Amy Merila
Paragould,AR
Summary
Dedicated Registered Nurse (RN) with progressive career history in case management, clinical documentation review, quality management, utilization management, home health care, hospice, and acute care. Experience in managed care organization, medical group, and HMO settings. Proven ability to build positive relationships with leaders, patients, members, family members, coworkers, and providers. Advocate and collaborator who empowers others with use of empathy, sincerity, and passion to enhance teamwork and improve outcomes.
Overview
18
18
years of professional experience
1
1
Certification
Work History
RN Weekend Manager
Hospice Of Michigan
09.2023 - Current
- Manage weekend operations of patient care activity and outcomes within the assigned area(s) of responsibility for a regionally based team(s) and ensures that a culture of compliance, accountability, patient outcomes and excellence is maintained. Collaborates extensively with staff and management from multiple departments to achieve outcomes.
- Performs management duties as manager on-call for triage clients with duties ranging from simple front-line support to full management responsibilities.
- Assist with prioritizing patient and family needs on the weekends.
- Actively keeps abreast of hospice and palliative care trends, best practices, and compliance requirements.
- Actively lead and promote a culture of excellence and innovation to continually improve employee engagement.
- Actively applies an inclusive management style.
- Works with colleagues from other department including other clinical operation departments and triage clients to facilitate excellent patient care on the weekends.
- Assists the Managers, Contact Center, with other responsibilities as assigned including but not limited to auditing charts, implementing processes, scheduling and payroll, and licensing.
- Assists the Manager, Contact Center in managing employee performance within assigned area(s) of responsibility.
- Assists the Managers, Contact Center in ensuring competency of staff with all EMR’s, triage client processes and referral and scheduling processes.
Quality Management Nurse Consultant
Aetna
08.2022 - Current
- Clinical documentation review of critical incident reports for DSNP Duals members in the states of Illinois and Michigan, who have risk to their health, safety, and welfare
- Use of critical thinking skills, nursing assessment, nursing judgement and company processes to develop a plan of care and provide direction to case managers to ensure the health, safety, and welfare of the members
- Provide ongoing education to case managers on critical incident company and state processes for compliance with required criteria
- Complete quality review of critical incidents within required timeframes
- Implementation of critical incident program for newly onboarded states
- Implementation process includes detailed program education to case manager supervisors and case managers
- Development of job aides and processes for critical incident reporting, specific to each state’s mandated criteria
- Participation in implementation planning and meetings
- Provide ongoing education of critical incident reporting and processes for current and new employees
- Daily use of Microsoft Office Suite
- Collaborate with clients, interdisciplinary teams, and coworkers to meet optimal outcomes for members
- Provide high level of service to members to meet quality indicators
- Manage high level of electronic correspondence daily, to provide prompt intervention and collaboration to case managers, administration/leadership, ancillary staff, and colleagues
- Leverage quality management tools to help interdisciplinary teams achieve optimal outcomes for members
- Utilize clinical guidelines, standardized care management plans, policies, procedures, and regulatory standards to resolve critical incident reports
- Use of multiple programs and data bases including Dynamo, QNXT, Med Compass, and multiple states critical incident reporting systems.
Registered Nurse Case Management Coordinator
Aetna
07.2013 - 08.2022
- Clinical documentation review of case management referrals for high cost, high acuity members using strong critical thinking skills, nursing assessment, nursing judgement and company processes to determine entry into case management services
- Daily use of Microsoft Office Suite
- Collaborate with clients, interdisciplinary teams, and coworkers to meet optimal outcomes for members
- Review reports from dedicated clients for high dollar claim triggers on members
- Assist with implementation of new processes to streamline productivity
- Provide high level of service to members to meet quality indicators
- Participate in continuing education
- Manage high level of electronic correspondence daily, to provide prompt intervention to client, administration, and colleagues needs
- Leverage case management tools to help interdisciplinary teams achieve optimal outcomes
- Collaborate with multidisciplinary teams to facilitate client care and reduce case management barriers
- Foster professional networks and relationships with service and resource providers to promote continuity and quality of care for clients
- Utilize clinical guidelines, standardized care management plans, policies, procedures, and regulatory standards while assessing benefits and member's needs to ensure appropriate administration of benefits
- Collaborate with clinical colleagues, supervisors, Medical Directors, and/or other programs to overcome barriers to meeting goals and objectives for members served
- Utilize case management process according to policies and procedures
- Reach out to members according to acuity level to collaborate and guide their care
- Discharge planning for members in acute or long-term care facilities
- Medication reconciliation and education
- Award for outstanding service as well and for outstanding case management and collaboration of care for a very high-risk high-cost member with complex comorbidities
- Develop and modify patient care plans and assist interdisciplinary team in identifying client needs and goals to determine priorities of care
- Educate patients and caregivers on healthcare protocols and processes
- Educate patients on disease management including diabetes, heart disease, and preventative care
- Utilization management/review with use of Milliman Clinical Guidelines and Aetna Clinical Policy Bulletins to determine approval or denial of claims
- Focus group leader for CMC department 2021-2022
- Leadership of department colleagues.
