Cheryl Rexwinkle
Welch,OK
Summary
Accomplished Case Manager adept at handling high caseloads without sacrificing quality of care. Operates exceptionally well in high-pressure environments. Recommends best resources and courses of action to benefit patient needs and return each to optimal quality of life. Experienced in fast-paced environments and adaptable to last-minute changes. Thrives under pressure and consistently earns high marks for work quality and speed. Adept at working effectively unsupervised, quick to master new skill sets. Efficient and concise in documentation using EMR. Knowledgeable in InterQual guidelines and program usage. Appreciates a company whose attention to detail and clinical review process is exemplary.
Overview
31
31
years of professional experience
Work History
Case Manager/Utilization Review Nurse
Integris Hospital
Miami, OK
01.2015 - 05.2024
- Collaborated with other service providers to ensure continuity of care for clients.
- Collaborated with medical professionals to coordinate treatment plans for clients.
- Provided referrals to appropriate health care providers or other community resources.
- Acted as an advocate for vulnerable populations by advocating for policy changes at the state level.
- Counseled clients on available resources within the community that could help meet their needs.
- Supported family members by providing information on local support groups.
- Facilitated communication between clients, families, caregivers, social services and other agencies to ensure client needs were met.
- Maintained accurate case records and documentation according to agency guidelines.
- Assisted with applications for government benefits such as Medicaid or Social Security Disability Insurance.
- Assessed clients' needs, developed service plans and monitored progress towards goals.
- Participated in professional development activities related to case management best practices.
- Assisted individuals with eligibility for available benefits.
- Coordinated support services and optimized communication between healthcare workers and patients.
- Ensured the appropriateness and timeliness of denial letters issued by insurance companies.
- Communicated with external partners such as managed care organizations or vendors on a regular basis.
- Identified opportunities for improvement within the utilization review process through data analysis.
- Monitored pre-authorization requests to ensure that all necessary information was received prior to approval or denial of services.
- Managed discharge planning process, connecting patients with post-acute care resources when necessary.
- Collaborated with multidisciplinary teams on developing strategies for improving care quality and controlling costs.
- Reviewed and updated utilization review criteria and guidelines to reflect current standards of practice.
- Contacted insurance carriers to obtain authorizations for services delivered to patients.
- Evaluated the quality of inpatient and outpatient services through pre-certification, concurrent, and retrospective reviews.
Staff RN/ Manager Pacemaker Clinic
Coffeyville Regional Medical Center
Coffeyville, KS
04.1993 - 12.2015
- Assisted with diagnostic tests and treatments, including IVs, catheterizations and blood draws.
- Administered medications safely according to hospital policies and procedures.
- Developed a positive rapport with all patients while providing quality nursing care.
- Compiled detailed reports on each shift's activities for review by supervisors.
- Identified potential risk factors or complications associated with patient care plans.
- Utilized advanced technology tools such as electronic medical records systems when caring for patients.
- Collaborated with physicians to develop individualized treatment plans for patients.
- Maintained accurate records of patient health information in accordance with HIPAA regulations.
- Participated in interdisciplinary teams to coordinate optimal patient care plans.
- Observed strict safety measures, including checking medication dosages before administration to patients.
- Coordinated with healthcare team to establish, enact and evaluate patient care plans.
- Collaborated with health groups to plan or implement programs designed to improve overall health of communities.
- Interpreted and evaluated diagnostic tests to identify and assess patient's condition.
- Maintained strict patient data procedures to comply with HIPAA laws and prevent information breaches.
- Achieved departmental goals and objectives by instituting new processes and standards for in-patient care.
- Utilized computerized Resource and Patient Management System (RPMS) and Electronic Health Record (EHR) system.
- Displayed strong telephone etiquette, effectively handling difficult calls.
- Identified opportunities for process improvement initiatives within the clinic setting.
- Oversaw the daily operation of the clinic, including patient flow, staffing levels, and quality assurance.
- Evaluated new technologies and equipment for implementation into the clinic's operating protocol.
- Coordinated scheduling of patients' appointments, tests, treatments and procedures.
- Collaborated with physicians and other healthcare professionals to coordinate optimal patient care.
- Maintained accurate documentation regarding patient care plans, treatment outcomes and follow-up activities.
- Reviewed medical records to identify potential areas of improvement in clinical processes.
- Analyzed data from various sources to improve overall services offered at the clinic.
- Ensured compliance with federal, state and local laws governing healthcare delivery systems.
- Performed nursing assessments and collected patient medical histories to help determine proper diagnosis.
- Observed, recorded and reported patients' conditions and reactions to drugs and treatments.
- Conducted specified laboratory tests to help detect conditions and determine diagnosis.
Education
Associate Degree in Nursing - Nursing Education
Labette Community College
Parsons, KS12-1992
Skills
- Utilization review
- Regulatory Compliance
- Records Management
- Referral Coordination
- Community Outreach
- Discharge Planning
Affiliations
- Recently retired from in-house nursing to farm with husband of 50 years. Relish the roles of being a grandmother and great grandmother.
- Still possessing the nurse's heart and drive to assist clients and care providers to have the best outcomes for superior healthcare and maintain financial feasability of the managed care systems.
Timeline
Case Manager/Utilization Review Nurse
Integris Hospital
01.2015 - 05.2024
Staff RN/ Manager Pacemaker Clinic
Coffeyville Regional Medical Center
04.1993 - 12.2015
Associate Degree in Nursing - Nursing Education
Labette Community College
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