Registered Nurse and Certified Case Manager with six years of workers' compensation experience, seven years experience of Utilization/Case Management in a hospital environment and total of twenty one years as a registered nurse in the state of Texas. As a Workers' Comp Nurse Case Manager, I utilize carrier specific networks to coordinate physician and provider care for the injured worker, perform on site medical reviews at hospitals, provide education to the injured worker and advocate for the injured worker. I perform 90% field case management and 10% telephonic case management. I mentor new case managers.
As a hospital based Case Manager, I identified and addressed patient's needs and communicated with the physician and nursing staff to help develop a viable hospital plan of care. I strove to insure healthcare continuum for timely placement and discharge, reduction in the length of stay and assurance of quality care. I led interdisciplinary discharge planning. I mentored new department members. I managed heavy daily patient volume including insurance reviews, appointment scheduling and patient referrals.
As a hospital based Staff Nurse, I provided pre and post- operative teaching to insure patient understanding and compliance to insure a healthy recovery and medical nursing care.
Coordinate communication between injured worker, physician, employer and claims adjustor.
Direct injured worker to approved vendors utilizing carrier specific networks.
Coordinate and document case activity and input information into applicable system.
Coordinate return to work efforts with the employer and identify transitional job options.
Provide consultation with claim adjustor with a cost effective objective.
Certified in Long Shore, Defense Based Act, Catastrophic and Long Term Disability.
Maintain average case load of thirty.
Perform telephonic case management for ten percent of case load.
Hospital Case Management/Utilization-monitor length of stay based on TMF guidelines.
Possessed knowledge with regard to Medicare guidelines.
Communicate with physician regarding treatment plan.
Led weekly interdisciplinary discharge planning.
Contacted insurance carriers and provided updated clinical information to obtain authorization for continued length of stay.
Addressed patient's needs and provided education to insure understanding and compliance with treatment plan and discharge plan.
Admission Nurse-educate patients regarding surgery procedure to insure informed consent and provide pre and post-operative teaching to insure compliance and avoid unnecessary complications.
Staff Nurse-medical and surgical nursing care.
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