Hi, I’m
Carol Wilson
Cedar Park,Tx
Summary
I have a proven track record of delivering high-quality care while maintaining patient safety and satisfaction. Results-oriented achiever with proven ability to exceed targets and drive success in fast-paced environments. Combines strategic thinking with hands-on experience to deliver impactful solutions and enhance organizational performance. Possesses versatile skills in project management, problem-solving, and collaboration. Brings fresh perspective and strong commitment to quality and success. Recognized for adaptability and proactive approach in delivering effective solutions. Innovative technology professional with several years of diverse experience. Skilled in enhancing systems and aligning technical solutions with business objectives. Proven success in leading projects from start to finish and contributing to organizational growth and success. Seasoned nursing professional offering proven clinical knowledge, natural interpersonal strengths and technical abilities. Knowledgeable about EMR charting, medication administration and interdisciplinary collaboration focused on optimizing patient care and support. Quality-focused and efficiency-driven leader. Equipped with strong problem-solving abilities, willingness to learn, and excellent communication skills. Poised to contribute to team success and achieve positive results. Ready to tackle new challenges and advance organizational objectives with dedication and enthusiasm. Proactive and goal-oriented professional with excellent time management and problem-solving skills. Known for reliability and adaptability, with swift capacity to learn and apply new skills. Committed to leveraging these qualities to drive team success and contribute to organizational growth.
Overview
35
years of professional experience
Work History
Humana Medicare Insurance
Case Management/Utilization Review/Discharge Planning RN
06.2016 - Current
Job overview
- I worked closely with Medical Directors, leadership and within the Medicare guidelines to develop a very successful weekend team of nurses which would allow for a 7days a week, seamless Front End review process within Humana Medicare. The ability to have this process was very beneficial for staying ahead of Medicare time-frames.
- Utilization of MCG and Interqual to determine appropriate level of care for the Pt. This was done by reviewing either faxed medical records or by reviewing Pt medical records in the Electric Medical Records used by the facility they were admitted to. I currently am fluent in over 18 different electronic records systems, which include Epic, Xsolis and Dragonfly, among multiple others.
- Mentored new nursing staff, contributing to a supportive work environment and improved retention rates.
- Enhanced the efficiency of the utilization review process by collaborating with interdisciplinary teams and streamlining communication channels.
- Streamlined data entry processes, ensuring timely submission of all required documentation for utilization review activities.
- Maintained strict adherence to HIPAA regulations, safeguarding sensitive patient information throughout all aspects of the utilization review process.
- Ensured compliance with regulatory guidelines by maintaining accurate documentation and records for all utilization review activities.
- Enhanced utilization review efficiency by streamlining processes and implementing new software tools.
- Maintained professional competence by staying current on industry trends, best practices, and regulatory requirements specific to utilization review nursing.
- Developed comprehensive staff training programs to enhance employees'' understanding of utilization review principles and practices.
- Reduced wait times for essential services by effectively managing utilization review caseloads and prioritizing urgent requests.
- Optimized resource allocation by conducting regular audits and identifying areas for improvement in the utilization review process.
- Demonstrated strong analytical skills by interpreting complex medical records and synthesizing relevant information for utilization review purposes.
- Conducted utilization review to verify medically necessary care is received in correct setting.
- Ensured compliance with regulatory guidelines by conducting thorough audits of medical records and utilization review reports.
- Ensured compliance with regulations and accreditation standards by maintaining accurate documentation of all utilization review activities.
- Implemented evidence-based practices to optimize patient care standards and protocols.
- Developed strong interdisciplinary team collaboration with a focus on continuous improvement in care delivery.
- Initiated recruitment and retention strategies for new hires to reduce staff turnover [Number]%.
- Established performance metrics to monitor progress toward departmental goals and drive ongoing improvements.
- Collaborated with cross-functional teams to ensure seamless integration of new features.
- Continuously updated skills through training courses, workshops, and self-study—staying current on industry trends and emerging technologies.
- Participated in regular code reviews, ensuring high-quality standards were consistently met across all development efforts.
- Participated in software field testing to verify performance of developed projects.
- Proved successful working within tight deadlines and a fast-paced environment.
HCA St David's Hospital
RN Case Manager, UR
06.2010 - 06.2016
Job overview
- 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.
- Enhanced communication between clients and providers through consistent follow-ups and progress updates.
- Achieved positive client outcomes by developing and implementing comprehensive case management plans.
- Advocated for client rights when interacting with external agencies or institutions, ensuring fair treatment at all times.
- Contributed to team discussions and case conferences actively, sharing insights and expertise with colleagues to optimize client support strategies.
- Coordinated services with other agencies, community-based organizations, and healthcare professionals to provide useful benefits to clients.
- Developed and implemented comprehensive case management plans to address client needs and goals.
- Collaborated with multidisciplinary teams to address client needs and formulate tailored support strategies.
