Catherine Wiley
Mount Laurel,NJ
Summary
Accomplished Clinical Care Coordinator with a proven track record at AmeriHealth Caritas, enhancing patient safety and implementing quality improvements. Expert in HIPAA compliance and interdisciplinary collaboration, I've led teams to achieve significant enhancements in clinical documentation and patient care processes, ensuring high standards of healthcare delivery and patient satisfaction. Patient-focused with supervisory experience with more than 40 years of background and success in delivering outstanding care to newborns all the way through geriatric patients. Adept at developing robust programs to educate nurses and improve patient outcomes. Excited to leverage background to take next career step with Patient Care Technicians at Lincoln Technical Institute. Results-driven Clinical Supervisor successful in creating innovative educational programs. Works with nurse leaders and healthcare staff to improve patient care and outcomes. Focused on developing strong teams while serving as positive role model.
Overview
40
40
years of professional experience
Work History
Clinical Care Coordinator
AmeriHealth Caritas Family of Companies
04.2012 - Current
- Implemented new policies and educated staff on changes.
- Coordinated, monitored, assigned, and documented patient and clinical care activities.
- Supervised and managed daily activities of clinical team consisting physicians, nurses, and support staff.
- Assessed clinical policies and procedures for compliance with changing regulations.
- Mentored new clinical staff members for proper onboarding and orientation processes.
- Upheld quality assurance procedures to maintain patient safety and satisfaction.
- Liaised with other healthcare professionals to develop comprehensive patient care plans and provide highest quality of care.
- Developed and updated policies and procedures, maintaining compliance with guidelines relating to HIPAA, benefits administration and general liability.
- Created customized care plans, working with hospital staff and families to assess and meet individual needs.
- Implemented successful healthcare program through professionalism, quality of care, medical teaching and patient satisfaction.
Manager of Utilization Review and Case Management
IntegraNet Medical Management Specialists
03.2011 - 11.2011
- Resolved staff member conflicts, actively listening to concerns and finding appropriate middle ground.
- Accomplished multiple tasks within established timeframes.
- Developed and maintained relationships with customers and suppliers through account development.
- Cross-trained existing employees to maximize team agility and performance.
- Streamlined and monitored quality programs to alleviate overdue compliance activities.
- Maintained professional demeanor by staying calm when addressing unhappy or angry customers/clients.
- Successfully managed budgets and allocated resources to maximize productivity and profitability.
- Established performance goals for employees and provided feedback on methods for reaching those milestones.
- Developed detailed plans based on broad guidance and direction.
- Established team priorities, maintained schedules and monitored performance.
- Defined clear targets and objectives and communicated to other team members.
- Cultivated positive rapport with Medical Directors and fellow employees to boost company morale and promote employee retention.
- Evaluated employee performance and conveyed constructive feedback to improve skills.
Transitional Care Coordinator/ Complex Case Mgr.
Bravo Health
05.2009 - 03.2011
- Asked appropriate open-ended questions to discover individual needs and requirements.
- Educated individuals on available educational materials, videos, and online sites.
- Collaborated with service members to provide effective transition planning.
- Researched and located appropriate services for patients with various disorders.
- Provided extensive support to patients and helped with acclimation to new settings.
- Created customized care plans, working with hospital staff and families to assess and meet individual needs.
- Established and maintained effective communication with staff, physicians and community organizations to promote high quality patient care.
- Liaised with other healthcare professionals to develop comprehensive patient care plans and provide highest quality of care.
- Developed and implemented comprehensive case management plans to address client needs and goals.
- Coordinated patient discharge planning and follow-up care.
Case Management/ Utilization Review
Temple East/ Northeastern Hospital
05.2000 - 05.2009
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Obtained authorizations from multiple insurance carriers for various levels of care.
- Submitted cases for criteria failures and helped facilitate resolutions and approvals.
- Devise or identify solutions for irregular requests and issues.
- Performed prior authorization review of services requiring notification.
- Performed admission reviews based for medical necessity based upon IQ specification.