Registered Nurse Case Manager
Brightstar Care
07.2016 - 01.2018
- Provide case management services for Medicare members with high-cost claims for multiple hospitalizations within a 6-month period
- Complete in-home health assessments, care planning, medication reconciliation, disease management with emphasis on diabetic education, and coordination of outpatient services
- Employee of the month recognition
- Develop and modify patient care plans and assist interdisciplinary team in identifying client needs and goals to determine priorities of care
- Gather and record patient health information and data to assess, identify and manage characteristics that affect care outcome
- Quality review of charts for HEDIS measures to identify areas of improvement
- Patient education on local resources and programs to promote safety in the home.
Registered Nurse Care Coordinator
Mayo Clinic Health Systems
01.2012 - 01.2013
- Assist with implementation of a new population health program with a Medicare third party payor in collaboration as a joint venture
- Complete patient health assessments, care plans, medication reconciliation, and patient education
- Evaluate and interpret HEDIS data
- Identify areas of improvement of HEDIS measures
- Collaborate with program leaders in program development and implementation.
Registered Nurse Case Manager
Home Health
01.2009 - 01.2012
- Manage a caseload of home health patients, providing skilled direct fundamental nursing care, health assessment, care planning, and collaborating with patients, providers, outpatient services, and inpatient services
- Care provided across the spectrum of ages from pediatric, maternity, to geriatric
- Leadership, supervision, and training of licensed practical nurses
- Recognized for outstanding documentation with the use of OASIS tool
- Leadership, supervision, and training of home health care aides including onboarding of new employees, delegation, performance review, and conflict resolution
- Development and implementation of the Mother Infant Program for Medicaid members.
Registered Nurse
Arkansas Methodist Medical Center
01.2006 - 01.2009
- Experience in ICU, ER, and Med/Surg units
- Provide skilled nursing care to critically ill patients in ICU
- IV infusions, medication drips, ventilator management, NG tube insertion and management, foley catheter care, wound care, medication management, prepared patients for procedures and tests
- Interpret lab results
- Complete physical assessments, care planning, and patient/family education
- Collaborated care with physicians, coworkers, and interdisciplinary teams
- Manage care from admission to discharge with interdisciplinary collaboration
- Provide direct patient care, stabilize patients, and determine next course of action for optimal patient outcomes
- Charge nurse for Emergency Department and Med/Surg unit
- Leadership and management of the staffing, patient assignments, delegation, conflict resolution, time management, and teamwork
- Supervision of licensed practical nurses and certified nursing assistants.
Education
Master of Science in Nursing: Nurse Administrator -
Arkansas State University
05.2023
Bachelor of Science in Nursing -
Arkansas State University
05.2006
Skills
- Excellent written and verbal communication skills
- Analytical and Critical Thinking
- Initiative-taking
- Strong attention to detail
- Documentation and clinical review
- Strong organizational skills
- Remote work environment
- Conflict resolution
- Collaboration talent
- Problem solving skills
- Leadership experience and skills
- Case Management
- Care Coordination
- Quality Improvement
Certification
- Registered Nurse, Board Examination, State of Arkansas, 2006, Arkansas
- Registered Nurse, Endorsement, State of Illinois, 2024, Illinois
- Registered Nurse, Endorsement, State of Michigan, 2024, Michigan
- Certified Case Manager (CCM) by Commission for Case Manager Certification, 2025
- BLS Certification, American Heart Association, 2024
Personal Information
Title: MSN, RN, CCM
Timeline
RN Weekend Manager
Hospice Of Michigan
09.2023 - Current
Quality Management Nurse Consultant
Aetna
08.2022 - Current
Registered Nurse Case Manager
Brightstar Care
07.2016 - 01.2018
Registered Nurse Case Management Coordinator
Aetna
07.2013 - 08.2022
Registered Nurse Care Coordinator
Mayo Clinic Health Systems
01.2012 - 01.2013
Registered Nurse Case Manager
Home Health
01.2009 - 01.2012
Registered Nurse
Arkansas Methodist Medical Center
01.2006 - 01.2009
Master of Science in Nursing: Nurse Administrator -
Arkansas State University
Bachelor of Science in Nursing -
Arkansas State University