Angela Wisdom
Soddy Daisy,TN
Summary
Versatile case management professional with proven track record in coordinating and optimizing client care processes. Expertise in assessing client needs, developing personalized plans, and connecting individuals with appropriate resources. Strong focus on team collaboration and achieving results, adaptable to changing needs, and skilled in communication, problem-solving, and time management. Reliable and goal-oriented, consistently ensuring high standards of service delivery.
Overview
20
20
years of professional experience
1
1
Certification
Work History
Case Manager Specialist
Lucet
12.2019 - Current
- Developed Eating Disorder Team. Established protocols, researched and developed company wide available resources: state-by-state list of facilities in each state and specific details of each one. Available information on staff education, websites containing educational, offers of assistance for funding, location of treatment facilities, and other items for both members and families.
- Provide appropriate referrals and assistance to providers in an effort to promote timely, quality care in the most appropriate treatment setting
- Analyzed case outcomes to identify trends and areas for improvement, driving continuous service enhancement.
- Conducted thorough assessments to identify client needs, laying groundwork for effective case management.
- Increased client satisfaction through diligent follow-up and personalized support.
- Collaborated with interdisciplinary teams to provide comprehensive support for clients facing complex challenges.
- Maintained current knowledge of industry best practices and relevant legislation affecting service delivery, ensuring that all client interventions were evidence-based and compliant with applicable guidelines.
- Established and maintained relationships with key stakeholders.
- Monitored program performance and outcomes for successful delivery of services.
- Facilitated successful transitions between levels of care by developing detailed discharge plans and coordinating resources.
- Strengthened relationships with community organizations to increase access to supportive resources for clients in need.
- Participated in regular professional development opportunities to stay current on best practices within the field of case management.
- Fostered open lines of communication with clients'' families and support networks, involving them in the case management process as appropriate.
- Assisted clients in setting achievable goals while providing ongoing encouragement and support throughout the process of reaching those objectives.
- Contributed to team discussions and case conferences actively, sharing insights and expertise with colleagues to optimize client support strategies.
- Enhanced communication between clients and providers through consistent follow-ups and progress updates.
- Educated clients on available programs, benefits, and services, empowering them to make informed decisions about their care needs.
- Monitored ongoing cases closely, adjusting case management strategies as needed based on evolving circumstances or new information.
- Conducted thorough assessments of clients'' situations, identifying issues, goals, and necessary interventions.
- Maintained accurate and timely documentation for all client interactions, ensuring compliance with regulatory requirements and confidentiality standards.
- Developed and implemented comprehensive case management plans to address client needs and goals.
- Notification to Medical Director and team of admit of high risk member. Notification to Medical Director approval of excessive days based on member presentation. Resulting in decrease in approval of unnecessary days, improved quality of care and education opportunity for utilization manager.
- Developed strong relationships with community partners, leading to increased availability of resources for clients in need.
- Conducted regular follow-up meetings with clients to monitor progress towards goals outlined in case plans while making adjustments as necessary.
- Coordinated services with other agencies, community-based organizations, and healthcare professionals to provide useful benefits to clients.
- Evaluated program effectiveness through ongoing monitoring and analysis of key performance indicators, driving continuous improvement efforts within the organization.
- Advocated for clients during meetings with service providers or legal representatives, promoting informed decision-making processes that respected individual autonomy and dignity.
- Implemented evidence-based interventions aimed at reducing recidivism rates among justice-involved clients.
- Conducted detailed assessments of clients'' needs, strengths, and barriers, ensuring appropriate resource allocation. Improved client outcomes by developing and implementing comprehensive case plans tailored to individual needs.
Nurse Unit Manager
Soddy Daisy Health Care Center
06.2019 - 12.2019
- Maintain nursing guidelines by writing and updating policies and procedures
- Maintain nursing operations by initiating, coordinating, and enforcing program, operational, and personnel policies and procedures
- Assure quality of care by developing and interpreting facility and nursing division’s philosophies and standards of care; enforces adherence to state board of nursing and state nurse practice act requirements and to other governing agency regulations; measure health outcomes against standards; making or recommending adjustments
- Maintain nursing staff job results by coaching, counseling, and disciplining employees; planning, monitoring, and appraising job results
- Facilitated smooth transitions between shifts, ensuring seamless continuity of care for all patients on the unit.
