Summary
Overview
Work History
Education
Skills
Accomplishments
Timeline
Generic

CASSANDRA PARTLOW-MARTIN

Beloit,WI

Summary

Currently in a dual position as a Case Manager/Utilization Review Nurse. Working in this position for almost five years; previously worked as a Med/Surg RN for 14 years, for the same facility.


Very proactive and reliable with the ability to work within a group or independently. Excellent written and verbal communication skills, attention to details and willingness to work diligently for positive company and patient outcomes.


Organized, dependable, and successful at multitasking, seeking a full time position where interpersonal skills, excellent time management and through documentation will facilitate a positive outcome for all involved,


Currently in the process of relocating to Mississippi and seeking a remote or hybrid Utilization Review position within the state.




Overview

19
19
years of professional experience

Work History

RN Case Manager/Utilization Review Nurse

Beloit Memorial Hospital
06.2019 - Current
  • Submit cases for criteria failures and help facilitate resolutions and approvals.
  • Promote positive outcomes with proactive assessment of patients' needs and development of targeted interventions to address identified barriers to recovery.
  • Foster a culture of continuous learning by actively participating in departmental meetings, trainings, and continuing education opportunities related to utilization review.
  • Minimize financial risk associated with denials or payment discrepancies through diligent validation of medical necessity prior to service provision.
  • Increase staff efficiency by providing ongoing education on proper documentation techniques necessary for accurate claims processing.
  • Supervise and maintain all utilization review documentation through Milliman Care Guidelines (MCG).
  • Assist discharge planning of medically stable patients who are ready for next level of care.
  • Obtain authorizations from multiple insurance carriers for various levels of care.
  • Enhance patient satisfaction by collaborating with interdisciplinary teams to develop individualized care plans, ensuring appropriate level of care.
  • Demonstrate commitment to ethical practice by upholding patient confidentiality and advocating for individual rights in all interactions with stakeholders.
  • Participate in performance improvement initiatives designed to enhance service delivery while maintaining fiscal responsibility.
  • Support data-driven decision-making by regularly analyzing trends in resource utilization, identifying opportunities for improvement, and implementing best practices.
  • Collaborate with registration department who verify insurance coverage and clarify benefits; facilitate authorization for medical services, reduce delays in patient care delivery.
  • Optimize hospital stays by monitoring admissions for appropriateness based on established clinical guidelines while considering each patient''s unique circumstances.
  • Perform admission reviews based for medical necessity based upon Milliman Care Guideline specification.
  • Support organizational growth and development through effective collaboration with interdisciplinary teams focused on improving the quality, safety, and efficiency of healthcare delivery.
  • Communicate with healthcare team members to plan, implement and enhance treatment strategies.
  • Evaluate patient histories, complaints, and current symptoms.
  • Follow all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
  • Equip patients with tools and knowledge needed for speedy and sustained recovery.
  • Manage patients recovering from medical or surgical procedures.
  • Document treatments delivered, medications and IVs administered, discharge instructions, and follow-up care.
  • Manage complex cases involving multiple comorbidities, requiring close monitoring and coordination of various healthcare services.
  • Educate patients and families on available medication resources, facilitating access to necessary support services.
  • Reduce hospital readmission rates through effective case management and patient education on self-care techniques.
  • Setup continuing iv antibiotics and/or tube feeding, if required, at discharge.

