
Dedicated nurse with expertise in patient care and clinical leadership. Focused on team collaboration and patient safety, while managing care plans and mentoring staff. Background includes bedside nursing, caregiving, and care coordination, showcasing strong critical thinking and effective communication skills.
• Evaluated medical necessity of patient care plans with physicians, DON, and HSA, ensuring optimal resource utilization.
• Collaborated with interdisciplinary teams through EMRs and secure digital platforms, enhancing communication and decision-making.
· Conduct thorough documentation review for new admissions, ER returns, and patient transfers, ensuring compliance with facility, state, and payer guidelines.
• Supervise LPNs and Medication Technicians, reviewing documentation for accuracy and compliance.
• Apply clinical judgment during emergency responses, ensuring adherence to established protocols and regulatory requirements.
• Assisted in maintaining quality standards by conducting regular audits and documentation checks, supporting compliance and care excellence.
· Delivered patient care by assessing, planning, implementing, and evaluating care plans, ensuring compliance with policies and procedures.
· Administer prescribed medications, treatments, and medical interventions in compliance with physician orders and healthcare protocols.
· Managed medical emergencies, including trauma and crises, facilitating timely and appropriate interventions.
· Provide care for patients with chronic conditions, acute illnesses, and mental health issues, coordinating with other healthcare providers as necessary.
· Perform comprehensive physical assessments and history reviews to determine patient health status and prioritize care needs.
Conducted initial medical screenings for incoming inmates to assess health status.
· Documented patient assessments, treatments, and progress in EMR, adhering to facility policies and legal standards.
• Collaborated with hospitals, clinics, and clinical teams to efficiently process service requests from members and providers.
• Oversaw the referral process, including intake, notification, prior authorizations, and census management, ensuring compliance with payer and regulatory requirements.
Managed member intake and admission/discharge information, ensuring accurate documentation and timely processing.
EMR/EHR Platforms (Epic, Cerner, Meditech) Utilization Review Tools (InterQual, MCG) HIPAA & CMS Guidelines Microsoft Office Suite Google Workspace Remote Collaboration Tools (Zoom, Teams, Slack) Staff leadership Clinical training Medical records management