- Led staff meetings to keep team informed of departmental changes and provide opportunities for nurses to share ideas and concerns.
- Led teams in driving successful patient outcomes by prioritizing standard of care and best practices.
- Streamlined nurse scheduling, ensuring adequate coverage for all shifts while minimizing overtime costs.
- Investigated and independently resolved complaints from staff, physicians, and patients by leveraging clinical judgment and unit management expertise.
- Evaluated patient histories, complaints, and current symptoms.
- Conducted regular performance evaluations for nursing staff members, providing constructive feedback and identifying opportunities for improvement.
- Raised staff retention rates by fostering a positive work culture focused on professional growth and development.
- Collaborated with administrators to evaluate nursing policies and procedures for potential improvements regularly.
- Contributed to hospital-wide accreditation efforts, maintaining compliance with industry standards for nursing practice.
- Developed and implemented quality improvement initiatives to provide best possible patient care and identify and address areas of concern.
- Used first-hand knowledge and clinical expertise to advocate for patients under care and enacted prescribed treatment strategies.
- Sustained quality standards by performing routine medication audits and upholding internal and industry best practices.
- Participated in evidence-based practice project implementation, nursing competency development and nursing simulation activities.
- Evaluated skills of nursing personnel and verified staff certifications for validity.
- Quickly responded to situations impacting safety and security to unit, actualizing crisis prevention interventions to control and de-escalate situations.
- Investigated and resolved issues affecting hospital operations and patient care.
- Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
- Conducted performance evaluations and provided constructive feedback to support professional growth of nursing staff members.
- Monitored clinical outcomes closely, identifying areas for improvement and implementing corrective actions.
Utilization Management Nurse
Blue Cross Blue Shield Tennessee
04.2018 - 06.2019
- Enhanced patient care by conducting comprehensive assessments and implementing appropriate interventions.
- Ensured compliance with regulatory guidelines by staying current on industry standards and participating in ongoing education opportunities.
- Streamlined utilization review processes by collaborating with interdisciplinary teams to develop individualized care plans.
- Contributed to team success by consistently meeting productivity goals while maintaining high-quality standards in job performance.
- Coordinated seamless transitions of care across multiple settings including acute care hospitals, rehabilitation facilities, and home care services.
- Applied critical thinking skills to assess complex medical cases and determine appropriate levels of care in accordance with industry benchmarks.
- Investigated and resolved issues affecting hospital operations and patient care.
- Used first-hand knowledge and clinical expertise to advocate for patients under care and enacted prescribed treatment strategies.
- Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
- Reduced healthcare costs through efficient utilization of resources and identification of unnecessary treatments or procedures.
- Contributed to organizational success by providing expert advice on medical necessity criteria and evidence-based practices in utilization review nursing.
- Submitted cases for criteria failures and helped facilitate resolutions and approvals.
- Demonstrated commitment to ethical practice by upholding patient confidentiality and advocating for individual rights in all interactions with stakeholders.
- Optimized hospital stays by monitoring admissions for appropriateness based on established clinical guidelines while considering each patient''s unique circumstances.
- Maintained up-to-date knowledge of payer-specific guidelines to ensure accurate authorizations for medically necessary services.
- Supported cost containment efforts by identifying overutilization trends and recommending strategies for improvement.
- Worked effectively in fast-paced environments.
- Improved patient outcomes by meticulously reviewing patient records to ensure appropriate care levels.
- Skilled at working independently and collaboratively in a team environment.
HEDIS Review Clinician
Anthem Blue Cross Blue Shield
01.2018 - 04.2018
- Company Overview: Contract
- Collaborated with healthcare providers to ensure timely submission of required documentation for HEDIS review.
- Analyzed electronic health records to identify areas for care improvement and cost reduction.
- Maintained strict adherence to HIPAA regulations while handling sensitive patient information during the review process.
