Summary
Overview
Work History
Education
Skills
Additional Information
Timeline
Generic

Barbara Drayton

PORT RICHEY,FL

Summary

Proactive Case Manager and Nurse Case Manager with extensive experience in concurrent reviews, patient education, and interdisciplinary collaboration. Demonstrated success in optimizing resource utilization, regulatory compliance, and improving patient outcomes. Skilled in care coordination, discharge planning, and client advocacy, bringing a comprehensive approach to patient care. Talented Case Manager adept at handling high caseloads without sacrificing quality of care. Operates in high-pressure environments while recommending best resources and courses of action to benefit patient needs and return each to optimal quality of life. Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy.

Hardworking and passionate job seeker with strong organizational skills eager to secure a position, where I can utilized my medical and nursing knowledge. Ready to help team achieve company goals.

I have been retired for a few years but still wish to utilize the formal and informal knowledge I have acquired though out my work life.

Overview

33
33
years of professional experience

Work History

Case Manager

Emblem Health Insurance
New York, NY
04.2004 - 02.2017

Maintained accurate documentation on all cases, ensuring compliance with regulations and confidentiality requirements.

  • Conducted thorough assessments of clients'' situations, identifying issues, goals, and necessary interventions.
  • Monitored ongoing cases closely, adjusting case management strategies as needed based on evolving circumstances or new information.
  • Educated clients on available programs, benefits, and services, empowering them to make informed decisions about their care needs.
  • Educated patients and caregivers on healthcare protocols and processes.
  • Served as a liaison between patients and various support services such as financial assistance programs, community resources, and mental health counseling to ensure holistic care was provided.
  • Collaborated with healthcare leaders and physicians to support and offer resources in performance of duties to maintain high-quality and efficient patient care.
  • Managed support services and fostered communication among social workers, therapists, hospital staff, and patients.
  • Applied critical thinking skills during case reviews to identify potential risks or challenges before they escalated into larger issues.
  • Promoted continuity of care by coordinating with healthcare providers, social workers, and family members in the development of discharge plans.
  • Educated patients on disease management techniques, empowering them to take control of their health and reduce complications.
  • Developed and modified patient care plans and assisted interdisciplinary team in identifying client needs and goals to determine priorities of care.
  • Ensured regulatory compliance by staying current on industry best practices and maintaining meticulous documentation records.
  • Optimized resource utilization by identifying opportunities for cost containment without compromising care quality.
  • Facilitated smooth transitions between healthcare settings by effectively communicating pertinent information to receiving facilities or home health agencies.
  • Enhanced interdisciplinary team communication, ensuring timely and accurate updates on patient progress.
  • Gathered and recorded patient health information and data to assess, identify and manage characteristics that affect care outcome.
  • Implemented aspects of patient care under physician orders and sought clarification when needed to promote safety, quality and cost-efficient care.
  • Collaborated with multidisciplinary teams to devise evidence-based treatment plans that improved patient satisfaction scores.
  • Initiated cross-discipline collaboration efforts that led to improved patient outcomes across various departments in the facility.
  • Reduced hospital readmissions through vigilant monitoring and prompt intervention for at-risk patients.
  • Observed, monitored, and reported changes in patient condition to supervising RN or physician in accordance with policies and procedures of medical facility.
  • Conducted thorough assessments to identify gaps in care and develop targeted interventions for improvement.
  • Advocated for patient needs, addressing concerns with healthcare providers and insurance companies to ensure optimal care was received.
  • Developed strong relationships with patients, families, and healthcare providers, fostering trust and open communication resulting in improved satisfaction scores.
  • Managed caseloads efficiently, prioritizing high-risk cases while ensuring all patients received appropriate attention and support.
  • Mentored new hires, sharing knowledge and expertise to foster a supportive learning environment promoting professional growth within the nursing team.
  • Conveyed treatment options, diagnosis information and home care techniques to patients and caregivers to continue care consistency.
  • Sustained quality standards by performing routine medication audits and upholding internal and industry best practices.
  • Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
  • Managed patients recovering from medical or surgical procedures.
  • Worked remotely for 9 years