- Facilitated workgroup meetings with medical personnel to find effective solutions to issues.
- Upheld HIPAA regulations and standards for protecting patient information.
- Generated medical reports on patient admissions, treatment and discharge for disbursement to various departments.
- Studied and researched various medical terms as well as software and coding systems.
- Retrieved medical data for physicians and patients.
- Secured confidential patient information from unauthorized access.
- Performed regular quality and validation assessments on patient data to verify accuracy.
- Conducted quality improvement and customer satisfaction surveys to evaluate patient care.
- Developed and maintained courteous and effective working relationships.
- Skilled at working independently and collaboratively in a team environment.
Perinatal Homecare Specialist
Healthy Homecomings
05.1999 - 05.2000
- Evaluated patient needs and feedback to drive product and service improvements.
- Cultivated positive relationships with vendors to deliver timely and cost-effective supply of services and materials.
- Evaluated staff performance and provided coaching to address inefficiencies.
- Helped meet changing demands by recommending improvements to business systems or procedures.
- Developed effective improvement plans in alignment with goals and specifications.
- Collected, arranged, and input information into database system.
Pediatric/OB Supervisor & Clinical Coordinator
Health Corporation of America
05.1998 - 05.1998
- Applied strong leadership talents and problem-solving skills to maintain team efficiency and organize workflows.
- Supported creation of detailed, technical financial models to value potential acquisition targets.
- Observed agency operations to verify conformance to specifications.
- Maintained overall safe work environment with employee training programs and enforcement of safety procedures.
- Helped meet changing demands by recommending improvements to business systems or procedures.
- Gathered, organized and input information into digital database.
- Developed effective improvement plans in alignment with goals and specifications.
- Created and managed project plans, timelines and budgets.
- Educated staff on organizational mission and goals to help employees achieve success.
- Evaluated staff performance and provided coaching to address inefficiencies.
- Supervised and managed daily activities of clinical team consisting of physicians, nurses, and support staff.
- Built strong relationships with patients and families for optimized care satisfaction.
Perinatal Case Manager
Independence Blue Cross
05.1995 - 05.1998
- Partnered with physicians, social workers, activity therapists, nutritionists, and case managers to develop and implement individualized care plans and documented patient interactions and interventions in electronic charting systems.
- Assisted clients in navigating housing, legal services and public benefits to gain access to valuable resources.
- 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.
- Analyzed trends and data to inform decision-making and program development.
- Monitored program performance and outcomes for successful delivery of services.
- Referred clients to appropriate team members, community agencies and organizations to meet treatment needs.
Quality Assurance Analyst
Cooper Hospital University
05.1992 - 05.1994
- Supported company in maintaining work environment focused on quality, communication, collaboration, integration, and teamwork.
- Reported progress, test metrics and results to project stakeholders.
- Gathered data on integration issues and vulnerabilities, reported findings and recommended improvements.
- Authored and maintained well-organized, efficient and successful manual test cases for entire team.
- Participated in team projects, demonstrating an ability to work collaboratively and effectively.
- Organized and detail-oriented with a strong work ethic.
Labor & Delivery Level III
Cooper Hospital University
05.1986 - 05.1992
- Assisted physician during delivery, examination and surgical procedures by anticipating needs, encouraging patient, and attending to baby after birth.
- Coordinated care of low and high-risk laboring women of childbearing age and immediate stabilization of newborn following delivery.
- Assessed infant health directly after birth using APGAR and monitored health for specified amount of time for any changes in status.
- Supported physicians in both planned and emergency Cesarean section procedures.
- Aided with induction of labor for women suffering from complications such as preeclampsia.
- Worked closely with doctors and midwives in coaching pregnant women through childbirth and post-natal recovery.
- Performed vital signs checks and administered vaccinations to infants following birth.
- Coached new mothers with breastfeeding techniques, postpartum self-care and infant care to promote easier transition into motherhood.
- Responded to emergency situations such as pre-eclampsia, early labor, and fetal distress.