Care Alternative's Hospice
Admission RN, Training
03.2006 - 06.2010
Job overview
- This was about restructuring and rebuilding a Hospice company from the bottom up.
- I developed charting and documenting guidelines for the Nurses to stay within for appropriate documentation per Medicare guidelines.
- I did teaching and training in medical/hospice symptoms and medical therapy. I created a holistic practice which involved family members for the betterment of the whole Hospice experience for the whole family and patient.
- Enhanced patient satisfaction through effective communication, empathy, and timely response to their needs.
- Collaborated with interdisciplinary teams for comprehensive patient care plans, resulting in better health outcomes.
- I did create community outreach for informing of the hospice process and it's benefits. I meet with multiple Physicians and Nursing facilities to collaborate on how we could make a person transitioning to the end of life much more seamless. In the process of working closely with multiple avenues in healthcare, many excellent professional relationships were created.
- This was a beautiful collaboration of multiple aspects within the community and within the 3 years I worked with this company, we went from 4 employees and 2 patients, to 2 offices consistenting of 25-30 nurses each, multiple office staff and a constant running census of 250 patients.
California Hospital
Emergency Nursing
01.2001 - 01.2006
Job overview
- Participated in ongoing professional development activities aimed at enhancing clinical skills proficiency while staying current with industry advancements impacting emergency nursing practice standards.
- Continuously pursued professional development opportunities by attending industry conferences, workshops, and seminars to stay current on best practices within the field of veterinary nursing.
- Increased the efficiency of the ER team by participating in continuous education opportunities related to emergency nursing practices and trends.
- Mentored new staff members to promote best practices in emergency nursing care, improving overall team performance.
- Expanded knowledge of emergency nursing procedures through continuous professional development activities.
- Improved patient outcomes by providing high-quality emergency nursing care in a fast-paced medical environment.
- Provided timely critical care consultations for patients in various hospital settings, including intensive care units and emergency departments.
- Participated in quality improvement initiatives aimed at enhancing the overall effectiveness and efficiency of emergency nursing care delivery within the department.
Bakersfield Memorial
Emergency Nursing/Trauma
01.2001 - 01.2006
Job overview
- Followed all safety protocols and took necessary precautions while providing care.
- Collaborated with multidisciplinary teams to provide comprehensive patient care during high-pressure situations.
- Responded to 911 calls for medical emergencies.
- Managed airway patency utilizing various non-invasive devices like oral or nasal airways, facilitating adequate oxygenation in compromised individuals.
- Documented detailed patient reports for seamless handoff to receiving medical personnel, ensuring continuity of care.
- Assisted with resuscitation, CPR, and emergency airway procedures.
- Supported efficient operations by regularly inspecting and restocking emergency vehicles with necessary supplies and equipment.
- Enhanced response times by effectively communicating with dispatchers, paramedics, and other healthcare professionals.
- Worked with nurses to assess patients and prepare for tests and procedures.
- Assisted in preparation and maintenance of patient charts, documenting all care given.
- Prepared patients for advanced interventions such as intubations or central line placements when required under physician guidance.
- Performed life-saving interventions such as CPR and AED administration for cardiac arrest patients.
- Administered CPR, oxygen and other life-saving medical treatments.
- Coordinated with hospital staff to ensure seamless transfer of care and successful patient outcomes during high-stress situations.
- Assisted in stabilizing trauma patients with proper immobilization techniques and rapid transport to medical facilities.
- Educated community members on emergency preparedness, promoting safety awareness among local residents.
St Anthony's Hospital
Er RN
01.2001 - 01.2006
Job overview
- Administered medications accurately and safely, reducing medication errors and adverse reactions.
- Enhanced patient satisfaction through effective communication, empathy, and timely response to their needs.
- Collaborated with interdisciplinary teams for comprehensive patient care plans, resulting in better health outcomes.
- Administered medications via oral, IV, and intramuscular injections and monitored responses.
- Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing conditions.
- Developed strong relationships with patients'' families, providing emotional support while addressing concerns or questions about care plans.
- Provided direct patient care, stabilized patients, and determined next course of action.
- Implemented infection control measures within the unit, maintaining a safe environment for both patients and staff members.
- Managed complex cases of critically ill patients, ensuring optimal treatment plans were executed effectively.
- Communicated with healthcare team members to plan, implement and enhance treatment strategies.
Long Island Jewish
Emergency Nursing/Trauma
01.2001 - 01.2006
Job overview
- Performed life-saving interventions such as CPR and AED administration for cardiac arrest patients.
- Collected pertinent patient information through thorough assessments, contributing to accurate diagnoses and treatments.
- Managed airway patency utilizing various non-invasive devices like oral or nasal airways, facilitating adequate oxygenation in compromised individuals.
- Maintained a sterile environment by adhering to strict infection control procedures during invasive procedures.
- Conducted patient intake and triage procedures.
- Followed all safety protocols and took necessary precautions while providing care.
- Enhanced response times by effectively communicating with dispatchers, paramedics, and other healthcare professionals.
