Angela Fye
North Wilkesboro,NC
Summary
Highly motivated Registered Nurse with over 21 years of experience possessing strong desire to take on new challenges. Strong work ethic, adaptability and exceptional interpersonal skills. Adepts at working effectively unsupervised and quickly mastering new skills. Smoothly deliver comprehensive patient care and delegate tasks according to patient needs and personnel skillsets. Dedicated to providing top quality care within multidisciplinary team environment. Detail oriented, responsive, and proficient.
Overview
21
21
years of professional experience
Work History
Utilization Management Nurse
Humana
Remote
06.2021 - 04.2022
- Enhanced patient care by conducting comprehensive assessments and implementing appropriate interventions.
- Reduced hospital readmissions through effective discharge planning and coordination of post-discharge care.
- Streamlined utilization review processes by collaborating with interdisciplinary teams to develop individualized care plans.
- Improved patient satisfaction scores by providing timely and accurate information on coverage, benefits, and authorization requirements.
- Maintained up-to-date knowledge of payer-specific guidelines to ensure accurate authorizations for medically necessary services.
- Coordinated seamless transitions of care across multiple settings including acute care hospitals, rehabilitation facilities, and home care services.
- Performed prior authorization review of services requiring notification.
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Submitted cases for criteria failures and helped facilitate resolutions and approvals.
- Participated in quality improvement initiatives to enhance the overall standard of care within the organization.
- Provided exceptional patient advocacy through active listening, empathy, and support during challenging situations.
Registered Nurse Case Manager
Humana
Remote
06.2019 - 06.2021
- Improved patient outcomes by consistently providing comprehensive assessments and developing tailored care plans.
- Enhanced interdisciplinary team communication through regular case conferences, promoting effective collaboration for optimal patient care.
- Streamlined care coordination processes to reduce hospital readmissions and emergency department visits.
- Evaluated patient progress and adjusted care plans accordingly, ensuring continuity of care across all healthcare settings.
- Implemented evidence-based nursing interventions, contributing to improved quality of care and patient satisfaction scores.
- Maintained detailed documentation of patient encounters, supporting accurate billing practices and data-driven decision making.
- Reduced unnecessary medical interventions by monitoring high-risk patients closely, intervening as needed based on clinical expertise.
- Conducted comprehensive assessments of patients'' physical, emotional, and social needs in order to develop individualized care plans that facilitated optimal health outcomes.
- Evaluated healthcare needs, goals for treatment, and available resources of each patient and connected to optimal providers and care.
- Responded promptly and professionally to patient questions and concerns.
- Performed evaluations on consistent basis to address changes in patient needs, conditions and medications, altering care plans when required.
- Liaised with physicians regarding patient needs, performance and changes.
- Developed care plans based on nursing diagnosis and incorporated therapeutic, preventive and rehabilitative nursing methods.
Home Health Registered Nurse Case Manager
Kindred Healthcare Inc.
Wilkesboro, NC
01.2001 - 04.2019
- Improved patient outcomes by implementing personalized care plans and closely monitoring progress.
- Collaborated with interdisciplinary team members for comprehensive patient assessments, resulting in tailored care strategies.
- Streamlined documentation processes to ensure accuracy and timely completion of required paperwork.
- Promoted patient self-management through health coaching and motivational interviewing techniques.
- Ensured regulatory compliance by adhering to federal, state, and agency guidelines in all aspects of home health nursing practice.
- Prevented complications by promptly identifying potential issues and taking appropriate action to address them.
- Maintained high-quality care standards by participating in ongoing professional development activities.
- Contributed to organizational goals by actively participating in performance improvement initiatives related to home health nursing practice.
- Enhanced overall quality of life for patients suffering from chronic illnesses using a holistic approach that addressed physical, emotional, psychological, social wellbeing.
- Took samples to complete diagnostic and routine assessment tests.
- Educated patients and families on disease processes, medications and treatments.
- Provided physical assessments, medication, and chronic disease management to home health patients.
- Coordinated with other healthcare team members to support patient needs.
- Administered medications and treatments as prescribed by physicians.
- Delivered after-hours care to patients based on strict role-call rotations.
- Monitored patient reactions after administering medications and IV therapies.
- Provided exceptional care to high-acute patients needing complex care such as ventilator management, extensive wound care and rehabilitation.
Education
Bachelor of Science - Nursing
09.2024
Associate of Science - Nursing
05.1998
Skills
- Utilization Review
- Time Management
- Organizational Skills
- Care Coordination
- Insurance Knowledge
- Problem Solving
- Performance Metrics
- Healthcare Regulations
- Critical Thinking
- Quality Improvement
- Medical Necessity Evaluation
- Interdisciplinary Collaboration
- Nursing Best Practices
- Case Management
- Healthcare Systems
- Discharge Planning Coordination
- Records Analysis
- Wound Care
- ICD-10
- Strong Clinical Judgment
References
References available upon request.
Timeline
Utilization Management Nurse - Humana
06.2021 - 04.2022
Registered Nurse Case Manager - Humana
06.2019 - 06.2021
Home Health Registered Nurse Case Manager - Kindred Healthcare Inc.
01.2001 - 04.2019
Capella - Bachelor of Science, Nursing
Wilkes Community College - Associate of Science, Nursing