Audra Cureton
Bethel Island,California
Summary
Patient-oriented, compassionate Nurse leader with a 13-year history in direct patient care, leadership and healthcare administration. Highly accomplished in precepting and educating healthcare teams to enhance patient care standards. Skilled in administering quality care to patients in long-term, home, hospice, medical-surgical, Neuroscience, Case Management and rehabilitative environments. Demonstrated leadership abilities that guide teams towards excellence in producing positive patient outcomes.
Overview
14
14
years of professional experience
1
1
Certification
Work History
Case Manager (Travel)
Medical Solutions Travel Agency
Omaha, NE
07.2023 - Current
- Provided case management services including intake, assessment, crisis intervention, advocacy, referral and monitoring of families.
- Collaborated with healthcare team to improve care quality, reduce costs and gauge patient progress.
- Updated and maintained discharge plan of care with physician, members of healthcare team, patients and families.
- Collaborated with physicians during medical rounds, updated treatment plans and provided plan of care to patients and families.
- Advocated for patients by identifying insurance coverage, communicating care preferences to practitioners and verifying interventions met patients' treatment goals.
- Obtained recommendations for inpatient or outpatient level of care by discussing cases with physician advisor.
- Arranged placement of admissions and transfers in accordance with clinical standards and guidelines.
Hospice Manager
Continuum Hospice
Concord, CA
11.2022 - Current
- Established solid relations with leadership and staff by attending board meetings and coordinating interdepartmental information exchanges.
- Maintained communication and transparency with governing boards, department heads and medical staff.
- Assessed need for additional staff, equipment and services based on historical data and seasonal trends.
- Administered fiscal operations for accounting, budget planning, authorizing expenditures and coordinating reporting.
- Utilized effective interpersonal, writing and active listening skills to build and cultivate positive relationships with patients, caregivers and physicians.
- Achieved departmental goals and objectives by instituting new processes and standards for patient care.
Director of Case Management
Kaiser Permanente
Antioch, CA
08.2020 - 05.2022
- Oversees the utilization management functions across the region in accordance to policies and procedures as well as federal, state and local regulations.
- Directs, organizes, plans and coordinates the utilization/ resource management and social services process assuring that the organizational goals and objectives for KFH/P are met. Directs development and implementation of quality and utilization standards across the hospital to ensure coordinated plans of treatment, customer focused delivery of services, and cost effective utilization of necessary services.
- Collaborates with other Service Directors in identifying and implementing innovative models and best practices, Develops services that achieve a high level of customer satisfaction. Utilizes research data to implement clinical changes and the delivery of patient care and member services.
- Responsible for efficient utilization of resources and develops processes to screen, interview, hire, train, and maintain the competency of all department staff.
- Develops, implements, and monitors departmental policies and procedures which support and meet the organizations goals and business objectives. Manages and resolves human resource, labor relations, employee, and department safety and risk management issues.
Manager of Case Management
Brown & Toland Medical Group
Oakland, CA
06.2019 - 08.2020
- Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out of network services, and appropriateness of treatment setting by utilizing the applicable medical policy and industry standards, accurately interpreting benefits and managed care products, and steering members to appropriate providers, programs or community resources. General knowledge of commercial coverage plans and usually covered benefits. Strong understanding of various reimbursement models and impact to care delivery, patient management and reimbursements such as ACOs, DRGs, Full Risk, etc.
- Works with medical directors in interpreting appropriateness of care and accurate claims payment. May also manage appeals for
services denied. - Conducts pre-certification, continued stay review, care coordination, or discharge planning for appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.
- Strong knowledge of Medicare and Medi-Cal guidelines and benefit resources as applicable to hospitalization and transition planning.
- Create training material for the outpatient and Inpatient case management departments. Train new hires to perform utilization review job functions.
Hospice Admission Nurse/Per Diem Registered Nurse
Continuum Care Hospice
Antioch, CA
02.2019 - 01.2020
- Ensured that each patient and his or her family received superior level of compassionate nursing and palliative care.
- Listened to patients and loved ones, offering emotional support and kindness to help with the end-of-life transition.
- Planned hospice care for elderly and disabled patients.
- Utilized effective interpersonal, writing and active listening skills to build and cultivate positive relationships with patients, caregivers and physicians.
- Guided patients' loved ones and caregivers in such tasks as pain management, wound care, and medication dosing.
