Cherry May Abalajon
Jamaica,NY
Summary
Compassionate and dedicated Registered Nurse with over 20 years of experience providing exceptional patient care in hospital/clinic setting. Skilled in a wide range of clinical procedures, with a strong focus on patient safety, health promotion, and patient education. Known for excellent communication and teamwork skills, along with a commitment to delivering high-quality care. Holds an active RN license and continuously pursues opportunities for professional development and certification.
Overview
22
22
years of professional experience
1
1
Certification
Work History
Clinical Oversight Compliance Consultant Sr.
Elevance Health
03.2024 - Current
- Responsible for evaluating and monitoring business activities and policies to ensure compliance with regulatory and contractual requirements and internal and external audits
- Oversee the company's delegated activities to ensure they are performed in compliance with the company's standards and regulatory requirements
- Monitor the performance of the agencies in compliance with the company's policies and procedures along with local, state, and federal regulations
Nurse Medical Management Sr. (Team Lead LTSS Department NY Medicaid)
Elevance Health
11.2021 - 03.2024
- Acts as Team Lead, resource person to team members, processes complex cases, intervenes with member and or provider complaints
- Processes daily/weekly census report and delegates assignments to nurses, performs monthly nurse audit to maintain consistency and ensure compliance with applicable criteria and NY State Guidelines
- Participates in the hiring process of new associates through interview and evaluation of the candidate
- Trains nurses on new policies and guidelines to ensure compliance with regulatory requirements
- Facilitator for case rounds
- Manages approximately 100 to 150 members
- Consults with medical directors to ensure medically appropriate, high-quality, cost-effective care throughout the medical management process
- Has knowledge of the Universal System Assessment of New York and interprets Time Tasking Tool
Nurse Medical Management I (LTSS Department)
Elevance Health
05.2017 - 11.2021
- Back-up to Sr
- Nurse (Nextgen report, assignment etc.)
- Assists with new staff training
- Conducts pre-certification for Personal Care Services (CDPAP or traditional PCS)
- Managed approximately 180 to 200 members
- Ensures member access to medical necessary, quality healthcare in a cost effective setting according to contract
- Consult with clinical reviewers and/or medical directors to ensure medically appropriate, high quality, cost effective care throughout the medical management process
- Collaborates with providers to assess member's needs for early identification of and proactive planning for discharge planning
- Cross-trained to Private Duty Nursing
Nurse Medical Management I (Outpatient Department)
Elevance Health
05.2016 - 05.2017
- Conducts pre-certification for Homecare, DME, Outpatient procedures and Out of Network service reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts
- Consults and collaborates with providers and other resources as appropriate; assessing, planning, and implementing options and services required to meet an individual's health needs within the scope of their benefit plan
- Ensures member access to medical necessary, quality healthcare in a cost effective setting according contract
Field RN Case Manager
North Shore LIJ Home Care Network
10.2013 - 05.2016
- In-charge of case management and nursing care of assigned case load of 25 to 30 patients
- Directs the Home Health Aides to ensure quality care is delivered
- Assess patient health problems and needs, and implement nursing care plans accordingly
- Coordinates services for patients to other disciplines, agencies and health care providers as needed
- Adheres to all agency policies, including but not limited to infection control and safety, education, reporting and practice implementation
Assistant Nurse Manager
Stern Center for Extended Care and Rehabilitation
07.2010 - 10.2013
- Responsible for the overall assessment, planning, implementation and evaluation of patient care on the unit
- Accountable for orientation and training of the new incoming nurses on unit
- Carried out the System, Facility and Nursing Service mission, vision, values and the overall strategic planning, clinical management, patient care, budgeting, financial management and quality management on the unit
- Contributed to the overall strategic planning, clinical management, patient care, financial management and quality management on the unit
- Managed 8 to 10 nurses and nursing activities in 30-35 -bed unit by providing comprehensive nursing guidance and maintaining outstanding patient satisfaction and care standards.
Staff Nurse
Brookhaven Rehabilitation & Health Care Center
01.2010 - 06.2010
- Provided all aspects of nursing care to residents in a rehabilitation of a Bariatric and Behavioral unit
- Assigned personnel to perform tasks as necessary
- Performed various nursing interventions such as wound dressing, vital sign monitoring, and specimen collection.
- Monitored patients' conditions and reported changes in physical presentation, appearance, and behavior to discuss treatment with physicians.
Mental Health Nurse-Per Diem
Holliswood Hospital
08.2009 - 01.2010
- Provided nursing care for an assignment of approximately 30 to 40 patients
- Identified, interpreted, and documented physical and emotional status and/or patterns such as assaultive or suicidal behavior, and response to treatment or medication
- Administered psychotropic medications to patients, and monitored reactions
- Educated patients in purpose, dosage, and side effects of medication
Clinical Nurse
General Clinical Research Center Mount Sinai Hospital
12.2005 - 07.2009
- Provided direct continuous care for research participants which was consistent with protocols and standard of care
- Assessed and evaluated the needs of research participants
- Collaborated with members of the health team and also the research team including the Principal Investigator and the study Coordinators
- Prepared set-ups for Out-Patients research participants
Staff Nurse
Cardinal Santos Medical Center
05.2003 - 03.2004
- Provided nursing care to patients with critical conditions
- Applied basic principles in preventive, restorative and rehabilitative care
- Provided holistic nursing care which addressed the many needs of the patient and family
Education
Bachelor of Science - Nursing (BSN)
World Citi College
Skills
- Commitment to Excellence
- Case Coordination
- Collaborative Care Coordination
- Comprehensive Clinical Evaluation
- Clinical Utilization Evaluation
- Regulatory Compliance Knowledge
- Compliance Oversight
- Analytical Problem-Solving
- Medical Record Documentation
- Patient Engagement
- Quality Assurance Review
- Critical Thinking and Resolution
Certification
National Council Licensure Examination (NCLEX), New York, Passed, 01/01/05
Personal Information
Title: Registered Nurse
Languages
English
Native or Bilingual
Timeline
Clinical Oversight Compliance Consultant Sr.
Elevance Health
03.2024 - Current
Nurse Medical Management Sr. (Team Lead LTSS Department NY Medicaid)
Elevance Health
11.2021 - 03.2024
Nurse Medical Management I (LTSS Department)
Elevance Health
05.2017 - 11.2021
Nurse Medical Management I (Outpatient Department)
Elevance Health
05.2016 - 05.2017
Field RN Case Manager
North Shore LIJ Home Care Network
10.2013 - 05.2016
Assistant Nurse Manager
Stern Center for Extended Care and Rehabilitation
07.2010 - 10.2013
Staff Nurse
Brookhaven Rehabilitation & Health Care Center
01.2010 - 06.2010
Mental Health Nurse-Per Diem
Holliswood Hospital
08.2009 - 01.2010
Clinical Nurse
General Clinical Research Center Mount Sinai Hospital
12.2005 - 07.2009
Staff Nurse
Cardinal Santos Medical Center
05.2003 - 03.2004
Bachelor of Science - Nursing (BSN)
World Citi College
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