- Developed and implemented strategies to improve labor and delivery processes and patient outcomes.
- Conducted comprehensive physical assessments and assisted with pain management.
- Assisted obstetricians and midwives with deliveries and cared for newborns directly after birth.
- Managed epidural analgesia infusions and monitored vital signs during labor and delivery.
- Provided emotional support and guidance to new mothers and families during labor, delivery and postpartum.
- Observed and documented patient factors such as diets, physical activity levels, and behaviors to understand conditions and effectively modify treatment plans.
- Conducted ongoing monitoring and evaluations of behaviors and conditions, and updated clinical supervisors with current information.
- Sustained quality standards by performing routine medication audits and upholding internal and industry best practices.
- Participated in evidence-based practice project implementation, nursing competency development and nursing simulation activities.
- Communicated with healthcare team members to plan, implement and enhance treatment strategies.
- Implemented care plans for patient treatment after assessing physician medical regimens.
- Documented treatments delivered, medications and IVs administered, discharge instructions, and follow-up care.
Med/Surg/Peds RN
JFK Hospital
05.1984 - 05.1986
- Trained new nurses in proper techniques, care standards, operational procedures, and safety protocols.
- Provided direct patient care, stabilized patients, and determined next course of action.
- Educated patients, families and caregivers on diagnosis and prognosis, treatment options, disease process, and management and lifestyle options.
- Managed care from admission to discharge.
- Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing conditions.
- Monitored patient reactions to drugs and carefully documented findings.
- Administered medications and treatments as prescribed by physicians.
- Administered medications via oral, IV, and intramuscular injections and monitored responses.
- Advised patients and caregivers of proper wound management, discharge plan objectives, safe medication use, and disease management.
- Evaluated patient histories, complaints, and current symptoms.
- Promoted patient and family comfort during challenging recoveries to enhance healing and eliminate non-compliance problems.
- Participated in evidence-based practice project implementation, nursing competency development and nursing simulation activities.
- Provided skilled, timely and level-headed emergency response to critically-ill patients.
- Delivered high level of quality care to diverse populations while overseeing patient admission and triaging based on acuity and appropriate department admission.
- 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.
- Implemented care plans for patient treatment after assessing physician medical regimens.
- Educated family members and caregivers on patient care instructions.
- Conducted ongoing monitoring and evaluations of behaviors and conditions, and updated clinical supervisors with current information.
- Performed frequent checks on life support equipment and made necessary adjustments to preserve optimal patient conditions.
- Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
- Offered exceptional care and support to individuals recovering from acute incidents and dealing with chronic conditions.
Education
Associate of Science - Nursing
Mercer County Community College
Trenton, NJ05.1984
Skills
- Monitoring tools
- Interdisciplinary Collaboration
- Organizational Skills
- Patient Safety
- Clinical Documentation
- Goal Setting
- HIPAA Compliance
- Medical Terminology
- Patient confidentiality
- Process Improvements
- Quality Improvement
- Physical Assessment
Timeline
Clinical Care Coordinator
AmeriHealth Caritas Family of Companies
04.2012 - Current
Manager of Utilization Review and Case Management
IntegraNet Medical Management Specialists
03.2011 - 11.2011
Transitional Care Coordinator/ Complex Case Mgr.
Bravo Health
05.2009 - 03.2011
Case Management/ Utilization Review
Temple East/ Northeastern Hospital
05.2000 - 05.2009
Perinatal Homecare Specialist
Healthy Homecomings
05.1999 - 05.2000
Pediatric/OB Supervisor & Clinical Coordinator
Health Corporation of America
05.1998 - 05.1998
Perinatal Case Manager
Independence Blue Cross
05.1995 - 05.1998
Quality Assurance Analyst
Cooper Hospital University
05.1992 - 05.1994
Labor & Delivery Level III
Cooper Hospital University
05.1986 - 05.1992
Med/Surg/Peds RN
JFK Hospital
05.1984 - 05.1986
Associate of Science - Nursing
Mercer County Community College
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