Nurse Case Manager

NYCHSRO/Care Review
NY.NY
02.2001 - 04.2004
  • Educated patients and caregivers on healthcare protocols and processes.
  • Served as a liaison between patients and various support services such as financial assistance programs, community resources, and mental health counseling to ensure holistic care was provided.
  • Increased referral rates by providing excellent service and building meaningful relationships with patients and caregivers.
  • Collaborated with healthcare leaders and physicians to support and offer resources in performance of duties to maintain high-quality and efficient patient care.
  • Managed support services and fostered communication among social workers, therapists, hospital staff, and patients.
  • Applied critical thinking skills during case reviews to identify potential risks or challenges before they escalated into larger issues.
  • Worked remotely and reviewed hospitalized patients on site at 8

Concurrent Review Nurse

Prudential Healthcare/Aetna
Suffern, NY
03.1996 - 03.2000
  • Maintained accurate records of case management activities in accordance with organizational policies and procedures, ensuring data integrity for reporting purposes.
  • Implemented quality improvement initiatives within the concurrent review process, leading to more accurate and efficient decisionmaking.
  • Improved patient outcomes by conducting thorough concurrent reviews and recommending appropriate care plans.
  • Contributed to the development of evidence-based policies and procedures for the case management department, ensuring alignment with industry best practices and regulatory requirements.
  • Identified opportunities for improvement within the case management department, contributing to overall operational efficiency gains.
  • Elevated patient satisfaction scores through proactive communication and addressing concerns promptly.
  • Developed strong rapport with patients and families by demonstrating empathy, active listening skills, and a genuine commitment to their wellbeing.
  • Supported effective care transitions by collaborating with healthcare providers, patients, and families to develop individualized discharge plans.
  • Worked remotely, and performed
  • on site chart reviews at NY hospitals

LPN

Valley Hospital
Ridgewood, NJ
10.1983 - 06.1990
  • Utilized time management skills to prioritize tasks effectively, allowing for efficient completion of daily responsibilities.
  • Maintained accurate documentation of all relevant clinical data, ensuring compliance with regulatory standards.
  • Implemented infection control measures, ensuring a clean and safe environment for patients and staff.
  • Managed patient care through closely monitoring respiration, blood pressure, and blood glucose levels.
  • Administered controlled narcotics, inserted IVs, and performed catheterizations.
  • Obtained patient vital signs and input/output measurements from inpatients.
  • Assisted with admissions, appointments, transfers, and discharges.
  • Performed wound care treatments using sterile techniques, promoting healing and preventing complications.
  • Adhered to treatment plan instructions when administering medications and treatments to patients.
  • Improved patient outcomes by providing high-quality nursing care and closely monitoring vital signs.
  • Cared for wounds, provided treatments, and assisted with procedures.
  • Reduced medication errors by accurately administering medications and diligently verifying patient information.
  • Participated in ongoing professional development opportunities to enhance knowledge base and skillset as an LPN.
  • Performed routine evaluations of each patient's status, needs, and preferences.

Education

Bachelor of Arts - Geography

William Patterson University
Wayne, NJ
12.1999

Associate of Arts - General

Bergen Community College
Paramus, NJ
06.1992

LPN - LPN

Bergen Pines County Hospital
Paramus, NJ
09.1976

Skills

  • Problem-Solving
  • Case Management
  • Case Documentation
  • Organization and Multitasking
  • Documentation And Reporting
  • Positive Attitude
  • Email and Telephone Etiquette
  • Client Advocacy
  • Care Coordination
  • Case Needs Assessment
  • Discharge Planning
  • Utilization review

Additional Information

Current active LPN license in State of New York

Timeline

Case Manager

Emblem Health Insurance
04.2004 - 02.2017

Nurse Case Manager

NYCHSRO/Care Review
02.2001 - 04.2004

Concurrent Review Nurse

Prudential Healthcare/Aetna
03.1996 - 03.2000

LPN

Valley Hospital
10.1983 - 06.1990

Bachelor of Arts - Geography

William Patterson University

Associate of Arts - General

Bergen Community College

LPN - LPN

Bergen Pines County Hospital
Barbara Drayton