Caroline Hauser, Bsn, Rn
Summary
Professional nurse leader with strong expertise in patient care and team management. Adept at fostering collaborative environments and ensuring high-quality healthcare delivery. Highly reliable, adaptable to changing needs, and skilled in patient assessment, critical thinking, and effective communication. Proven track record of driving positive outcomes through teamwork and strategic planning.
Overview
14
14
years of professional experience
1
1
Certification
Work History
Episodic Care Manager
Blue Cross Blue Shield of North Carolina
01.2023 - Current
- Subject Matter Expert (SME) for Medicare Outpatient
- Onboarding and precepting new employees to Outpatient task list
- Develop and present process improvements to obtain maximum operational efficiency
- Consult on Behavioral Health cases for MA process
- Leverage critical thinking skills for reviews and process evaluation
- Conduct thorough medical reviews for Medicare Advantage members, applying CMS policies to determine medical necessity and adherence to medical necessity standards.
- Consult with Medical Medical Directors to provide recommendations for sending cases to outside vendors for review
- Navigate multiple software systems proficiently, including Care Radius, and Facets, to streamline workflow and enhance data management efficiency.
Nurse Medical Management I
Elevance
04.2021 - 01.2023
- Assisted with launch of Healthy Blue program
- Group Lead for Medicaid Inpatient Utilization Team
- Subject Matter Expert for Medicaid
- Onboarded and Precepted new employees to Inpatient team
- Project Management
- Collaborated with multi-disciplinary teams for member care
- Promoted a culture of safety, diversity and inclusion
- Utilization Management- pre-certification, initial and concurrent review, appeals, and discharge planning
- Maintained compliance with Policies, State Regulations
Assistant Nurse Manager
Novant Health Medical Park Hospital
02.2020 - 11.2020
- Performance management of staff
- Implemented process changes
- Conducted educational in-services for staff
- Facilitated team meetings
- Led interdisciplinary teams
- Assisted with discharge planning
Staff Nurse, Emergency Department
Wake Forest Baptist Health
11.2019 - 01.2020
- Provided psychiatric and substance use direct patient care
- Facilitated interdisciplinary team management of patients
- Triaged patients for provider assessment
- Medication management
- Rapid Response Team
Assistant Nurse Manager
Wake Forest Baptist Health
02.2019 - 11.2019
- Led and supervised nursing teams across eight units
- Ensured adherence to safety standards and best practices
- Behavioral Health and Medicine unit support team
- Implemented creative solutions in an ever-fluctuating environment
- Supervise and delegate nursing care activities
- Served as clinical resource for staff
- Consulted on complex cases
- Foster professional development within the Medicine Division
- Created unit assignments
- Rapid Response Team
- De-escalation team
- MOAB trained
Registered Nurse, Endoscopy
Northeast Digestive Health Center
12.2018 - 02.2019
- Prepared patients for endoscopy and colonoscopy procedures
- Managed pre-op and post-procedure care
- Delivered comprehensive post-op education to patients and their support person
- Provided compassionate patient-centered care
Charge Nurse
Wake Forest Baptist Health
03.2018 - 01.2019
- Supervised and delegated nursing care activities
- Provided compassionate, empathetic patient-centered care
- Coordinated interdisciplinary team management of patients
- Meticulously monitored complex medical devices
- Educated patients and families
- Responded to emergencies and adverse events
ICU Clinical Nurse
Atrium Health University City
10.2016 - 04.2018
- Improved ICU efficiency by collaborating with interdisciplinary team members for optimal patient outcomes.
- Provided skilled, timely and level-headed emergency response to critically-ill patients.
- Advanced clinical knowledge through ongoing professional development activities, including workshops, conferences, and certifications.
- Promoted patient safety by diligently monitoring vital signs, administering medications, and performing life-saving interventions.
Charge Nurse
Select Specialty Hospital LTAC
11.2017 - 02.2018
- Trained new nurses in proper techniques, care standards, operational procedures, and safety protocols.
- Conducted daily shift briefs to inform staff of changes in patient care assignments.
- Served as a liaison between nursing staff, physicians, and management, fostering open communication channels among all parties involved in patient care.
