Mercy Smithwick
Morris Plains,USA
Summary
Registered Nurse with active New York and NLC licenses, specializing in telephonic care management. Over 7 years of experience in developing and monitoring person-centered service plans, coordinating with interdisciplinary teams, and educating members on health management to enhance quality and cost-effective care.
Overview
1
1
Certification
32
32
years of professional experience
Work History
Nurse Care Manager – LTSS Care Manager Disease Management
Emblem Health
Brooklyn, NY
11.2022 - Current
- Develops, implements, and monitors person-centered service plan, and ensures continuity of care across all healthcare settings by collaborating with the interdisciplinary care team, PCP, member/member's representatives, and specialists.
- Provide case management to our members including medical, social, psychological, physical and spiritual needs by developing, implementing and monitoring the care plan, in conjunction with the PCP, caregivers and other team members, to help meet the member's needs.
- Conducted telephonic assessments of members' medical, psychosocial, physical, and spiritual needs to inform care decisions.
- Instructed members on disease processes, preventative health measures, and quality of life interventions to enhance overall well-being.
- Leveraged benefit structure and community-based resources to effectively address member needs.
- Knowledgeable in and adheres to CMS/DOH regulations and policies.
Nurse Care Manager – DSNP
Elderplan, an MJHS Company
Brooklyn, NY
06.2021 - 11.2022
- Managed comprehensive case management for members' medical, social, psychological, physical, and spiritual needs by developing, implementing, and monitoring care plans with PCP, caregivers, and interdisciplinary team, ensuring holistic support for members.
- Develops, implements, and monitors person-centered service plan, and ensures continuity of care across all healthcare settings by collaborating with the interdisciplinary care team, PCP, member/member's representatives, and specialists.
- Provides telephonic assessments of members' medical, psychosocial, physical and spiritual needs.
- Leveraged benefit structure and community resources to effectively address and fulfill members' diverse needs.
- Provided education to members on disease processes, preventive health, and quality of life interventions, empowering them to make informed health decisions.
- Knowledgeable in and adheres to CMS/DOH regulations and policies.
RN Nurse Care Manager / Care Management
Centene Corporation
Suffern, NY
09.2016 - 03.2021
- Performing ongoing Telephonic care management duties including member assessments, coordinating, and planning all aspects of medical and supporting services for members to promote quality and cost-effective care.
- Developed, assessed, and adjusted the care plan to promote desired outcomes.
- Assess the member's current health status, resource utilization, past and present treatment plan and services-, prognosis-, short- and long-term goals, treatment, and provider options.
- Coordinated services among PCPs, specialists, medical providers, and non-medical staff to address comprehensive medical and socio-economic needs of clients.
- Maintaining and documenting assessments, Reviewing Concurrent and Prior Authorizations, and pertinent clinical information into appropriate medical management systems.
- Review of requested clinical services, evaluation of medical records and submitting them to Utilization Team.
- Participated in integrated team care management rounds to enhance collaborative decision-making.
- Identified risk management quality concerns and reported scenarios to appropriate resources for timely resolution.
RN Case Manager
United Health Group / Optum
Atlanta, GA
04.2012 - 08.2016
- Followed up on members post-hospital discharge, educating them on readmission prevention and health management through telephone calls.
- Performed Case management and disease process management of chronic conditions, such as diabetes, heart failure, chronic obstructive airway disease.
- Identified gaps and barriers in treatment plans to enhance member care.
- Assessed and interpreted beneficiary needs, gaps, and requirements related to members' condition and care needs.
- Assessed members' current health status on short- and long-term disability through outbound calls.
- Conducted pre-admission counseling for members.
Medical Case Manager
Hartford Life
Alpharetta, GA
06.2009 - 03.2012
- Coordinated communication and care planning among healthcare providers to optimize treatment and support for members.
- Managed case and conducted medical reviews for members post-hospital discharge and those with chronic conditions on short term disability to ensure proper care and support.
- Educated patients to enhance self-management and understanding of their health conditions.
- Directed members to specialized services and resources to address their specific needs.
- Interacted with Medical Directors on challenging cases.
Field RN Care Manager / Clinical Coordinator / Quality Assurance
United Home Care - Pruitt Corporation
Atlanta, GA
08.2005 - 06.2009
- Oversaw field case reviews for Medicare members with chronic or acute conditions and recent hospital discharges, ensuring comprehensive care coordination.
- Conducted quality assurance reviews of clinical records and documentation to enhance compliance and accuracy.
- Ensured compliance, reviewed medical records, OASIS and completed required clinical medical reviews submitted, timely.
- Performed active chart review ensured completeness of the medical record on an ongoing basis.
- Analyzed all provided and collected audit data, identified trends for staff re-training.
- Provided Clinical education and onsite assessment of clinical assessment of Care Nurse Aids.
- Developed interdisciplinary care plans and other case management tools by participating in meetings.
- Accurately and consistently Monitored delivery of care by completing patient rounds.
- Documented accurate care and identified progress toward desired care outcomes.
- Assessed outcomes of care in collaboration with interdisciplinary team, measuring effectiveness of interventions to inform future care strategies.