- Counseled caregivers and families on end-of-life planning and educated on patient care options.
- Helped patients and families feel comfortable during challenging and stressful situations, promoting recovery and reducing compliance issues.
RN Utilization Review/Case Manager (Kaiser)
The Judge Group Inc.
Irvine, CA
01.2019 - 06.2019
- Coordinated home care, home infusion, and durable medical equipment, reducing patient wait times.
- Conducts utilization review for in-house patients and/or those members at contracted facilities. Assists in the discharge planning process.
- Conducts clinical reviews based on established treatment criteria.
- Collaborates with physicians on clinical reviews and ensured each patient was transitioned to the appropriate level of care.
- Applied medical criteria and clinical judgement to researched cases to evaluate and establish determinations.
- Reviewed patient admissions to determine medical necessity as directed by the Interqual criteria.
- Determined medical necessity and cost-effectiveness of services through utilization review processes.
- Trained/Oriented newly hired case managers in the Emergency Department.
Workers' Compensation Case Manager
ExamWorks
Antioch, CA
08.2019 - 10.2019
- Effectively communicates with injured employees, medical professionals, field claims staff, attorneys, and others to obtain information, and to negotiate medical treatment and return to work plans using critical thinking skills, clinical expertise and other resources as needed to achieve an optimal case outcome.
- Utilizes the Nursing Process (assessment, diagnosis, planning, intervention and evaluation) to facilitate medical management to attain maximum medical improvement and return-to-work (RTW) per state jurisdictional requirements.
- Appropriately utilizes internal and external resources and referrals i.e., Utilization Review, Peer Review, Field Claims Specialists, Regional Medical Director Consults, and Vocational Rehabilitation to achieve best possible case outcome.
- Follows general technical direction from nurse manager, senior medical and disability case manager and/or CCMU staff to resolve highly complex medical and/or RTW issues and/or successfully manage catastrophic injuries.
- Documents all RN activities accurately, concisely and on a timely basis. This includes documenting the medical and disability case management strategies for claim resolution, based on clinical expertise. Adheres to confidentiality policy.
- Appropriately applies clinical expertise to claims and delivers services in an efficient and effective manner. Accurately and appropriately documents billable time for work performed.
- Conduct in-person visits on assigned cases with injured employees, medical professions and the employer to assess medical recovery, physical capabilities, RTW barriers, physical job requirements, modified duty opportunities.
Director of Nursing & Patient Care Services
TrueMed Home Health
Walnut Creek, CA
11.2017 - 06.2019
- Coordinated and supervises the delivery of home health services, activities and patient care provided by an interdisciplinary staff/team in the home setting.
- Formulated and monitors quality and performance criteria, policies procedures and service standards.
- Established, implemented, and maintained patient care and service standards to meet member service needs and expectations.
- Monitored and facilitated workflows, maximizing utilization of resources to provide the highest quality of care.
- Managed staff, provided clinical supervision and implements, delivers and evaluates/improves assigned programs and services.
- Ensured compliance in meeting all regulations and standards related to home health, Medicare, TJC, Title 22, and other federal, state, and local requirements.
Ensures accuracy and completeness of patient records. - Identified service delivery/quality issues and implements corrective actions/plans for improvement.
- Determined the appropriate staffing requirements and develops processes to interview, hire, train and maintain the competency of all department staff.
Director of Nursing
Legacy Nursing & Rehabilitation Center
Martinez, CA
07.2016 - 11.2017
- Developed and maintained quality care systems and standards, including but not limited to, creating and improving medical protocols/guidelines for a 100 bed facility.
- Established and maintained positive relationships with government regulators, residents, families, other area health care providers, physicians and community at large.
- Ensured efficacy of treatments through monitoring of treatment regimens.
- Actively maintained up-to-date knowledge of applicable state and Federal laws and regulations.
- Monitored staffing patterns and nursing care hours for efficiency and made changes when necessary.
- Revised policies and procedures in accordance with changes in local, state and federal laws and regulations.
- Implemented changes needed to correct deficiencies found during government inspections.
- Budgeted, managed and scheduled a staff of 24 nurses, fostering a positive environment supportive of both staff and patients.
