Bettina Thompson
Mt. Dora,FL
Summary
Experienced nursing professional bringing demonstrated clinical expertise, leadership skills and technical knowledge. Proficient in updating charts, monitoring medications and working with multidisciplinary teams to optimize patient care. Quality-driven and efficient with strong interpersonal abilities.
Overview
13
13
years of professional experience
1
1
Certification
Work History
Specialty Care Manager
Perform Specialty (Amerihealth Caritas Inc)
Orlando, FL
01.2021 - Current
- Partnered effectively with various stakeholders including Health Plan, Clinicians, and Patients to conduct medication utilization reviews, resulting in the prevention of medication waste, decreased hospitalizations/ER visits, and improved medication adherence.
- Conducted regular follow-up with patients to assess satisfaction with services and identify any unmet needs.
- Educated clients and families on disease management, prevention strategies, and healthy lifestyle choices.
- Managed caseloads effectively, prioritizing needs and ensuring timely access to necessary services.
- Evaluated effectiveness of interventions by tracking trends in patient outcomes over time.
- Maintained up-to-date knowledge about operating policies and procedures related to regulatory guidelines (URAC)
- Prepared written summaries detailing findings from utilization review activities upon request.
- Provided training on proper completion of authorization forms for staff members.
- Responded promptly to inquiries regarding authorization requests from providers or patients.
- Maintained detailed documentation of all utilization review activities according to applicable standards.
- Collaborated with providers to obtain required clinical information, supporting prior authorization determinations and individual inquiries.
- Liaised between patients, healthcare providers, and insurance companies to clarify coverage and authorize services.
- Maintained strict patient data procedures to comply with HIPAA laws and prevent information breaches.
System Analyst, Supervisor of Care Coordination, RN Care Coordinator
Orlando Health
Orlando, FL
11.2015 - 10.2020
- Educated patients on disease processes, treatments, nutrition, lifestyle modifications, medication adherence, and self-management strategies.
- Attended weekly meetings with interdisciplinary team members to discuss new cases, track progress on existing cases, identify areas of concern, and provide guidance when needed.
- Collaborated with physicians and other healthcare providers to coordinate comprehensive care for chronic conditions.
- Supervised, trained and evaluated Case Managers in the delivery of services to clients.
- Monitored caseloads for timely completion of tasks and patient outcomes.
- Participated in quality improvement initiatives aimed at improving communication between providers during transitions of care.
- Created applicable procedures, training, and operating standards to implement quality improvement plans.
- Participated in site visits with providers to verify accuracy of reported data elements.
- Collaborated with other departments on initiatives such as educational outreach activities aimed at improving performance outcomes.
- Assessed accuracy of coding by performing retrospective review of members' medical records.
- Conducted chart reviews in accordance with NCQA guidelines and standards.
- Analyzed trends in performance data to identify areas of improvement for targeted outreach programs.
- Provided education sessions for clinical staff on topics such as proper documentation techniques.
- Established and maintained positive relationships with physicians, hospital staff, patients and families.
- Communicated with external partners such as managed care organizations or vendors on a regular basis.
- Contributed to the development of educational materials related to disease prevention or management.
Admission RN
Vitas Healthcare
Maitland, FL
04.2015 - 01.2016
- Coordinated with physicians, social workers, chaplains, and other healthcare providers to ensure continuity of care.
- Educated patients regarding end-of-life issues such as advance directives and palliative care options.
- Participated in multidisciplinary team meetings to discuss patient status updates.
- Responded promptly to inquiries from referral sources regarding admission criteria or availability of beds and services within the hospice program.
- Evaluated new admissions for appropriateness of level of service required.
- Ensured compliance with federal regulations governing the Medicare Hospice Benefit Program.
- Assessed patient symptoms in order to develop appropriate interventions that addressed physical, psychological, spiritual, and emotional needs.
Personal Health Consultant (Contract)
Healthcare Support Staffing
Apopka, FL
08.2014 - 04.2015
- Conducted patient assessments and monitored progress of disease management programs (CAD, COPD, Diabetes, Asthma, HTN).
- Utilized motivational interviewing to educate individuals with chronic illnesses on effective self-management techniques.
- Identified barriers that prevent individuals from adhering to treatment plans and developed solutions to overcome them.
- Prepared reports summarizing findings from assessments, tests, labs and other QA activities for primary care provider review.