Senior RN Trauma and Orthopedics
Dekalb Medical Center
Atlanta, Georgia
08.2003 - 11.2005
- Performed phlebotomy, IV infusions, tracheotomy procedures, Incubation and extubating patients, post anesthetic care as required in all nursing aspects.
- Designed comprehensive in-service training in family planning, health education, trauma, and orthopedic rehab.
- Assessing, planning, implementing, and evaluating patient care plans in consultation with healthcare professionals.
- Evaluated medical information and provided direct bedside nursing care to pre-and post-surgery patients.
- Preparing, administering, and recording prescribed medications.
- Changed wound dressings to promote healing and prevent infection., inserting catheters, and starting IVs.
- Adjusting specialized medical equipment as needed, as well as interpreting and recording measurements.
- Monitoring patients' vitals and reporting adverse reactions to medications in a timely manner.
- Collaborated with healthcare team to develop effective discharge plans for patients. with the healthcare team.
- Answered patient and family questions to provide clarity on surgical procedures. and educating patients and their families on surgical procedures and post-surgery care.
- Maintaining and updating patient files, medical charts, and health records.
- Adhering to best nursing practices, standards, and protocols.
Senior RN E Grade Trauma Orthopedics Unit
Heartlands Hospital East
Birmingham, U.K
12.1999 - 04.2003
- Assessing, planning, implementing, and evaluating patient care plans in consultation with healthcare professionals.
- Evaluated medical information and provided direct, individualized bedside nursing care to pre- and post-surgery patients, ensuring optimal recovery.
- Preparing, administering and recording prescribed medications.
- Changing dressings, inserting catheters, and starting IVs.
- Adjusted specialized medical equipment and interpreted measurements.
- Monitoring patients' vitals and reporting adverse reactions to medications in a timely manner.
- Collaborated on discharge planning with healthcare team to facilitate smooth transitions and continuity of care.
- Educated patients and their families on surgical procedures and post-surgery care, enhancing understanding and compliance.
- Attending and scheduling Interdisciplinary team meetings and providing reports to Doctors and Nursing team.
- Accurately documenting plan of care and communication for continuity of care.
- Birmingham U.K
RN D Grade - Trauma Center, Burns Unit, Orthopedics
Selly Oak Queen Elizabeth University Hospital
, U.K
05.1997 - 11.1999
- Triage patients and evaluate the severity of the patient’s injuries.
- Delivered nursing interventions during emergency situations to stabilize patients.
- Provide IV insertion, intubation, medicine administration, blood drawing, and many other medical procedures.
- Prepare patients for surgery or diagnostic testing.
- Preparing, administering, and recording prescribed medications.
- Performed wound care, catheter insertion, and IV initiation to ensure patient comfort and safety.
- Monitoring patients' vitals and reporting adverse reactions to medications in a timely manner.
- Adjusted specialized medical equipment and interpreted measurements.
- Collaborated within U.K. healthcare setting to enhance patient care delivery.
Registered Charge Night Nurse
Ranburg Medical Center
, South Africa
05.1994 - 03.1997
- Quickly and accurately assessed patient care needs.
- Collaborated with doctors and staff to enhance patient care quality.
- Performed all requested diagnostic tests.
- Diagnosed and developed treatment plans collaboratively with doctors and staff.
- Managed multiple cases, prioritizing patient needs to ensure timely interventions.
- Always complied with all legal and safety requirements.
- Worked at maximum efficiency without compromising quality of care.
- Acted in a composed and professional manner, especially under pressure.
- Monitored coworkers' performance and addressed concerns to reduce potential errors.
- Provided follow up care instructions to patients and made necessary referrals.
- Maintained accurate and up-to-date patient charts.
- Worked in Johannesburg, South Africa, providing healthcare services.
Education
Bachelor of Science - Nursing
United Kingdom Central Council for Nursing
Registered Nursing Diploma / Associate of Science -
Andrew Flemming Parirenyatwa School of Nursing
HarareCertification
- Georgia, RN License, RN171615 (Compact)
- New York, RN License, #784880
- Texas, RN License
- Nurse Licensure Compact, RN Nursing License
Personal Information
Title: RN, BSN
Timeline
Nurse Care Manager – LTSS Care Manager Disease Management
Emblem Health
11.2022 - Current
Nurse Care Manager – DSNP
Elderplan, an MJHS Company
06.2021 - 11.2022
RN Nurse Care Manager / Care Management
Centene Corporation
09.2016 - 03.2021
RN Case Manager
United Health Group / Optum
04.2012 - 08.2016
Medical Case Manager
Hartford Life
06.2009 - 03.2012
Field RN Care Manager / Clinical Coordinator / Quality Assurance
United Home Care - Pruitt Corporation
08.2005 - 06.2009
Senior RN Trauma and Orthopedics
Dekalb Medical Center
08.2003 - 11.2005
Senior RN E Grade Trauma Orthopedics Unit
Heartlands Hospital East
12.1999 - 04.2003
RN D Grade - Trauma Center, Burns Unit, Orthopedics
Selly Oak Queen Elizabeth University Hospital
05.1997 - 11.1999
Registered Charge Night Nurse
Ranburg Medical Center
05.1994 - 03.1997
Bachelor of Science - Nursing
United Kingdom Central Council for Nursing
Registered Nursing Diploma / Associate of Science -
Andrew Flemming Parirenyatwa School of Nursing