RN Case Manager (Contract)
Medical Staffing Solutions
Evansville, IN
05.2016 - 07.2016
- Prepared clients for discharge by reviewing amplifying discharge plans; coordinating discharge and post-discharge requirements, orienting and training family members; providing resources.
- Served as a liaison between medical doctors and other members of the interdisciplinary team
- Responsible for monitoring patients treatment and insurance coverage plans to ensure that their needs are entirely met.
- Assisted patients in navigating the health care system. Coordinate Specialty care and other resources.
- Ongoing evaluation and documentation of patient progress in EMR.
- Travel assignments include: Kaiser Antioch and John Muir Medical Center/float to the following departments: Orthopedics, Emergency Department, Telemetry, Med-surg, Neurosurgery, Palliative Care, Dialysis, Intensive Care Unit, Surgical, Oncology.
Registered Nurse Case Manager/Utilization Review
Hill Physicians Medical Group
San Ramon, CA
03.2014 - 05.2016
- Secured insurance authorizations to rehabilitation facilities or long-term care placement.
- Coordinated home care, home infusion, and durable medical equipment, reducing patient wait time by 79%.
- Arranged placement of admissions and transfers in accordance with clinical standards and guidelines.
- Obtained recommendations for inpatient or outpatient level of care by discussing cases with physician advisor.
- Helped patients navigate the healthcare system and their care plans by educating them on relevant subject areas and answering questions throughout the treatment process.
- Collaborated with physicians during medical rounds, updated treatment plans, and provided plan of care to patients and families.
Utilization Review Nurse Manager/Case Manager
UCSF Medical Center
San Francisco, CA
06.2011 - 02.2014
- Coordinated resources and services in response to individual patient's needs and fiscal realities, performs utilization review activities and oversees coordination of complex discharge planning for assigned case load, and facilitates patient movement through the continuum of care.
- Active member of the interdisciplinary team, contributes to team goal setting. Acts as a consultant to the clinical team, service lines and other departments and participates in program development and quality improvement initiatives.
- Provided age appropriate assessments, interpretation of data, and delivery of interventions.
- Demonstrated the ability to work with any patient regardless of race, gender, religious affiliation, cultural beliefs, lifestyle, and disease process or treatment plan.
- Trained and oriented new employees. Pilot discharge before noon program
- Float Case Manager: Neurosurgery, Hospice, Orthopedics, Telemetry, Med-Surg, General Surgery.
Education
Master of Science - Nursing
Capella University
Minneapolis, MN08.2023
Bachelor of Science - Nursing
Chamberlain College Of Nursing
2014
Skills
- Clinical Leadership
- Personnel management
- Relationship building
- Multidisciplinary Team Collaboration
- Service Utilization Improvements
- Problem-Solving
- Knowledge of Medicare, Medicaid, Managed Care
- Performance metrics
- Performance improvements
- Palliative Care
- Process Improvements
Affiliations
American Nurses Association
The Commission for Case Management
Certification
Basic Life Support (BLS) Certification; Expiration 12/2024
Registered Nurse in State of California - License 766859; Expiration 11/30/2023
Certified Case Manager -License #4210009; Expiration 11/30/2023
Timeline
Case Manager (Travel)
Medical Solutions Travel Agency
07.2023 - Current
Hospice Manager
Continuum Hospice
11.2022 - Current
Director of Case Management
Kaiser Permanente
08.2020 - 05.2022
Workers' Compensation Case Manager
ExamWorks
08.2019 - 10.2019
Manager of Case Management
Brown & Toland Medical Group
06.2019 - 08.2020
Hospice Admission Nurse/Per Diem Registered Nurse
Continuum Care Hospice
02.2019 - 01.2020
RN Utilization Review/Case Manager (Kaiser)
The Judge Group Inc.
01.2019 - 06.2019
Director of Nursing & Patient Care Services
TrueMed Home Health
11.2017 - 06.2019
Director of Nursing
Legacy Nursing & Rehabilitation Center
07.2016 - 11.2017
RN Case Manager (Contract)
Medical Staffing Solutions
05.2016 - 07.2016
Registered Nurse Case Manager/Utilization Review
Hill Physicians Medical Group
03.2014 - 05.2016
Utilization Review Nurse Manager/Case Manager
UCSF Medical Center
06.2011 - 02.2014
Master of Science - Nursing
Capella University
Bachelor of Science - Nursing
Chamberlain College Of Nursing