- Developed strong relationships with healthcare providers through effective communication and professional collaboration during the review process.
- Improved HEDIS performance by conducting thorough medical record reviews and data extraction.
- Participated in ongoing professional development opportunities to stay current with industry best practices for HEDIS review and reporting.
- Enhanced accuracy of HEDIS reporting through meticulous documentation and validation of collected data.
- Operated computer-based systems to retrieve and store information and records.
- Streamlined the data collection process, reducing time spent on manual record reviews and increasing efficiency.
- Demonstrated flexibility in adapting to changes in project scope or requirements, maintaining high standards of performance and accuracy at all times.
- Worked effectively in fast-paced environments.
- Skilled at working independently and collaboratively in a team environment.
- Excellent communication skills, both verbal and written.
- Demonstrated respect, friendliness and willingness to help wherever needed.
- Assisted with day-to-day operations, working efficiently and productively with all team members.
- Worked flexible hours across night, weekend, and holiday shifts.
- Organized and detail-oriented with a strong work ethic.
- Learned and adapted quickly to new technology and software applications.
- Demonstrated strong organizational and time management skills while managing multiple projects.
HEDIS Review Clinician
Blue Cross Blue Shield Tennessee
05.2017 - 01.2018
- Company Overview: Contract
- Collaborated with healthcare providers to ensure timely submission of required documentation for HEDIS review.
- Analyzed electronic health records to identify areas for care improvement and cost reduction.
- Maintained strict adherence to HIPAA regulations while handling sensitive patient information during the review process.
- Developed strong relationships with healthcare providers through effective communication and professional collaboration during the review process.
- Improved HEDIS performance by conducting thorough medical record reviews and data extraction.
- Participated in ongoing professional development opportunities to stay current with industry best practices for HEDIS review and reporting.
- Enhanced accuracy of HEDIS reporting through meticulous documentation and validation of collected data.
- Operated computer-based systems to retrieve and store information and records.
- Streamlined the data collection process, reducing time spent on manual record reviews and increasing efficiency.
- Demonstrated flexibility in adapting to changes in project scope or requirements, maintaining high standards of performance and accuracy at all times.
- Worked effectively in fast-paced environments.
- Skilled at working independently and collaboratively in a team environment.
- Excellent communication skills, both verbal and written.
- Demonstrated respect, friendliness and willingness to help wherever needed.
- Assisted with day-to-day operations, working efficiently and productively with all team members.
- Worked flexible hours across night, weekend, and holiday shifts.
- Organized and detail-oriented with a strong work ethic.
- Learned and adapted quickly to new technology and software applications.
- Demonstrated strong organizational and time management skills while managing multiple projects.
Telehealth Nurse Clinical Manager
TeamHealth Medical Call Center
05.2015 - 04.2017
- Participated in quality improvement initiatives related to telehealth nursing practice, enhancing service delivery and patient experience.
- Managed and motivated employees to be productive and engaged in work.
- Enhanced customer satisfaction by resolving disputes promptly, maintaining open lines of communication, and ensuring high-quality service delivery.
- Maximized performance by monitoring daily activities and mentoring team members.
- Assisted in organizing and overseeing assignments to drive operational excellence.
- Enhanced team productivity by implementing agile methodologies, leading to more efficient project completion.
- Organized professional development programs for staff, leading to improved performance and skill sets.
- Boosted employee morale and reduced turnover through development and implementation of comprehensive rewards and recognition program.
- Streamlined workflows by identifying bottlenecks in existing systems and implementing appropriate solutions.
- Cultivated positive rapport with fellow employees to boost company morale and promote employee retention.
- Reduced operational costs through comprehensive process improvement initiatives and resource management.
Department Head Allied Health
Delta Career Education Corporation
01.2015 - 05.2015
- Maintained detailed records of student attendance, participation, and academic performance for accurate reporting and evaluation purposes.
- Maintained regular office hours to provide struggling students with additional course help.
- Assessed students' progress and provided feedback to enhance learning.
- Designed course materials that aligned with learning objectives while also meeting diverse learning needs of the student population.
