Registered nurse and certified case manager with three years of workers compensation case management, ten years of Utilization/Case management at an insurance agency and a total of twenty seven years as a registered nurse in the state of Texas. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
As a workers' compensation nurse, I utilize carrier specific networks to coordinate physician and provider care for the injured worker, perform onsite medical reviews at appointments, provide education to the injured worker and advocate for the injured worker. I perform 90% field case management and 10% telephonic case management. I mentor new case managers.
Following NICU babies in facilities that have United Healthcare insurance and the care they are receiving Approve and/or deny days based on MCG guidelines, acuity and status of care using medical necessity. Work with Case Manager of facility to facilitate discharge and anticipate potential discharge needs. Assist with any anticipated needs and ensure in network doctors. Provide facility with DME’s and home care companies that are approved through UHC. Work with Medical Directors at UHC to help facilitate discharge of NICU in a timely manner. Follow up with families post discharge to see how infant is progressing at home and assist with any needs of the family.
Assessed, evaluated and cared for neonate and pediatric patients.
Communicated with family members and loved ones to provide information about patient care, treatments and medical options.
Administered medications and fluids and checked vital signs on critically ill newborns.
Provided high level of quality care for each and every patient in 90-bed neonatal ICU unit.