Summary
Overview
Work History
Education
Skills
Licensecertification
Skillsabilities
References
Timeline
Generic

Christy Hughes

Flat Rock,AL

Summary

Seasoned nursing professional offering proven clinical knowledge, natural interpersonal strengths and technical abilities. Knowledgeable about EMR charting, medication administration and interdisciplinary collaboration focused on optimizing patient care and support. Quality-focused and efficiency-driven leader. Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.

Overview

8
8
years of professional experience

Work History

RN Case Manager

Zelis Healthcare
03.2024 - Current
  • Provided emotional support to patients coping with chronic illness or end-of-life decisions, fostering resilience during difficult times.
  • Managed complex cases involving multiple comorbidities, requiring close monitoring and coordination of various healthcare services.
  • Collaborated closely with physicians to develop individualized treatment plans, supporting optimal patient outcomes.
  • Educated patients and families on available community resources, facilitating access to necessary support services.
  • Ensure appropriate utilization of services including reviewing for medical necessity of services using Milliman Care Guidelines.
  • Implemented care plans for patient treatment after assessing physician medical regimens.

Acute Care Case Manager

CHI Health Care/Commons Spirit
05.2023 - 03.2024
  • Working in the acute care setting has allowed gaining additional skills and insight to the holistic approach to healthcare
  • Assist patients to the safe/best next level of care to meet their needs
  • Work closely with Medical Licensed Providers and multiple other disciplines to achieve the best plan possible for the patient
  • This is a fast paced environment promotes utilization of organization and prioritization skills to achieve the goals of every day.
  • Maintained accurate documentation on all cases, ensuring compliance with regulations and confidentiality requirements.
  • Conducted thorough assessments of clients'' situations, identifying issues, goals, and necessary interventions.

Nurse Case Manager, Senior Analyst-SNP

Cigna Health Care
01.2022 - 05.2023
  • Working as a Case Manager, I help to coordinate care across various disciplines and levels
  • Assist members with any needs, work to meet HEDIS Measures, utilize the MIPPA process, and work with the PCP to develop a care plan for the member
  • Work to educate members and/or their families regarding their health and work to find the best possible outcome for their individual needs
  • Manage the assigned caseload effectively to meet the requirements noted per CMS and the Business MOC
  • Audited/reviewed assessments performed by Care Coordinator Assistants for accuracy, meeting business needs, turnaround times, and ensuring the best care for the member.
  • Educated patients and caregivers on healthcare protocols and processes.
  • Served as a liaison between patients and various support services such as financial assistance programs, community resources, and mental health counseling to ensure holistic care was provided.

Case Manager (SNP)

BLUE CROSS BLUE SHIELD OF TN
07.2017 - 12.2021
  • Working as a Care Coordinator/Case Manager in the Dual Special Needs Department (SNP), coordinate care across various disciplines and levels
  • Assist members via phone calls, with any needs, work to meet HEDIS/STARS Measures, utilize the MIPPA process, and work with the PCP to develop a care plan for the member
  • Work to educate members and/or their families regarding their health and work to find the best possible outcome for their individual needs
  • Manage caseload effectively to meet the requirements noted per CMS and the BCP MOC
  • Have audited/reviewed assessments performed by Care Coordinator Assistants for accuracy, meeting business needs, turnaround times, and ensuring the best care for the member
  • Review records per the appeals/grievance process
  • This process allows accurate review of medical necessity, member need, and ensure healthy outcomes
  • Worked in Appeals and Grievances reviewing medical records and information to achieve the best outcome for the member and the company
  • Assisted Utilization Management with reviewing clinical information for medical necessity and requests for services
  • Utilized MCG Criteria to review service requests, escalating to the MD when necessary for further review.
  • Maintained accurate documentation on all cases, ensuring compliance with regulations and confidentiality requirements.
  • Conducted thorough assessments of clients'' situations, identifying issues, goals, and necessary interventions.
  • Monitored ongoing cases closely, adjusting case management strategies as needed based on evolving circumstances or new information.

Staff Nurse

Parkridge Medical Center
04.2016 - 09.2021
  • Worked in the Ambulatory Care/Surgery/Outpatient department
  • Perform daily head to toe assessments, Port A Cath Access and Removal; medication/outpatient infusions, IV care, Blood Transfusions, as well as pre-op and post op care
  • Teaching is an important part of nursing, including post op care, medications, home care, and f/u care with provider
  • Perform daily tasks of computer charting including data/order entry
  • Strong documentation in the EMR, which allows anyone following work/notes to have a full picture of the patient and his/her needs
  • Served as a preceptor for new nurses and support staff
  • Charge Nurse relief when applicable ensuring and maintaining a positive work environment with smooth flow of the work day
  • General Medical/Surgical Nursing including Assessments, Medication Administration, Prioritizing Acuity, Admission, Discharges, Wound Care/Dressing Changes, and Education
  • This role required strong organization skills and assessment skills to allow for productive and efficient care of patients.
  • Administered medications via oral, IV, and intramuscular injections and monitored responses.
  • Performed various nursing interventions such as wound dressing, vital sign monitoring, and specimen collection.
  • Assessed physical, psychological, physiologic, and cognitive status of patients.
  • Monitored patients' conditions and reported changes in physical presentation, appearance, and behavior to discuss treatment with physicians.
  • Developed strong rapport with patients and families, fostering trust and open communication during challenging times.
  • Demonstrated excellent time management skills while juggling multiple priorities in a fast-paced environment.

Education

Associates of Applied Science in Nursing - NURSING

NORTHEAST AL COMMUNITY COLLEGE
Rainsville, AL
05.2007

HIGH SCHOOL DIPLOMA -

IDER HIGH SCHOOL
Ider, AL
05.1992

Skills

  • Chronic Disease Management
  • Discharge Planning
  • Multidisciplinary Approach
  • Care Coordination
  • Utilization review
  • Accurate Documentation
  • Attention to Detail
  • Clear Patient Communication
  • Organization
  • Time Management

Licensecertification

  • Registered Nurse-Multi State Compact License, 2020, Current
  • Registered Nurse-State of TN Board of Nursing, June 2007
  • Certified Case Manager-CCM, April 2017, Current
  • BLS, 07/2023, Current

Skillsabilities

Meeting business needs, Turnaround times, Ensuring the best care for the member, Working with the patient and their family to meet their individual needs, Detail-oriented person, Strong skills with Multi-Disciplinary Teams, Excellent oral and written communication skills, Working well with others, Active team member, Proficient in Microsoft Computer skills, imaging, documentation and communication, Quick learner, Able to work on multiple projects at once, Able to work and thrive in a fast-paced environment, Proficient in organization and multitasking

References

  • Lia Pritchard, RN, CCM, 423-430-0529
  • Jessica Williams, RN, BSN, 417-204-9105
  • Carie Whitaker, RN/Peer, 423-619-4669

Timeline

RN Case Manager

Zelis Healthcare
03.2024 - Current

Acute Care Case Manager

CHI Health Care/Commons Spirit
05.2023 - 03.2024

Nurse Case Manager, Senior Analyst-SNP

Cigna Health Care
01.2022 - 05.2023

Case Manager (SNP)

BLUE CROSS BLUE SHIELD OF TN
07.2017 - 12.2021

Staff Nurse

Parkridge Medical Center
04.2016 - 09.2021

Associates of Applied Science in Nursing - NURSING

NORTHEAST AL COMMUNITY COLLEGE

HIGH SCHOOL DIPLOMA -

IDER HIGH SCHOOL

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