Wellpoint/Elevance Health Star+Plus 21 & older population
STAMFORD
1
Certification
14
years of professional experience
Compassionate Nurse with extensive experience as an MCO Case Manager, Service Coordinator, and Home Health RN, complemented by admissions experience in a Behavioral Health Hospital. Seeking Care Manager role to enhance holistic, client-centered care and facilitate access to social and medical support. Strong problem-solving, critical-thinking, and analytical skills drive effective communication and efficient time management.
Work History
RN Field Service Coordinator Case Manager
7 Years 8 Months
Wellpoint/Elevance Health Star+Plus 21 & older population | 02.2019 - Current
Working remotely to manage tasks and communications effectively.
Member visits for identification/evaluation for medical necessity, coordination of care, and case management of member needs.
Performing in-person, telephonic, and audio-visual assessments.
Mentoring and training new hires.
Experience with LIDDA the Local Intellectual & Developmental Disability Authority and behavioral health.
Experience with Fair Hearings.
Performing in-person, telephonic, and audio-visual assessments to ensure comprehensive member evaluation and managing needs.
Utilizing Word, Outlook, and Excel to produce documents and manage communications.
Documenting patient information accurately in electronic health records.
Performing chart audits.
Intake Admissions Registered Nurse
6 Months
Oceans Behavioral Hospital | 08.2018 - 02.2019
Conducted mental health and nursing assessments to identify patients’ mental and medical needs.
Working with families, hospitals, police, nursing homes, CPS/APS and other entities to ensure patients’ needs are adequately met.
Verified insurance benefits for patients.
Collaborated with families, hospitals, police, nursing homes, and CPS/APS to coordinate comprehensive care for patients.
Maintained comprehensive health records in both paper and electronic formats to support patient care and treatment planning.
Responsible for patient care coordinator to ensure they receive appropriate care.
Routine visits along with OASIS visits and completion of required paperwork.
Provide daily supervision of field nurses and Home Health Aides to ensure the quality of services and maintenance of standards are met
Oversaw case management for patients with complex chronic conditions by assessing needs, developing and implementing care plans, and updating plans as patient needs evolved.
Conducted chart audits to ensure accurate documentation and compliance with ICD-10 coding for insurance billing.
Management of education to New and current Field Staff in routine visits, OASIS visits, OASIS documentation and diagnoses coding to assure that objectives and efficiency is maintained.
Review and investigate the clinical content, diagnoses, medical history, medications, fee status, and other procedures from the records of clients
Direct staff toward the appropriate use of community resources
Participate in audits, UR interdisciplinary team conferences, and represents Agency in the community as requested.
Chart Audit reviews including assuring correct documentation and ICD 10 coding to bill insurances
Review each clinician’s schedule for recertification, discharges, and aide supervisory visits
Review weekly schedule submitted by clinician for changes or updates
Engaged in community-related functions as needed.
Promote and exemplify Company mission, vision, and values always
Conducted home visits to provide personalized client care..
Take client visits in the home setting as needed.
Assist with the orientation of new professional staff to familiarize them with Agency policies and procedures.
Participating in community related functions as necessary
Home Health Administrator/DON/Supervising Nurse
5 Years 8 Months
Stamford Memorial Hospital Home Health Care & BeyondFaith Homecare & Rehab | 04.2012 - 12.2017
Stamford Hospital Home Health was bought by BeyondFaith Homecare & Rehab in 2015 where I remained Administrator until the office was absorbed into the Abilene office.
Implemented and supervised agency administrative policies and oversight of service provision
Implement an effective budgeting and accounting system that promotes the health and safety of the agency’s clients
Ensured accurate and timely documentation of all services provided
Employ or contract with qualified personnel
Organize/direct the agency’s ongoing functions
Ensure that the documentation of services provided is accurate and timely
Implement QAPI System and development of improvement programs
Supervise and evaluate client satisfaction survey reports on all clients served.
Supervised and evaluated client satisfaction survey results for all clients served.
Chart auditing.
Provided on-call support to address immediate client concerns
Executed accurate paper charting and documentation for client files.
Performed detailed reviews of charts to ensure accuracy and completeness.
Staff RN from January 2009 to April 2012 then promoted to Administrator.
Staff LVN from February 2006 to January 2009, transitioned to RN position upon receiving an RN License.
Education
Associate Degree - Pre-requirements And Nursing License
Cisco Junior College | Abilene, TX
License
License - Vocational Nursing Program
Texas State Technical College | Breckenridge, TX
Diploma - High School Diploma
Lueders-Avoca High School | Avoca, TX
Skills
Member needs assessment.
Community resource research
Care coordination.
Care planning
Care plan development
Caregiver education.
Clinical decision-making.
Family advocacy
Member and caregiver education
Member and family advocacy
Care planning
Professional conduct.
Professional manners
Certification
RN License Number: 763688 Expiration: January 2027
Personal Information
1401 HUDSON RD, STAMFORD TX 79553
325.721.8002
01.22.1983
RN License Number: 763688 Expiration: January 2027
Timeline
RN Field Service Coordinator Case Manager
Wellpoint/Elevance Health Star+Plus 21 & older population
02.2019 - CurrentRead More
Intake Admissions Registered Nurse
Oceans Behavioral Hospital
08.2018 - 02.2019Read More
Clinical Manager/Case Manager
BeyondFaith Homecare & Rehab of Abilene, LLC
12.2017 - 08.2018Read More
Home Health Administrator/DON/Supervising Nurse
Stamford Memorial Hospital Home Health Care & BeyondFaith Homecare & Rehab
04.2012 - 12.2017Read More
Cisco Junior College
Associate Degree from Pre-requirements And Nursing License