- Served on college committees focused on improving academic programs, policies, or procedures for greater institutional effectiveness.
- Evaluated and supervised student activities and performance levels to provide reports on academic progress.
- Collaborated with colleagues on curriculum development, incorporating best practices for effective instruction and learning outcomes.
- Developed diversified course curriculum to meet regulatory standards and support learning objectives.
- Designed and implemented various educational activities and programs to meet student needs.
- Ensured curriculum alignment with academic standards through regular course review and updates.
- Reviewed program materials and coordinated updates to keep department materials relevant and accurate.
- Assisted in accreditation processes by gathering necessary documentation, preparing reports, and participating in site visits as needed.
- Mentored junior faculty members, providing guidance on teaching methodologies, research projects, and academic publishing.
- Passionate about learning and committed to continual improvement.
- Worked flexible hours across night, weekend, and holiday shifts.
Department Head Medical Assisting Program
Education Corporation of America
11.2012 - 11.2014
- Maintained detailed records of student attendance, participation, and academic performance for accurate reporting and evaluation purposes.
- Maintained regular office hours to provide struggling students with additional course help.
- Assessed students' progress and provided feedback to enhance learning.
- Designed course materials that aligned with learning objectives while also meeting diverse learning needs of the student population.
- Served on college committees focused on improving academic programs, policies, or procedures for greater institutional effectiveness.
- Evaluated and supervised student activities and performance levels to provide reports on academic progress.
- Collaborated with colleagues on curriculum development, incorporating best practices for effective instruction and learning outcomes.
- Developed diversified course curriculum to meet regulatory standards and support learning objectives.
- Designed and implemented various educational activities and programs to meet student needs.
- Ensured curriculum alignment with academic standards through regular course review and updates.
- Reviewed program materials and coordinated updates to keep department materials relevant and accurate.
- Assisted in accreditation processes by gathering necessary documentation, preparing reports, and participating in site visits as needed.
- Mentored junior faculty members, providing guidance on teaching methodologies, research projects, and academic publishing.
- Passionate about learning and committed to continual improvement.
- Worked flexible hours across night, weekend, and holiday shifts.
Clinical Lead Behavior Health
Mountain States Health Alliance
10.2004 - 07.2007
- Responsible for day-to-day operations of acute sections
- Managed 25 plus employees clinical and nonclinical
- Collaborated with physicians and interdisciplinary teams to arrange discharge outcomes for discharged patients based on assessment of patient’s health
Education
Diploma - Nursing
St. Mary’s Medical Center School of Nursing
Master of Science - Nursing
University of Phoenix
10.2007
Bachelor of Science in Nursing - Nursing
University of Phoenix
05.2005
Skills
- Client advocacy
- Ethical practice
- Case assessment
- Problem-solving
- Critical thinking
- Team collaboration
- Verbal and written communication
- Decision-making
- Data entry and analysis
- Client relationship management
- Case management
- Utilization review
Certification
- Certified Case Manager
Timeline
Case Manager Specialist
Lucet
12.2019 - Current
Nurse Unit Manager
Soddy Daisy Health Care Center
06.2019 - 12.2019
Utilization Management Nurse
Blue Cross Blue Shield Tennessee
04.2018 - 06.2019
HEDIS Review Clinician
Anthem Blue Cross Blue Shield
01.2018 - 04.2018
HEDIS Review Clinician
Blue Cross Blue Shield Tennessee
05.2017 - 01.2018
Telehealth Nurse Clinical Manager
TeamHealth Medical Call Center
05.2015 - 04.2017
Department Head Allied Health
Delta Career Education Corporation
01.2015 - 05.2015
Department Head Medical Assisting Program
Education Corporation of America
11.2012 - 11.2014
Clinical Lead Behavior Health
Mountain States Health Alliance
10.2004 - 07.2007
- Certified Case Manager
Diploma - Nursing
St. Mary’s Medical Center School of Nursing
Master of Science - Nursing
University of Phoenix
Bachelor of Science in Nursing - Nursing
University of Phoenix
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