CHARLENE OTIS
Abilene
Summary
Accomplished Registered Nurse with 23 years of diverse clinical and office experience, specializing in OB/GYN, Pediatrics, IDD, Telemetry, Neurology, Medical-Surgical, and Home Health Care management. Proven expertise in auditing and remote case management, complemented by a strong background in multidisciplinary team training and education. Skilled in ensuring accurate clinical documentation and effective utilization management, with a successful track record in supervisory roles within home care settings. Currently pursuing CCM certification while maintaining active Minnesota and DC state nurse licenses for 2024.
Knowledgeable telephonic care coaching with background in primary care nursing. Adept at providing compassionate and comprehensive patient care, including managing treatment plans and supporting patient recovery. Demonstrated critical thinking and effective communication skills in high-pressure healthcare environments.
Overview
23
23
years of professional experience
Work History
Primary Nurse Case Manager I
Blue Cross Blue Shield of Texas
07.2023 - Current
- Single source of contact for members, health care personnel and all other entities involved in managing care. Performs concurrent review, discharge planning and care coordination along with UM interventions. Identifies alternate treatment programs; consults with physicians, providers, members, and other resources to evaluate options and services required to meet an individual’s health needs.
- Promotes quality and cost-effective outcomes; and serves as liaison to physicians and members. Other functions include episodic case management, determining member assignment of treatment, and pre-admission/post-discharge counseling for an acute condition. Working with medical directors and other cross functional team members to establish ongoing care for members.
- Establish relationships with the member through the immediate post discharge follow-up period or until all short-term care needs are met through concurrent review. Provide education/local resource information and encourage member (self) education. Functioning in a clinical care advisory role, with training and education. Assesses members for wellness education and disease management, introduces members to our website tools, educates members regarding wellness and specific conditions, and facilitates the coordination of care for identified members.
- Obtains other state licenses not with contact nursing states. Works with multidisciplinary team including auditing, social workers, behavior health, managers and medical directors to lead in solutions for cost effectiveness while providing evidence-based results to member of the United States.
Case Manager II
Superior Health Plan/Centene Corporation
11.2016 - 07.2023
- Assess the member's current health status, resource utilization, past and present treatment plan and services-, prognosis-, short- and long-term goals, treatment, and provider needs. Worked with multidisciplinary team to create solutions for member’s current needs.
- Utilize assessment skills and discretionary judgment to develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs and promote desired outcomes. Conduct research and worked with others for staff knowledge on the needs of the member.
- Coordinate services between Primary Care Physician (PCP), specialists, medical providers, and non-medical staff as necessary to meet the complete medical socio-economic needs of members. Worked with management and leadership if identified needs of a member did not have current solution.
- Provide patient and provider education. Reviewed training and clinical knowledge to familiarize with the needs of the client and provider education including HEDIS measures.
- Facilitate members’ access to community-based services with home modification, DME and worked to problem solve with any other needs they may have that a clinical nurse can assist with.
- Monitor referrals made to community-based organizations, medical care and other services to support the members’ overall care management plan through and create solutions with any issues that arise.
- Actively participate in integrated team care management rounds with leadership. Worked with group work studies including training and incorporated a training video for clinical training that compromised of education on CDS.
- Identify related risk management quality concerns and report these scenarios to the management to assist with solutions.
- Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems.
- Assisted my team with clinical training for new employees with all the concepts of the team needs. Developed teaching materials for the team and assisted managers with creating Power Point presentations in team meeting via remote and face to face.
- Participate in case management committees and work on special projects related to case management as needed.
- Worked with auditing on trends and assisted management with audit policy and procedure to assist the workflow of the cross functional team relationship.
Nurse Manager, CM Facilitator, CM
Abilene State Supported Living Center
01.2015 - 07.2016
- Started as cm for cottages. Was promoted to cm facilitator within 2 months
- Nurse manager over cottages/unit 4 within 6 months
- Role as nurse manager included overseeing 18 RN’s and LVN’s on unit that provided hands on patient care
- Oversight of all the homes on the unit involving nursing and medical needs. Annual, quarterly and prn productivity assessments of nurse quality of care
- Meeting with medical and nursing administration as well as pharmacy for QA
RN Home Health Case Manager
Kindred Home Health
05.2013 - 10.2013
- Case management of 40-50 patients in community for acute home health
- Admission of patients using oasis charting form, weekly visits along with roc visits
- Referral to therapy. Contact with PCP and specialist’s office for care of member at home
- Education to member and family for expected d/c. Referral and f/u on DME equipment in home
- On call rotation and weekly/prn IDT team meetings for promotion of care for patient.
RN Pediatric Case Manager
Kinder Hearts Home Health, LLC
02.2010 - 05.2013
- Case management of medically fragile pediatric home patients ages 0-21 years old
- Oversee nurses in the home giving direct care to those patients (LVN’s and RN’s)
- Care Coordination with hospitals, physicians, DME suppliers, families, Hospice, schools, therapies to make goals for patients
- Scheduling of nurses in homes monthly and schedule coordination of nurses for request off, call ins or family request
- Chart auditing of peers and self
- Audits of each nurse note in home for each nurse for Medicaid and insurance guidance compliance in following POC
- Supervisory visits to homes every 90 days or prn with a distance as far as 120 miles
- Post hospital visits for patients in hospital longer than 24 hours
- Weekly case conference attendance for Abilene, San Angelo and Wichita Falls Branch of Pediatrics
- Performs skilled nursing visits for acute patients with frequencies: visits have included wound care with wound vac, feeding education with NGT, New gastrostomy button placement, respiratory function with apnea monitor and pulse oximetry, teaching of new diabetics, weight monitoring with feeding assistance, new tracheostomy teaching if not eligible for private duty nursing, vesicostomy and foley catheter teaching, pre partum teaching for high risk pregnancies in children under 21, PICC line ABX teaching with pumps, PICC line dressing, peripheral lab draws, CL lab draws
- On call with other RN’s; answering phone triage and occasional visits to homes after hours holidays
- Admits on all new pediatric patients assigned to this CM with generating of 485, POC, all required documentation for Traditional Medicaid, First Care Medicaid, Superior, TriCare, BCBS, United Healthcare and private pay.
