ALAINA SPAULDING
Summary
Experienced Registered Nurse Case Manager who delivers consistent and professional work with excellent ability to advocate & coordinate referrals/provider recommendations effectively with patients, providers, employers, family, claims adjuster, & other healthcare team professionals while working independently. Excellent leadership skills with 12 years in Nursing. Skilled at identifying needs and developing effective plans of action to provide intervention and assistance to meet patient specific goals. Possesses strong organizational, interpersonal and communication skills.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Telephonic Nurse Case Manager II
Genex Services LLC
02.2023 - Current
- Ensured HIPAA compliance by maintaining strict confidentiality when discussing sensitive patient information over the phone or via electronic correspondence.
- Collaborated with interdisciplinary teams to optimize patient-centered interventions and ensure continuity of care.
- Maintained meticulous documentation of case management activities, facilitating accurate billing and compliance with regulatory requirements.
- Collaborated with other health care professionals regarding plan of care and variances in plan implementation to achieve outcomes.
- Screened medical records and information for necessity and appropriateness and referred for physician review cases not meeting medical criteria.
- Assessed current treatment plan to identify barriers, clarify or determine realistic goals and objectives and seek potential alternatives.
- Provided empathetic emotional support for patients facing challenging health concerns, fostering trust and open communication.
- Served as a liaison between healthcare providers and insurance companies, providing essential information to facilitate informed decision-making processes efficiently.
- Maintained up-to-date knowledge of regulatory guidelines, ensuring adherence to industry standards throughout the review process.
- Managed caseloads of patients with complex medical conditions, ensuring timely access to appropriate care and services.
- Enhanced patient satisfaction by fostering strong relationships and providing ongoing education on disease management strategies.
- Monitored progress towards treatment goals, adjusting care plans as needed to maximize success rates.
- Collected and aggregated data to identify problems or trends, such as turnaround time and issues with physician offices.
- Coordinated referrals to specialists, hospitalizations, ER visits, ancillary testing, and other enabling services for patients.
- Worked with providers to define quality metrics and outcome reporting process.
- Collected and inputted case data in managed care system and timely and accurately generated required correspondence and review notification for management.
- Facilitated timely referrals to appropriate specialists, expediting necessary treatments and improving overall health outcomes.
- Helped patients navigate complex insurance processes, easing their financial burden while ensuring access to necessary treatments.
Nurse Case Manager II
CORE HEALTH NETWORKS
01.2019 - 02.2023
- Injury triage intake process by collecting, organizing and analyzing information about reported injury and making recommendations within cope of practice to involved employee and sending injury triage intake report to client
- Effectively communicates with injured employees, medical professionals, attorneys, adjusters and others to obtain information, and to negotiate medical treatment and return to work plans using critical thinking skills, clinical expertise and other resources as needed to achieve an optimal case outcome with the goal to include facilitating early return to work
- Utilizes the Nursing Process to facilitate medical management to attain maximum medical improvement and return-to-work (RTW) per state jurisdictional requirements
- Assigned to manage highly complex cases including catastrophic injuries by appropriately following clients procedures and protocols within the state work comp guidelines
- Accurately and appropriately documents billable time for work performed
- Achieves annual chargeable time goal
- Coordinate patient care by ensuring timely coordinate of referrals to specialists, outpatient imaging, therapy referrals, IME/FCE appointment coordination
- Reviewed medical records and utilized ODG guidelines to determine if treatment will be authorized by carrier to anticipate future coordination for care
- Trains new staff members, services as a resource person for staff and clients
- Participated in helping to develop company injury charting program
- Which included helping IT developers build system for work flow that is customized for our case managers and testing new system before implementing to all staff members
- Developed new client protocol template to improve consistently of protocols that are customized to client to ensure case managers are able to easily review protocols to ensure delivery of clients request
- Completed COVID-19 intake screenings and provided direction based on CDC and company/client guidelines
- Accurately and appropriately documents billable time for work performed
- Achieves annual chargeable time goal
- Handles special projects for quality improvement or process improvement as assigned.
Post-Anesthesia Care Unit Staff Registered Nurse
THIBODAUX REGIONAL MEDICAL CENTER
05.2018 - 09.2020
- Achieved optimal patient outcomes by carefully monitoring conditions and delivering comprehensive support
- Provides immediate post-operative care to surgery patient
- Assist anesthesiologist with pre-operative procedures such as nerve blocks, spinal blocks, central lines, and arterial lines
- Delivered evidence-based, cost-effective care following facility policies
- Administers medications to help control post-operative pain and nausea as well as administers and monitors IV conscious sedation in compliance with LA State Board of Nursing
- Provides patients and families education tailored to their individual post-op care plan
- Served as a member of our facility's Quality Measurement Team.
- Assessed physical, psychological, physiologic, and cognitive status of patients.
- Provided emotional support for patients and families during difficult times, helping them navigate the healthcare system with compassion and understanding.
Emergency Room Registered Nurse
LADY OF THE SEA GENERAL HOSPITAL
11.2017 - 06.2020
- Provides emergency nursing care to those patients arriving to the emergency room
- Triage, assess, and intervene using ESI and the nursing process
- Collaborates with other facilities to transfer patients to receive the appropriate care according to condition and interventions needed
- Managed care delivery and effectively allocated resources with proper patient triage
- Educate patients and families upon discharge, including home care instructions and medications Administers medication and carries out physician orders
- Documents accurately and clearly using T-System
- Maintained optimal patient status with rapid assessment and treatment of critical concerns
- Handled needs of multiple patients by delegating assignments and monitoring work of assistants
- Advocated for patient needs to facilitate care in emergency situations
- Administered life-saving measures to stabilize ill and injured patients
- Assisted physicians with procedures to implement care
- Explained patient condition to family members to foster supportive and compassionate environment.
- Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing conditions.
- Streamlined emergency room operations by efficiently triaging patients according to the severity of their condition.
Nursing Unit Coordinator
THIBODAUX REGIONAL MEDICAL CENTER
06.2016 - 05.2018
- Coordinated unit schedules by setting up appointments for examinations, tests and procedures
- Input physician and nursing orders into EMR for units' patients
- Completed patient rounds to continually assess care delivery and changes in condition
- Facilitate smooth communication between patients, families and clinical staff as part of quality care delivery
- Supported efficient department operations by ordering, stocking and organizing supplies
- Directed, supervised and evaluated work activities of Unit RNs & PCTs personnel.
- Coordinated and maintained referral sources related to admissions, discharges, and follow up services to sustain daily census requirements.
- Achieved program goals by effectively motivating and supervising medical, technical and clerical staff
- Coordinated effective interdepartmental collaboration through open communication between medical staff
- Directed and conducted recruitment, hiring and training of personnel
- Improved care delivery by monitoring performance and optimizing strategies
- Maintained knowledgeable and skilled staff, recruiting top candidates and overseeing continuous training initiatives
- Stayed at forefront of medical and technical advances, evaluating options and integrating useful solutions.
- Collaborated with interdisciplinary teams to develop individualized care plans tailored to each patient's needs.
Staff Registered Nurse
THIBODAUX REGIONAL MEDICAL CENTER
05.2012 - 06.2016
- Provide bedside nursing care to patients with complex, chronic illnesses including congestive heart failure, chronic obstructive pulmonary disease, diabetes, dementia, & cerebrovascular accident on a busy Medical-Surgical Unit, which consist of pediatric, adults, and geriatric populations
- Initiated and developed the patient's plan of care which established goals-based on nursing diagnosis and incorporated therapeutic, preventive, and rehabilitative nursing interventions
- Identify patient health risk factors, such as allergies, pre-existing conditions, or prior treatment, to anticipate obstacles to care
- Accurately documented assessment, interventions, education, and all pertinent medical information in patient EMR
- Participated on Discharge Quality Improvement team and decreased the length of discharge process by 60%
- Participated in interdisciplinary rounding to ensure high-quality, cost-effective care to patients
- Collaborate with physicians and providers to create patient specific plan of care and made changes to care plan as needed
- Educated patients and families on treatment plan, discharge plan, and medications.
Education
Bachelor of Science in Nursing - Nursing -
Nicholls State University
Thibodaux, LA05.2012
Skills
- Proficient with learning/navigating multiple EMR/EHR systems including Unity, Meditech, Athena, TSystem, Cority & claims portal systems
- Knowledgeable of ICD-10, HIPPA, OSHA, CMS, & other organization/state/national regulations
- Proficient with all Microsoft programs including Microsoft Word, Excel, PowerPoint, OneNote and Outlook
- Quality Improvement
- Proficient data entry/patient care documentation
- Excellent critical thinking & time management skills
- Performs work accurately with strong attention to detail
- Very tech/computer savvy
- Excellent communicator, both verbal and written
- Experienced handling Complex Case Management issues/care coordination
- Experienced/knowledgeable of Worker's Compensation state/national laws & guidelines
Certification
- Pediatric Advanced Life Support
- Oncology Nurse Certified
- Six Sigma LEAN Trained
- Crisis Prevention Intervention Trained
Additional Information
Certified Workman's Compensation Professional (CWCP) October 2020
Certified Case Manager Certificate (CCMC) Testing August 2024
LHA Essentials of the Charge Nurse Training April 2017
Certified Medical-Surgical Registered Nurse (CMSRN) April 2017
Six Sigma LEAN Trained January 2016
Timeline
Telephonic Nurse Case Manager II
Genex Services LLC
02.2023 - Current
Nurse Case Manager II
CORE HEALTH NETWORKS
01.2019 - 02.2023
Post-Anesthesia Care Unit Staff Registered Nurse
THIBODAUX REGIONAL MEDICAL CENTER
05.2018 - 09.2020
Emergency Room Registered Nurse
LADY OF THE SEA GENERAL HOSPITAL
11.2017 - 06.2020
Nursing Unit Coordinator
THIBODAUX REGIONAL MEDICAL CENTER
06.2016 - 05.2018
Staff Registered Nurse
THIBODAUX REGIONAL MEDICAL CENTER
05.2012 - 06.2016
Bachelor of Science in Nursing - Nursing -
Nicholls State University
- Pediatric Advanced Life Support
- Oncology Nurse Certified
- Six Sigma LEAN Trained
- Crisis Prevention Intervention Trained
Similar Profiles
Trisha Lane MSN/Ed RN-BCTrisha Lane MSN/Ed RN-BC
RN Case Manager at Genex Services LLCRN Case Manager at Genex Services LLC
Julie KellyJulie Kelly
Accounts Payable Supervisor at Genex Services LLCAccounts Payable Supervisor at Genex Services LLC
Sandra HiggsSandra Higgs
Financial Analyst II - Medical Services Support 5 at Genex Services, LLC (formally CompAlliance, LLC and GSG Associates, Inc.)Financial Analyst II - Medical Services Support 5 at Genex Services, LLC (formally CompAlliance, LLC and GSG Associates, Inc.)