- Administered CPR, oxygen and other life-saving medical treatments.
- Coordinated with hospital staff to ensure seamless transfer of care and successful patient outcomes during high-stress situations.
- Assisted in stabilizing trauma patients with proper immobilization techniques and rapid transport to medical facilities.
- Documented detailed patient reports for seamless handoff to receiving medical personnel, ensuring continuity of care.
Ellis Hospital
Emergency Nursing
01.2001 - 01.2006
Job overview
- Actively participated in professional development opportunities to maintain up-to-date knowledge on emergency nursing practices and current healthcare trends.
- Participated in ongoing professional development opportunities to remain current on best practices in emergency nursing care.
- Continuously updated knowledge on current best practices in emergency nursing through professional development opportunities, journal reviews, and attending conferences.
- Participated in continuous education programs to stay updated with latest in emergency nursing practices.
Grace Inpatient Hospice
Inpatient Hospice RN
01.2000 - 01.2001
St Joseph's Mercy Hospital
ER, Pediatric Nurse Specialist ER
01.1998 - 01.2000
Gentle Care Nursing
Pt/Family Education/Advocate/Home RN
01.1996 - 01.1998
Job overview
- Ensured proper follow-up care for patients by accurately recording test results and relaying critical information to healthcare providers.
- Ensured continuity of care for patients transitioning between providers by coordinating medical record transfers and timely communication with new caregivers.
- Proactively addressed patient questions or concerns about their health status or treatment plans while maintaining a compassionate demeanor at all times.
- Contributed to the accuracy of billing procedures by diligently verifying insurance coverage and processing claims.
- Increased patient engagement with their own healthcare journeys by providing thorough explanations of treatment plans, test results, and other pertinent information.
- Improved patient satisfaction by efficiently managing medical records and ensuring timely access to vital information.
UW Health University Hospital
Picc nurse/Code Response Team/ Float Pool
01.1995 - 01.1998
Job overview
- Supported hospital staff by providing education on proper PICC line maintenance and troubleshooting techniques.
- Improved patient outcomes by carefully inserting and maintaining PICC lines in accordance with best practices.
- Demonstrated exceptional attention to detail when documenting patient care, ensuring accurate and complete medical records.
- Consistently met organizational goals for quality metrics such as time-to-insertion ratios and insertion success rates for PICC lines placed per shift.
- Proactively identified potential issues with existing vascular access devices, resulting in reduced complications from early interventions.
- Enhanced patient comfort during procedures through the use of effective communication and bedside manner.
- Contributed to a positive work environment through active participation in team meetings and ongoing professional development opportunities.
- Reduced infection rates by consistently adhering to strict infection control protocols while performing PICC insertions.
- Maintained a high level of clinical competency by attending relevant continuing education courses and seeking certification in vascular access and infusion therapy.
- Delivered comprehensive pre-and post-procedure education to patients, easing anxiety related to their vascular access device.
- Minimized complications related to vascular access devices by staying current with industry advancements and adjusting care practices accordingly.
- Mentored new nursing staff on the intricacies of PICC line placement and maintenance, fostering a culture of continuous learning and growth.
- Educated family members and caregivers on patient care instructions.
- Used first-hand knowledge and clinical expertise to advocate for patients under care and enacted prescribed treatment strategies.
Johns Hopkins All Children's Hospital
Pediatric RN
01.1990 - 01.1995
Education
St Petersburg Junior CollegeSt. Petersburg, FLA
Associate from Nursing RN
Skills
- Fluent in over 18 Electric Medical records programs including Epic and Cortex
- Trained in Interqual and Milliman guidelines
- Experience in training and leadership within ER and Utilization Review environments
Timeline
Case Management/Utilization Review/Discharge Planning RN
Humana Medicare Insurance
06.2016 - Current
RN Case Manager, UR
HCA St David's Hospital
06.2010 - 06.2016
Admission RN, Training
Care Alternative's Hospice
03.2006 - 06.2010
Emergency Nursing
California Hospital
01.2001 - 01.2006
Emergency Nursing/Trauma
Bakersfield Memorial
01.2001 - 01.2006
Er RN
St Anthony's Hospital
01.2001 - 01.2006
Emergency Nursing/Trauma
Long Island Jewish
01.2001 - 01.2006
Emergency Nursing
Ellis Hospital
01.2001 - 01.2006
Inpatient Hospice RN
Grace Inpatient Hospice
01.2000 - 01.2001
ER, Pediatric Nurse Specialist ER
St Joseph's Mercy Hospital
01.1998 - 01.2000
Pt/Family Education/Advocate/Home RN
Gentle Care Nursing
01.1996 - 01.1998
Picc nurse/Code Response Team/ Float Pool
UW Health University Hospital
01.1995 - 01.1998
Pediatric RN
Johns Hopkins All Children's Hospital
01.1990 - 01.1995
St Petersburg Junior College
Associate from Nursing RN
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