Carol Hylton
Jupiter,USA
Summary
Registered Nurse with over 20 years of progressively greater responsibilities in various aspects of health care delivery. A professional who is adept at interpreting and applying policies, regulations, and laws. Proficient in patient advocacy, staff training and development as well as public relation functions. Record of excellence in managing multiple projects simultaneously and independently. Particularly effective at leading resource teams to bring complex projects to positive resolution. Self-motivated, and self confident, with a commitment to excellence beyond goals and expectations.
Overview
1
1
Certification
27
27
years of professional experience
Work History
Director, Care Coordination
Baptist Health South Florida Bethesda Hospital
2019.01 - Current
- Responsible for the planning, priority setting, coordination, implementation and evaluation of programs related to patient care coordination and throughput.
- Operational responsibility for the overall management of human, fiscal and material resources as well as integration of the Care Coordination Department as it relates to the strategic plan of the organization.
- Enhanced team collaboration through regular communication, goal setting, and performance evaluations.
- Established a culture of continuous improvement by fostering open communication channels and empowering employees to voice their ideas.
Manager, Case Management
Florida Medical Center
2017.01 - 2019.01
- Provides proactive planning and development of tools and programs that optimizes quality of care, clinical outcome, utilization, cost and patient satisfaction.
- Evaluates opportunities to optimize utilization and reimbursement across populations of patients to meet organizational strategic objectives and reduce denials.
- Demonstrates responsibility and accountability in the performance of assessment, reassessment, development and implementation of the patient's plan of care, in relation to discharge needs and follow up care and in accordance with the Utilization Management Plan.
- Demonstrates current knowledge of federal, state and other regulatory agencies' requirements.
- Track/trend variances to care and make recommendation to develop action plan to improve process.
- Managed and motivated employees to be productive and engaged in work.
- Accomplished multiple tasks within established timeframes.
- Maximized performance by monitoring daily activities and mentoring team members.
- Resolved staff member conflicts, actively listening to concerns and finding appropriate middle ground.
Regional Manager Case Management
Broward Health
2015.01 - 2016.01
- Oversees Coordinator supervising employees involved in concurrent and retrospective utilization review.
- Oversees Coordinator supervising clinical social services to areas of the Hospital served.
- Design, implements and monitors processes to ensure hospital services are utilized at the appropriate level of care and setting.
- Ensures areas of responsibility are operating in compliance with Joint Commission, State and Federal regulations as well as hospital policies.
- Maintains departmental policy and procedure manual.
- Designs and implements effective processes to minimize payer denials, related to medical necessity.
- Develops and implements activities to optimize length of stay, assures timely patient throughput and ensures appropriate discharge planning.
- Ensures appropriate utilization of resources, facilities and services by reviewing admission, duration of stay, professional services rendered for both inpatients and observation patients.
- Participates in selection, orientation and ongoing staff training of qualified Case Management staff.
- Attends medical staff meetings as appropriate to provide education related to utilization, federal guidelines.
- Promoted a culture of continuous improvement through ongoing process reviews, employee engagement initiatives, and open channels of communication.
- Supervised staff to optimize brand expansion initiatives and productivity.
Director of Case Management
HCA University Hospital and Medical Center
2009.01 - 2015.01
- Responsible for the supervision of the following functions: Case Management, Care Coordination, Social Services, Discharge Planning and Utilization.
- Assures the department moves the patient through the continuum of care with comprehensive assessment and implementation of the case management function.
- Functions as a resource person for supervisory staff members and assists in necessary education of the individual supervisory members of staff.
- Oversees the day to day operations of the department.
- Develops, implement, and review the Utilization Management Plan annually.
- Responsible for coordination and facilitating multiple resources, internal and external, into a unique and single approach to care coordination for each patient assigned to case management services.
- Identifies and implement processes that support and promote efficient patient care across the healthcare continuum resulting in optimal clinical outcomes, appropriate utilization of resources, and appropriate and accurate reimbursement.
- Liaison between medical, nursing and ancillary staff in implementing the case management process.
- Proficient in Meditech and Midas software.
- Proficient in Interqual Criteria.
- Devised and implemented cost-control plans to enhance department operations.
- Leveraged technology solutions for improved communication, documentation, and overall efficiency within the case management department.
- Established clear objectives for direct reports, fostering an environment that encouraged professional growth while aligning with organizational goals.
Clinical Documentation Specialist
HCA East Florida Division
2008.01 - 2009.01
- Obtained appropriate physician documentation for clinical conditions or procedures to support severity of illness, expected risk of mortality, and complexity of care of the patient.
- Identified and recorded principal and secondary diagnosis, principal procedures and assigns working DRG.
- Collaborated with physicians, nurses, clinical care providers, and HIM coders to clarify diagnoses.
- Identified the need to clarify documentation in the medical record.
- Communicated with physicians, nurses, and/or clinical care providers to capture the documentation in the medical record that supports the patient's severity of illness.
- Provided information and education to physicians and ancillary staff not responding to prompters.
- Conducted ongoing physician and staff education to provide information on documentation requirement.
- Liaison between professional and the medical staff.
Adjunct Clinical Nursing Instructor
Broward College
2000.01 - 2006.01
- Responsible for connecting the classroom material and its real life application and for accommodating the varied learning styles and paces of clinical students.
- Conducted formal student performance evaluations, as well as providing feedback.
- Applied critical thinking concepts and presented information to students from varying backgrounds, utilizing different teaching methods to facilitate different learning style.
Quality Manager/Educator
HCA East Florida Division All About Staffing
2000.01 - 2003.01
- Promoted quality achievement and performance improvement throughout the organization.
- Responsible for the development, implementation and communication of policies to maintain compliance with quality system requirements.
- Liaison between HCA, EFD facilities and clinical administrators to coordinate education and ensure compliance with regulatory requirements.
- Wrote and implemented new rework procedures to standardize processes and streamline workflow.
- Improved quality processes for increased efficiency and effectiveness.
Education
Bachelor of Science - Nursing
Florida International University
Miami, Florida01.1998
Master of Science - Business Administration
University of Phoenix
Fort Lauderdale, Florida01.2002
Skills
- Effective relationship management
- Organizational strategy development
- Clear and concise communication
- Strategic decision-making
- Innovative thinking
- Organizational change management
Certification
- Registered Nurse- Florida
- Registered Nurse- New York
- McKesson Interqual Certified Instructor (IQCI)
Affiliations
American Case Management Association
Timeline
Director, Care Coordination
Baptist Health South Florida Bethesda Hospital
2019.01 - Current
Manager, Case Management
Florida Medical Center
2017.01 - 2019.01
Regional Manager Case Management
Broward Health
2015.01 - 2016.01
Director of Case Management
HCA University Hospital and Medical Center
2009.01 - 2015.01
Clinical Documentation Specialist
HCA East Florida Division
2008.01 - 2009.01
Adjunct Clinical Nursing Instructor
Broward College
2000.01 - 2006.01
Quality Manager/Educator
HCA East Florida Division All About Staffing
2000.01 - 2003.01
Master of Science - Business Administration
University of Phoenix
Bachelor of Science - Nursing
Florida International University