Certified Nurse Case Manager II, 10/2013, present, Carefirst Blue Cross Blue Shield, Easton, Md, United States, Verified benefits and acted as liasion between patients and essential healthcare personnel Reduced patient rehospitization rates 13% in 2016 Increased patient case opening 6% in 2016; increased alternate patient program participation 14% in 2016 Coordinated care with hospitals, home care agencies, physicians, mental health providers, Skilled nursing/Acute care facilites, and members to ensure best patient outcomes Kept up to date case histories of patients. Analyzed patients' mental abilities and examined medical reports to establish treatment and achievable rehabilitation objectives. Provided patients with information about surgical risks. Monitored and reported achieved and non achieved treatment goals to physician. Advised and informed patients about drug interactions, secondary effects and doses.
Outcomes Management, 4/11/2016, Present, Tug Valley ARH Regional Medical Center, South Williamson, KY, United States, By using Interqual, I determine if patients meet inpatient or outpatient status. If the status cannot be determined, I send the case into our secondary reviewer, and then submit clinical to insurance companies. I also upload and manage appeals for the UR part of the job. My secondary job requirement is discharge planning. I approach every inpatient patient and all observation patients appropriate for discharge help, and ensure that they have all the proper equipment and support when they go home. If they don't have proper support, etc, I work with social workers, insurance companies, and doctors to make sure the patients have the best possible outcome. Within this job I use Star daily, as well as Microsoft Word and Microsoft Excel.
Continue my career in Nursing to move the health care industry forward and drive positive outcomes by supporting diverse member populations. Educating members on managing their own health care and allowing them to make informed decisions about their plan of care with their Medical Doctors.
Breakfast Server, June 2016, Present, Comfort Inn, Weed, CA, United States, No
Registered Nurse, April 2008, present, Kaiser Permanente, Portland, Oregon, United States, As a Team Based Care RN (most current position at Kaiser), I assist patients and their families/caregivers with managing their health conditions. I provide education, support and proactive outreach to support improved health outcomes/increased quality of life and decreased utilization for the health care organization. I assist patients and family members with determining appropriate level of care in conjunction with the disease trajectory of their illnesses. Mainly, these services are provided for the 65 and older population. I also provide education for life care planning in the event that a patient becomes very ill. In this position, I work with an interdisciplinary team of medical providers, navigators, social workers, pharmacists and other health care disciplines.As a RN for Kaiser's Primary Care at Home program (from 10/2015 to 6/2016), I worked with a team of medical providers, LPNs and social workers to provide medical and social services to patients who are home bound. I worked at a call center location, providing telephonic support to the field providers - medical providers and social workers and to the patients and their caregivers.As a RN regional case manager for Kaiser (from 4/2008 to 10/2015), I worked as a chronic condition case manager, providing telephonic, emergency room and hospital transition outreach to assess patient current status and provide education as indicated. I also ensured that patients had the needed follow up, along with identifying any barriers to care. Also, as a regional case manager, I provided intensive case management to patients with multiple chronic conditions, in person and telephonically in a primary care setting. I had extensive training in motivational interviewing, to assist patients in identifying their ability to make change and provided needed support to elicit change.
Senior Licensed Practical Nurse, January 2012, Present, Hernando County Sheriff's Office Detention Center, Brooksville, FL, USA, As Senior LPN, assumed the authority and responsibilities of the Clinical RN Supervisor during her absence, during night shift, or at other times so designated.Under the general supervision of the RN Clinical Supervisor, plans, coordinates and reviews the work of subordinate staff nurse members for proper work performance.Ensure the proper flow of relevant information to the RN Clinical Supervisor by providing a daily report of shift eventsProvide new nursing staff with additional training and guidance assisting them in their professional advancement.Complete performance evaluations on staff nurses assigned to night shift.Oversee clinic visits and sick calls occurring on assigned shift.Ensure physical assessments and medical histories on inmates are completed in a timely manner as required by law.Performs additional duties as directed by higher authority.