
Conducted preoperative risk assessments, ongoing assessments and evaluations to prepare patients for surgery and manage healing process.
Managed support services and fostered communication among social workers, therapists, hospital staff and patients.
Educated patients and caregivers on healthcare protocols and processes.
Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
Obtained authorizations from multiple insurance carriers for various levels of care.
Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
Performed admission reviews based for medical necessity based upon specification.
Performed prior authorization review of services requiring notification.
Supervised and maintained all utilization review documentation through Interqual, Morecare, and MCG.
Amedisys Home Health Services - Registered Nurse Case Manager York, NE, 05/2004 - 05/2007
Authored clinical notes and updates to be reviewed by patient's primary physician.
Participated in patient and family planning process, as well as provided instructions and addressed question and concerns.
Worked with suppliers and vendors on provision of medical equipment, items and services.
Prepared clinical notes and updates for review by primary physician.
Authored initial assessments of patients and family to develop plans for individual home care needs.
Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
Supervised and maintained all utilization review documentation through Interqual.
Concentra - Assistant Director of Progressive Care Unit Van Nuys, CA, 01/2001 - 04/2004
Performed rounds to observe care and interview staff, residents and families.
Collaborated with staff, management and external groups to coordinate patient care.
Established new policies and updated existing policies to improve standard of care for patients.
Recruited, hired and coached employees to offer high-quality, cost-effective care to all patients.
Generated and reviewed incident reports, including employee write-ups, actualizing appropriate corrective action plans to mitigate ongoing and potential situations.
Methodist Hospitals - Registered Nurse City, STATE, 09/1992 - 12/2001
Provided direct patient care, stabilized patients and determined next course of action.
Managed care from admission to discharge, including patient assessments, care planning, health educations and discharge support.
Administered medications via oral, IV and intramuscular injections and monitored responses.
Participated in nursing simulation activities, evidence-based practice project implementation and competency development to further nursing education.
Monitored patient condition, including interpreting and tracking EKG readings, identifying irregular telemetry readings and updating team members on changes in stability or acuity.
Provided exceptional care to high-acute patients needing complex care such as ventilator management, extensive wound care and rehabilitation.
Minimized hospital stays with recovery-centered approaches, reducing average in-patient stay length.
Reviewed post-operative orders and continuously monitored patients' post-operative vitals, set up PCA and fluids and oriented patients to unit.
Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing conditions.
Trained new nurses in proper techniques, care standards, operational procedures and safety protocols.
Educated patients, families and caregivers on diagnosis and prognosis, treatment options, disease process and management and lifestyle options.
Audited charts and reviewed clinical documents to verify accuracy.
Contributed substantially to successful department JCAHO accreditation by consistently operating to highest standards of care.
Collected blood, tissue and other laboratory specimens and prepared for lab testing.
Advocated for patients by communicating care preferences to practitioners, verifying interventions met treatment goals and identifying insurance coverage limitations.
Methodist - Certified Phlebotomist Technician City, STATE, 01/1986 - 03/1992
Followed physician orders to correctly administer therapeutic phlebotomy.
Resolved unusual test orders by contacting physicians, nursing stations or reference laboratories.
Spoke with patient to gather information for lab records, reduce fear or anxiety and optimize cooperation.
Protected patients by following infection control, sharps disposal and biohazardous waste disposal procedures.
Promoted mission, vision and values of organization and trained new clinical staff in phlebotomy procedures.
Performed bedside tests like bleeding time tests and entered results into patient charts.
Tracked collected specimens by initialing, dating and noting times of collection.
Used personal protective equipment correctly to protect coworkers and patients.
Labeled transfer tubes and followed exact directions for handling and storing specimens for transport.
Centrifuged blood samples as outlined in clinical protocols.
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