- Conducted comprehensive patient assessments, interpreting diagnostic data
- Demonstrated proficiency in Rapid Response and code events
- Improved patient safety and emergency readiness
- Provided patient-centered care for complex patients
Charge Nurse
Carolinas ContinueCare Hospital
03.2016 - 10.2016
- Led teams in driving successful patient outcomes by prioritizing standard of care and best practices.
- Managed staffing schedules, ensuring adequate coverage while minimizing overtime expenses.
- Coordinated discharge planning, collaborating with patients, families, and healthcare providers to ensure seamless transitions of care.
- Delivered high level of quality care to diverse populations while overseeing patient admission and triaging based on acuity and appropriate department admission.
- Facilitated therapeutic communication, conflict resolution and crisis intervention by redirecting negative behaviors and helping patients regain or improve coping abilities.
Registered Nurse, Cardiac Telemetry
Atrium Health
07.2015 - 03.2016
- Provided comprehensive cardiac education to patients and families, empowering them in self-care management postdischarge.
- Improved patient outcomes by consistently monitoring cardiac telemetry and promptly responding to critical changes.
- Demonstrated expertise in various cardiac procedures such as EKG interpretation, defibrillation, cardioversion, and administration of emergency medications.
- Documented treatments delivered, medications and IVs administered, discharge instructions, and follow-up care.
- Ensured optimal clinical outcomes for cardiac patients through timely identification of potential complications and prompt intervention.
- Optimized patient outcomes in high-stress scenarios by remaining calm, focused, and utilizing critical thinking skills to provide appropriate interventions.
Registrar
Atrium Health Cabarrus
04.2011 - 07.2015
- Enhanced patient experience by coordinating timely and efficient referrals to specialists.
- Streamlined referral processes for improved patient satisfaction and reduced wait times.
- Collaborated with healthcare providers to ensure accurate and comprehensive referral documentation.
- Served as a liaison between patients, providers, and insurance companies during the referral process, addressing any concerns or questions that arose along the way.
- Communicated with insurance companies to verify coverage and obtain authorizations for medical treatments and procedures.
Education
Bachelor of Science - Nursing
Western Carolina University
Cullowhee, NC01-2017
Associate Degree in Nursing - Nursing
Rowan-Cabarrus Community College
Salisbury, NC01-2015
Skills
- Team leadership
- Problem-solving
- Decision-making
- Staff training and development
- Team building
- Strategic planning
- Staff development
- Team collaboration
Certification
- Registered Nurse License (RN) - North Carolina Board of Nursing.
Timeline
Episodic Care Manager
Blue Cross Blue Shield of North Carolina
01.2023 - Current
Nurse Medical Management I
Elevance
04.2021 - 01.2023
Assistant Nurse Manager
Novant Health Medical Park Hospital
02.2020 - 11.2020
Staff Nurse, Emergency Department
Wake Forest Baptist Health
11.2019 - 01.2020
Assistant Nurse Manager
Wake Forest Baptist Health
02.2019 - 11.2019
Registered Nurse, Endoscopy
Northeast Digestive Health Center
12.2018 - 02.2019
Charge Nurse
Wake Forest Baptist Health
03.2018 - 01.2019
Charge Nurse
Select Specialty Hospital LTAC
11.2017 - 02.2018
ICU Clinical Nurse
Atrium Health University City
10.2016 - 04.2018
Charge Nurse
Carolinas ContinueCare Hospital
03.2016 - 10.2016
Registered Nurse, Cardiac Telemetry
Atrium Health
07.2015 - 03.2016
Registrar
Atrium Health Cabarrus
04.2011 - 07.2015
- Registered Nurse License (RN) - North Carolina Board of Nursing.
Bachelor of Science - Nursing
Western Carolina University
Associate Degree in Nursing - Nursing
Rowan-Cabarrus Community College
Similar Profiles
Tiffany PriceTiffany Price
Customer Service Representative at Blue Cross Blue Shield of North CarolinaCustomer Service Representative at Blue Cross Blue Shield of North Carolina
Sherri LeonardSherri Leonard
Senior Pharmacy Services Specialist at Blue Cross Blue Shield Of North CarolinaSenior Pharmacy Services Specialist at Blue Cross Blue Shield Of North Carolina
Tiffani BullockTiffani Bullock
State Operations Claims Customer Service Represent at Blue Cross Blue Shield of North CarolinaState Operations Claims Customer Service Represent at Blue Cross Blue Shield of North Carolina