- Renewal of authorizations every 3-6 months including 485’s every 90 days for chronic patients and every 60 for acute patients
RN Supervisor, Technology Department
Sears Methodist Retirement System
07.2007 - 01.2010
- Oversee operations of Technology Department including Automated Medication Machines, Emergency Response Systems and Tele Heath for 80 private pay client accounts.
- Oversee 1 LVN in management for client medication machines and health status changes
- Process payroll, client billing
- Partner with physicians for quality care of al medication machine clients
- Develop and implement procedures for expansion sites statewide
- Coordinate training with local nursing schools for nursing students to experience clinical care in the home health setting
Registered Nurse for Telemetry, Neurology/Medical Surgical
Hendrick Medical Center
01.2007 - 05.2007
- Hands on patient care with needs ranging from basic medical/surgical/ neurology/ cardiac, OB/GYN, infant and pediatric care. Advanced needs as an RN intensive at times with medication administration PO, CL, OG and GT. Pre and post-surgery care along with catheter care, peripheral IV start/d/c.
Licensed Vocational Nurse for Mothercare/Nursery/Pediatrics
Hendrick Medical Center
11.2004 - 11.2006
- Hands on patient care with needs ranging from basic medical/surgical/ neurology/ cardiac, OB/GYN, infant and pediatric care. Advanced needs as an RN intensive at times with medication administration PO, CL, OG and GT. Pre and post-surgery care along with catheter care, peripheral IV start/d/c.
Licensed Vocational Nurse for Pediatric Home Health
Choice Home Health
09.2003 - 11.2003
- Home in care for private duty nursing to disabled pediatric clients including assessments, administration via GB, exercise recommended by PT, care of GB tube, in home charting.
Licensed Vocational Nurse for home MHMR
Soma Resources
03.2003 - 08.2003
- 48 MHMR clients living in Abilene Community Housing. Medication administration, Assessments, Physician and pharmacy coordination of care, teaching in home to care attendants and house supervisors, on call, respond to emergency situations.
Licensed Vocational Nurse for Mothercare/Nursery/Pediatrics
Hendrick Medical Center
05.2002 - 03.2003
- Hands on patient care with needs ranging from basic medical/surgical/ neurology/ cardiac, OB/GYN, infant and pediatric care. Advanced needs as an RN intensive at times with medication administration PO, CL, OG and GT. Pre and post-surgery care along with catheter care, peripheral IV start/d/c.
Education
Certified Case Manager Certification -
Commission for Case Manager Certification (CCMC)
04.2024
Bachelor of Nursing Applied Science Degree - undefined
University of Texas at Arlington
Arlington, Texas08.2021
Associate Degree of Applied Science of Nursing - undefined
Cisco Junior College
Abilene, Texas12.2006
Certificate Licensed Vocational Nursing Services - undefined
Cisco Junior College
Abilene, Texas05.2002
Skills
- Clinical judgment
- Compassionate care
- Health promotion
- Emergency care
- Disease prevention
- Compassionate communication
- Nutrition counseling
- Geriatric care
- Mental health support
- Postpartum care
- Pediatric care
- Teamwork and collaboration
Timeline
Primary Nurse Case Manager I
Blue Cross Blue Shield of Texas
07.2023 - Current
Case Manager II
Superior Health Plan/Centene Corporation
11.2016 - 07.2023
Nurse Manager, CM Facilitator, CM
Abilene State Supported Living Center
01.2015 - 07.2016
RN Home Health Case Manager
Kindred Home Health
05.2013 - 10.2013
RN Pediatric Case Manager
Kinder Hearts Home Health, LLC
02.2010 - 05.2013
RN Supervisor, Technology Department
Sears Methodist Retirement System
07.2007 - 01.2010
Registered Nurse for Telemetry, Neurology/Medical Surgical
Hendrick Medical Center
01.2007 - 05.2007
Licensed Vocational Nurse for Mothercare/Nursery/Pediatrics
Hendrick Medical Center
11.2004 - 11.2006
Licensed Vocational Nurse for Pediatric Home Health
Choice Home Health
09.2003 - 11.2003
Licensed Vocational Nurse for home MHMR
Soma Resources
03.2003 - 08.2003
Licensed Vocational Nurse for Mothercare/Nursery/Pediatrics
Hendrick Medical Center
05.2002 - 03.2003
Bachelor of Nursing Applied Science Degree - undefined
University of Texas at Arlington
Associate Degree of Applied Science of Nursing - undefined
Cisco Junior College
Certificate Licensed Vocational Nursing Services - undefined
Cisco Junior College
Certified Case Manager Certification -
Commission for Case Manager Certification (CCMC)
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