Work Preference
Summary
Overview
Work History
Education
Skills
Accomplishments
Timeline
Open To Work
Hi, I’m

Christina McElvogue

Registered Nurse
Moncks Corner,South Carolina
Christina McElvogue

Work Preference

Job Search Status

Open to work
Desired start date: 2 weeks notice

Desired Job Title

Telephonic Nurse Case ManagerCompliance AuditorUtilization Review NurseAudits and Appeals NurseRegistered Nurse

Work Type

Full Time

Location Preference

RemoteHybrid
Location: Moncks Corner, South Carolina, USCharleston, SCColumbia, SC
Open to relocation: No

Salary Range

$89000/yr - $200000/yr

Important To Me

Career advancementWork-life balanceCompany CulturePersonal development programsHealthcare benefitsWork from home optionPaid time offPaid sick leave401k match

Summary

Seasoned nursing professional with extensive clinical expertise dedicated to delivering cost-effective healthcare services for medically rehabilitated individuals through the development of patient-centered case management plans. Proven ability to leverage independent nursing judgment and evidence-based clinical decision-making to optimize health outcomes across the care continuum. Demonstrated experience in managing chronic disease processes and collaborative care planning, complemented by strong collaboration skills and adaptability in dynamic environments. Committed to conducting thorough utilization reviews to ensure effective resource use, compliance with healthcare regulations, and continuous improvement in patient outcomes.

Overview

18
years of professional experience

Work History

Humana/Centerwell
Charleston, South Carolina

Divisional, Telephonic RN Care Manager
01.2017 - Current

Job overview

  • Delivered comprehensive care management utilizing advanced clinical assessment skills.
  • Facilitated effective communication between patients and healthcare providers to ensure continuity of care.
  • Assisted in reducing emergency room visits by offering appropriate guidance to patients over the phone.
  • Conducted comprehensive utilization reviews to ensure compliance with healthcare regulations.
  • Orchestrated comprehensive care strategies aimed at improving patient quality of life and preventing hospital admissions.
  • Collaborated with healthcare teams to assess patient care plans and optimize resource allocation.
  • Collaborated with interdisciplinary teams across various departments, ensuring optimal coordination of patient care services.
  • Coordinated training sessions to equip new hires with essential skills and knowledge for team success.
  • Designed and implemented a reference tool for diabetes gap closures, while providing guidance and support to members for effective heart failure management.
  • Contributed to a positive work environment through active participation in team meetings and collaborative problem-solving efforts.
  • Received 5 nursing collaboration awards, 4 Bronze STAR awards, 2 Silver STAR awards to validate my commitment to team work, resource allocation and quality excellence.
  • Collected and inputted case data in managed care system and timely and accurately generated required correspondence and review notification for management.
  • Pursued advanced training and experiences to cultivate essential clinical leadership capabilities.
  • Explained course of care and medication side effects to patients and caregivers in easy-to-understand terms.
  • Facilitated therapeutic communication, conflict resolution and crisis intervention by redirecting negative behaviors and helping patients regain or improve coping abilities.
  • Served as a liaison between patients, families, physicians, insurance providers, and other healthcare professionals for seamless care coordination efforts.
  • Utilized electronic health records systems proficiently for efficient documentation of clinical information according to regulatory standards.
  • Enhanced patient care by developing and implementing individualized care plans.

Hill-Rom, Inc.
Charleston, South Carolina

Sr. Clinical Review Nurse
01.2011 - 01.2017

Job overview

  • Conducted thorough analysis of 30 medical records and wound assessments per day to verify beneficiary qualifications in accordance with CMS Guidelines.
  • Compiled and organized comprehensive audit packets specifically for RAC certification and ALJ audits related to Medicare claims.
  • Analyzed Medicare claims to develop precise discussion and redetermination responses for effective appeal resolutions.
  • Analyzed clinical data and conducted reviews to guarantee compliance with established patient care standards.
  • Partnered with diverse teams to design and execute quality enhancement strategies.
  • Evaluated and analyzed patient data to identify trends and enhance healthcare outcomes.
  • Facilitated training sessions for nursing staff to enhance proficiency in clinical reviews and documentation standards.
  • Designed and developed comprehensive training materials to enhance understanding of clinical review protocols.
  • Analyzed and improved workflow systems to achieve faster turnaround times in clinical reviews.
  • Evaluated clinical documentation through systematic audits to ensure precision and adherence to established regulations.
  • Facilitated education sessions for nursing staff to emphasize significance of precise documentation for future medical record reference.
  • Conducted thorough analysis of medical records, identifying discrepancies and working closely with healthcare providers to enhance patient information accuracy.
  • Executed comprehensive audits of clinical documentation, ensuring adherence to quality standards.
  • Engaged with billing department to rectify claims processing discrepancies, ensuring accurate reimbursement for services rendered.
  • Analyzed and implemented strategies for performance improvement, optimizing workflows and boosting productivity levels organization-wide.
  • Coordinated outreach to providers, state agency offices, and applicants to collect critical data and records required for final case determinations.