Triage Nurse Case Manager, Team Lead
USIS/ Amerisys
Altamonte Springs, FL
12.2013 - 07.2014
- Managed and made independent decisions on Workers' Compensation medical claims
- Provided triage decisions that include referral to an emergency department, urgent care center, primary care provider, or other medical specialist as needed.
- Identified symptoms and recommended treatments or follow-up care based on established protocols and guidelines.
- Utilized reference materials such as lab results, medication lists, x-rays, in order to accurately assess patient needs.
- Facilitated in the training of new hires on organizations policies and procedures.
- Performed administrative duties such as scheduling appointments for follow up visits or referring patients to specialists.
- Maintained detailed case files documenting all pertinent information related to the claim.
RN Care Coordinator-Interventional Radiology, MICU Registered Nurse
Florida Hospital
Orlando, FL
10.2011 - 11.2013
- Provided direct patient care, including wound dressing, administering medications, catheterization, and IV therapy.
- Managed PA catheters and arterials, vasoactive drug administration and titration, thrombolytic therapy, dysrhythmia interpretation, and chest tube management.
- Communicated effectively with physicians, family members, allied health professionals, and other healthcare providers regarding patient care issues.
- Assessed patients for changes in condition and reported any abnormalities to the physician.
- Utilized critical thinking skills to assess complex situations and make appropriate decisions in emergency situations.
- Maintained accurate documentation in the medical record according to hospital policy.
- Collaborated with interdisciplinary team members to develop individualized treatment plans for each patient.
- Utilized a wide range of medical equipment, including ventilators and intravenous (IV) pumps, to support patient care.
- Ensured that all Interventional Radiology personnel followed proper safety protocols while performing surgeries.
- Provided post-procedure care instructions to patients prior to discharge from hospital.
- Assessed potential risks associated with each surgical procedure before it was scheduled.
- Facilitated communication between surgeons and other healthcare professionals involved in a patient's care plan.
- Coordinated with surgeons, anesthesiologists, nurses, and other medical staff to ensure the smooth running of surgical operations.
- Reviewed patient charts prior to surgery date to ensure accuracy of data entered into system.
- Gathered current medical information and reviewed histories to gather details for surgeons.
- Collaborated and established strong working relationships with physicians, supervisors and colleagues.
Education
Epic Ambulatory System Analyst -
Orlando Health
01.2020
Associates of Nursing -
Florida Hospital College of Health Science
01.2011
Bachelor of Science, Management -
University of Florida
01.2006
Skills
- Care Planning and Coordination
- Utilization review
- Documentation And Reporting
- Relationship Building
- Time Management
- Team Collaboration
- Staff training and motivation
- Task Prioritization
Professional Highlights
- Managed patients with chronic conditions for 10 years, resulting in increased quality scores and physician reimbursement.
- Key contributor to successful adoption of Epic EHR during transition from Allscripts EMR.
- Successfully led a team of 15 staff members, aiding Central Florida's largest healthcare organization in bridging care gaps for owned Primary Care Provider offices and Clinical Integrated Network. This achievement contributed to the renewal of ACO contracts and a remarkable shared saving amounting to over $3 million.
- Simplified the process of clinical documentation and prior authorization submission for specialty pharmacy, resulting in prompt approval of routine Hemophilia medication within 10 days of next fill date and a below-average pharmacy bleed rate.
Accomplishments
- You Matter Award- Providing excellent customer service
- Excellence Award- For QI efforts resulting companies 2024 URAC accreditation
Certification
- Registered Nurse- Florida Board of Nursing
- BLS Certified
Timeline
Specialty Care Manager
Perform Specialty (Amerihealth Caritas Inc)
01.2021 - Current
System Analyst, Supervisor of Care Coordination, RN Care Coordinator
Orlando Health
11.2015 - 10.2020
Admission RN
Vitas Healthcare
04.2015 - 01.2016
Personal Health Consultant (Contract)
Healthcare Support Staffing
08.2014 - 04.2015
Triage Nurse Case Manager, Team Lead
USIS/ Amerisys
12.2013 - 07.2014
RN Care Coordinator-Interventional Radiology, MICU Registered Nurse
Florida Hospital
10.2011 - 11.2013
Epic Ambulatory System Analyst -
Orlando Health
Associates of Nursing -
Florida Hospital College of Health Science
Bachelor of Science, Management -
University of Florida
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