Carrie Hale, RN, MSN

Serve as PRN weekend inpatient rehabilitation liaison with collaboration efforts among patients, their families, case managers, therapists, nursing staff, and medical directors.
Actively evaluate and screen patients to determine needs and provide necessary placement recommendations for post-acute care.
Present potential inpatient rehabilitation candidates to Medical Director for medical acceptance.
Coordinate admissions of inpatient rehabilitation patients with entire care team.
Evaluate patient readiness for inpatient rehab admission by completing pre-admission screening.
Prepare and maintain HIPAA-compliant records, including documentation such as clients' personal and eligibility information.

Project managed all audit and CAP activities .
Served as operations manager for Clinical Quality Improvement Initiatives.
Ensured regulatory compliance and audit readiness for Complex Case Management programs in DC and NC Markets.
Trained market staff on policies and procedures to establish strong foundation for client development.
Advised clients of state and federal requirements and emerging conflicts and presented solutions that enhance client business goals.
Collaborated with internal audit team and escalated negative trends up to executive leadership to ensure timely remediation.

Served as clinical quality manager and subject matter expert for behavioral health tele-therapy company.
Performed clinical quality audits to assist with identifying trends.
Improved quality processes for increased efficiency and effectiveness.
Remediated gaps in clinical documentation by collaborating with Learning & Development to provide clinician retraining.
Authored and edited policies, procedures, job aids, and auditing tools to reflect progressive updates and approved changes.
Followed quality standards and procedures to minimize errors and maximize customer satisfaction.

Served as clinical quality auditor and subject matter expert for clinical quality internal audits in preparation for third party, external audits.
Developed and proposed solutions for making positive improvements to operational and patient care strategies.
Researched and compiled statistical data to identify gaps and strengths.
Worked closely with leadership to efficiently complete projects.
Served as SME and collaborated with clinical quality team members to achieve exemplary inter-relater reliability results.
Identified issues, analyzed information and provided solutions to problems.

Served as pre-authorization RN for services that included durable medical equipment, home health services, inpatient and outpatient procedures, emergency transportation, and various pharmacological agents.
Reviewed patient records, researched requests and provided coverage determinations based on policy limits, determination guidelines, and state and federal mandates.
Communicated coverage determinations and recourse details to providers.
Enforced operational compliance with state and federal laws and DOI standards.
Gathered information from multiple sources to assist with coverage determination reviews.

Performed all patient care activities in ICU, pre-op and PACU.
Served as mentor, preceptor and chart auditor, as well as staff nurse with patient assignments.
Performed various nursing interventions such as wound dressing, vital sign monitoring and specimen collection.
Conferred with physicians to discuss diagnoses and devise well-coordinated treatment approaches.
Trained new nurses in proper techniques, care standards, operational procedures and safety protocols.