Amy Hines
Pineville,La
Summary
Knowledgeable Case Manager experienced in coordinating care for [Type] individuals. Proactive and resourceful with strong knowledge of community resources. Strong communicator with passion for helping others and to make a difference in the lives of my patients and their families by providing them with the best care possible and giving them the best outcomes possible.
Overview
28
28
years of professional experience
Work History
Structural Heart Coordinator
Rapides Regional Medical Center
08.2018 - Current
- Coordinate all structural heart procedures between Cath Lab, Surgery and Non-invasive Cardiology
- Facilitate relationships with my patients as they proceed down the path to intervention
- Ensure patients meet CMS criteria set forth for all structural procedures, knowing the criteria set forth for each procedure
- Procure insurance authorizations for structural procedures and providing clinical to clinical appeals and reviews
- Providing patient families with all information before, during and after the procedure to ensure they are comfortable with the state of the patient
- Liaison between the Department of Cardiology and Medical Staff Offices to ensure all information between the 2 is correct.
- Attended professional meetings and conferences to maintain and improve professional competence.
- Reviewed and evaluated new and current programs to determine success and compliance with state, local and federal regulations and recommended necessary modifications.
Care Assure Nurse Navigator
HCA Healthcare
02.2016 - 08.2018
- Assisting patients with navigating the medical system
- Reviewing MD discharge orders and educating the patient on exactly what the Dr wishes for them to do
- Reviewing MD discharge medication list and educating the patients accordingly
- Identifying patients that meet the Cardiology Criteria for Arrhythmia, Depressed EF, CHF and Valve disease trigger
- Educating the patients on their hospital stay and answering any questions they have regarding events or testing that they may have encountered in the hospital setting
- Coordinating with the MD offices to make sure patients have follow up visits and that they attend them
- Communicating with the MD office staff any issues the patient may identify
RN Case Manager
Christus St Frances Cabrini Hospital
07.2014 - 11.2015
- Responsible for discharge planning for all patients assigned to the Oncology/Renal Unit
- Assisting patients with ensuring they have the best discharge options and making the connections between the patients and outside medical providers
- 2
- Utilization review of Commercial and Medicare insured patients
- Reviewing medical records of the patients and sending a daily review to the insurance company
- Reviewing the medical record to insure that the patients meet the medical necessity for either inpatient or observations status
- 3
- Readmission assessments of patients being readmitted within 30 days of discharge
- Inquiring of patients, families and other medical providers to find out why the patients are being readmitted and what can be done to prevent any further readmissions
- Also identifying patients that are high risk for readmission and notifying the PIC nurses to be aware that these patients are high risk
- 4
- Case Management of the patients on the
- Oncology/Renal unit
- Working closely with the interdisciplinary team to formulate a plan of care for the patient
- Helping to identify the patients in need of further care after the acute phase and getting the needed referrals
- Communicating the plan of care to all members of the interdisciplinary team to insure the continuity of the plan of care
- 5
- Length of stay
- Working closely with the care team to notify them of the LOS and helping to find ways to keep patients from extending the length of stay.
Nurse Liaison
Healthsouth Corporation
01.2014 - 06.2015
- Resposible for marketing all programs to MD offices,
- Home Health offices , Assisted Livings and hospitals 2
- Responsible for prescreening patients for admission and communicating with the Medical Director
Adjunct Instructor
Louisiana College
01.2009 - 05.2010
- Responsible for the instruction of students in
- Fundamentals of Nursing 2
- Clinical Instructor for Fundamentals of Nursing 3
- Responsible for grading of care plans and clinical
- Performance 4
- Responsible for the instruction and testing of students on the Perioperative chapters in Med/Surg
Staff RN
Rapides Regional Medical Center
01.2008 - 09.2013
- Patient care duties in the Operating
- Room, both in the Main Operating
- Room and at Women’s and Children’s Hospital 2
- Charge Nurse duties when assigned
- 3
- Management of the Operating Room
- Schedule in the evening time and the management of staffing for the Surgical cases
- 4
- Responsible for maintaining the Malignant
- Hyperthermia cart and the Trauma Cart and maintaining stock of both
- Responsible for inservicing staff on both carts yearly.
Clinical Educator, Staff RN
Christus St Frances Cabrini Hospital
01.1997 - 01.2007
- Responsible for the educational needs of the surgical staff
- Responsible for coordinating inservices and CEU's 3
- Responsible for the training of new Surgical Techs and
- RN's 4
- Responsible for the Infection Control Issues in the department,researching all infections 5
- Responsible for patient care duties in the Operating Room time management, and ordering supplies for the General and Orthopedic Surgery Specialties
Staff RN
Winn Parrish Medical Center
01.1996 - 01.1997
- Responsible for patient care on a Med/Surg unit.
Staff RN
St Frances Cabrini Hospital
01.1995 - 01.1996
- 1
- Responsible for patient care activities on the Rehabilitation Unit 2
- Responsible for collaborating with the Rehab team to provide care for the patients
Education
B.S - Nursing
Louisiana College
1995
Skills
- Quality Assurance Controls
- Eligibility Assessments
- EMR Systems
- Progress Evaluation
- Medical Records Management
- Verbal and Written Communication
- Interdisciplinary Collaboration
- Determine Medical Necessity
- Utilization Management
- Case Planning
- Case Planning and Management
- Resource Identification
- Multitasking and Organization
- Utilization Criteria
- Resource Management
- Case Management Tracking
Timeline
Structural Heart Coordinator
Rapides Regional Medical Center
08.2018 - Current
Care Assure Nurse Navigator
HCA Healthcare
02.2016 - 08.2018
RN Case Manager
Christus St Frances Cabrini Hospital
07.2014 - 11.2015
Nurse Liaison
Healthsouth Corporation
01.2014 - 06.2015
Adjunct Instructor
Louisiana College
01.2009 - 05.2010
Staff RN
Rapides Regional Medical Center
01.2008 - 09.2013
Clinical Educator, Staff RN
Christus St Frances Cabrini Hospital
01.1997 - 01.2007
Staff RN
Winn Parrish Medical Center
01.1996 - 01.1997
Staff RN
St Frances Cabrini Hospital
01.1995 - 01.1996
B.S - Nursing
Louisiana College