SMC Charleston/Trident Regional Medical
Charleston, South Carolina

Registered Nurse/Float Pool
01.2008 - 01.2011

Job overview

  • Oversaw electronic charting systems and executed comprehensive chart audits. Partnered with healthcare professionals to drive compliance with documentation standards.
  • Managed procedures and utilization of specialty beds across various hospital departments.
  • Coordinated interactions among patients, families, doctors, and social workers to ensure effective patient education and support.
  • Provided care for 5-8 patients per shift in the following areas: orthopedic, cardiac, telemetry, neurological, pediatric, geriatric, surgical, medical, women’s health, dialysis, oncology, and PCU patients. Helped maintain patient comfort and safety during treatment. Supported healthcare teams in delivering quality patient care.
  • Managed medication distribution and treatment implementation in alignment with physician directives to uphold patient safety standards.
  • Engaged with multidisciplinary teams to develop and deploy individualized care plans addressing the unique needs of various patient demographics.
  • Provided mentorship to new nursing staff, emphasizing best practices in patient care and promoting a cohesive team dynamic.
  • Facilitated seamless shift changes to maintain continuity of care through detailed handoff reports for incoming nursing staff.
  • Collaborated in interdisciplinary meetings to promote patient advocacy and ensure patient concerns were effectively communicated.
  • Fostered a culture of patient-centered care by consistently demonstrating empathy, respect, and professionalism in all interactions with patients and families.
  • Pursued continuous education and attended nursing practice conferences to ensure licensure compliance and professional growth.
  • Optimized documentation workflows by ensuring timely and accurate updates to electronic health records.
  • Delivered compassionate end-of-life care, ensuring emotional support for patients and families during challenging moments.
  • Assessed and managed critical emergency scenarios, implementing immediate actions to stabilize patients for further treatment.
  • Facilitated health screenings and assessments to enhance community outreach and extend care beyond traditional hospital environments.
  • Streamlined patient discharge processes, facilitating smoother transition back to home care.
  • Supported surgical operations by coordinating necessary equipment and supplies to achieve successful outcomes.
  • Coordinated with pharmacy personnel to ensure prompt delivery of medications, supporting efficient patient care.
  • Facilitated conflict resolution and crisis intervention to redirect negative behaviors and enhance patients' coping skills.
  • Facilitated comprehensive care for patients during recovery from medical and surgical interventions.
  • Delivered skilled emergency interventions to stabilize critically-ill patients and ensure optimal care.
  • Facilitated high-quality care provision to diverse groups, managing patient admissions and triage to optimize departmental efficiency.
  • Streamlined clinical documentation processes by creating new dialysis treatment flow sheet and log forms in partnership with healthcare team.

Education

Charleston Southern University
Charleston, South Carolina

Baccalaureate of Science from Nursing
01.2008

Skills

  • Healthcare Coordination expertise
  • Microsoft software expertise
  • Organizational time strategies
  • Detail-oriented approach
  • Cultivating strong partnerships
  • Continuous improvement strategies
  • Concise verbal/written communication
  • Problem-solving skills
  • Strong task management
  • Medicare and Medicaid knowledge
  • Adherence to evidence-based guidelines
  • Data records analysis

Accomplishments

Received 5 Nursing Collaboration Awards

Received 4 Bronze STAR awards

Received 2 Silver STAR awards

Salute NRG member.

Received Nursing Excellence Award for Best Motivator

Timeline

Divisional, Telephonic RN Care Manager

Humana/Centerwell
01.2017 - Current

Sr. Clinical Review Nurse

Hill-Rom, Inc.
01.2011 - 01.2017

Registered Nurse/Float Pool

SMC Charleston/Trident Regional Medical
01.2008 - 01.2011

Charleston Southern University

Baccalaureate of Science from Nursing

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