Medical-Surgical RN

Beloit Memorial Hospital
07.2005 - 06.2019
  • Developed strong rapport with patients through active listening skills, empathetic communication, and genuine concern for their wellbeing.
  • Improved patient outcomes by implementing evidence-based nursing interventions and individualized care plans.
  • Managed complex medication regimens/administration for multiple patients simultaneously, accurately, and timely.
  • Demonstrated commitment to professional development through continuing education opportunities and staying current with best practice.
  • Reduced infection rates by maintaining strict adherence to infection control protocols and sterile technique during wound dressings and invasive procedures.
  • Conducted patient and family teaching sessions on disease processes, discharge planning, postoperative care, medication, and health maintenance to promote successful transitions to home or other care settings.
  • Enhanced patient safety through vigilant monitoring and assessment of vital signs, lab values, and symptoms.
  • Collaborated with interdisciplinary healthcare team to optimize care quality and continuity for medical-surgical patients.
  • Performed comprehensive physical assessments on newly admitted patients to establish baseline data for ongoing care planning.
  • Mentored nursing students during clinical rotations,
  • Utilized critical thinking skills when managing complex cases involving multiple comorbidities or rapidly changing clinical situations.
  • Served as a preceptor for newly hired nurses, providing guidance on hospital policies, unit-specific protocols, and best practices in medical-surgical nursing.
  • Evaluated the effectiveness of implemented nursing interventions and adjusting care plans accordingly.
  • Patient advocate.
  • Recognized early warning signs of deteriorating patient conditions, initiating rapid response measures to prevent further complications or emergencies.
  • Administered medications via oral, IV, inserted peripheral catheter/central line, and intramuscular injections and monitored responses.
  • Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing conditions.
  • Administered medications and treatment to patients and monitored responses while working with healthcare teams to adjust care plans.
  • Managed care from admission to discharge.
  • Trained new nurses in proper techniques, care standards, operational procedures, and safety protocols.
  • Updated patient charts with data such as medications to keep records current and support accurate treatments.
  • Provided direct patient care, stabilized patients, and determined next course of action.
  • Evaluated healthcare needs, goals for treatment, and available resources of each patient and connected to optimal providers and care.
  • Organized and managed care of patients undergoing various therapies and procedures.
  • Advised patients and caregivers of proper wound management, discharge plan objectives, safe medication use, and disease management.
  • Conferred with physicians to discuss diagnoses and devise well-coordinated treatment approaches.
  • Monitored patient condition by interpreting and tracking EKG readings, identifying irregular telemetry readings and updating team members on changes in stability or acuity.
  • Maintained quality care and comfort for patients with heart failure, pulmonary hypertension, end-stage renal disease, coronary artery disease and other conditions.
  • Delegated nursing assignments to LPNs and delegating tasks to CNAs and unit clerks.
  • Participated in nursing simulation activities, evidence-based practice project implementation and competency development to further nursing education.
  • Contributed substantially to successful department JCAHO accreditation by consistently operating to highest standards of care.
  • Documented treatments delivered, medications and IVs administered, discharge instructions, and follow-up care.
  • Educated patient, family members and caregivers on patient care instructions and home management of disease processes.
  • Evaluated patient histories, complaints, and current symptoms.
  • Communicated with healthcare team members to plan, implement and enhance treatment strategies.
  • Monitored patient reactions after administering medications and IV therapies.
  • Managed patients recovering from medical or surgical procedures.
  • Explained course of care and medication side effects to patients and caregivers in easy-to-understand terms.
  • Provided skilled, timely and level-headed emergency response to critically-ill patients.
  • Offered exceptional care and support to individuals recovering from acute incidents and dealing with chronic conditions.
  • Quickly responded to situations impacting safety and security to unit, actualizing crisis prevention interventions to control and de-escalate situations.
  • Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
  • Observed and documented patient factors such as diets, physical activity levels, and behaviors to understand conditions and effectively modify treatment plans.
  • Implemented care plans for patient treatment after assessing physician medical regimens.
  • Delivered high level of quality care to diverse populations while overseeing patient admission and triaging based on acuity and appropriate department admission.
  • Conducted ongoing monitoring and evaluations of behaviors and conditions, and updated clinical supervisors with current information.
  • Facilitated therapeutic communication, conflict resolution and crisis intervention by redirecting negative behaviors and helping patients regain or improve coping abilities.
  • Recorded details regarding therapies to keep patient charts updated.
  • Equipped patients with tools and knowledge needed for speedy and sustained recovery.
  • Conveyed treatment options, diagnosis information and home care techniques to patients and caregivers to continue care consistency.
  • Participated in evidence-based practice project implementation, nursing competency development and nursing simulation activities.
  • Sustained quality standards by performing routine medication audits and upholding internal and industry best practices.
  • Leveraged feedback and process improvement opportunities to create safer and healthier environment and increase patient satisfaction.

Education

Bachelor of Science - Nursing

Chamberlain College of Nursing
Addison, IL
02.2019

Associate of Science - Nursing

Blackhawk Technical College
Janesville, WI
05.2005

BBA - Business Management

University of Mississippi
University, MS
08.1986

Skills

  • Utilization Review/Case Management
  • Clinical Assessment Review
  • Community Resource Referrals-for medication assistance/compliance
  • Strong Clinical Judgment
  • Patient Care Assessment
  • Accurate Documentation
  • Patient and family advocacy/promote patient care
  • Attention to Detail
  • CPR/AED
  • Microsoft 365/Outlook/Excel
  • ICD-10/ EMR

Accomplishments

    Beloit Health System/Beloit Memorial Hospital Core Values Pin Recipient -Satisfaction, Integrity and Engagement

Timeline

RN Case Manager/Utilization Review Nurse

Beloit Memorial Hospital
06.2019 - Current

Medical-Surgical RN

Beloit Memorial Hospital
07.2005 - 06.2019

Bachelor of Science - Nursing

Chamberlain College of Nursing

Associate of Science - Nursing

Blackhawk Technical College

BBA - Business Management

University of Mississippi

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CASSANDRA PARTLOW-MARTIN