Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Cora Williams

Sparta,TN

Summary

Seeking to advance in Utilization Management, I aim to leverage my extensive background as a nurse and case manager to facilitate professional growth. My objective is to apply my acquired skills to execute meticulous work, ensuring patients attain the appropriate status, thereby contributing to precise billing and increased revenue for the hospital. My comprehensive understanding of the intricate social dynamics inherent in the medical field, coupled with my commitment to making sound clinical decisions, positions me to optimize outcomes for both patients and the healthcare institution.

Overview

17
17
years of professional experience
1
1
Certification

Work History

RN Case Manager

Vanderbilt Wilson County Hospital
Lebanon, TN
07.2020 - Current
  • Facilitate the coordination of discharge planning across diverse payer categories, including uninsured, government, and commercial entities
  • Conduct preadmission screening resident review (PASRR) and preadmission assessment evaluations (PAE) as required
  • Provide assistance and resources for socially complex situations with acute care settings and engaging with Adult and Child protective services as needed.
  • Support families by offering guidance on home health, hospice, skilled nursing placement, coordinate durable medical equipment, and other relevant resources
  • Attend daily multi-disciplinary meetings to gain insights into discharge timing, addressing patient needs, enabling informed communication with insurance companies and aiding in sound clinical decision- making related to utilization management
  • Coordinate Peer to Peer discussion, in collaboration with the Physician Advisor to establish suitable dates and time
  • Conduct comprehensive initial and continued stay reviews while utilizing InterQual or MCG while maintaining correct patient status
  • Assessed patient medical records to determine the appropriateness of requested services and procedures.

RN, Pediatric/ Med Surg Floor, Case Manager

Sumner Regional Medical Center
TN, 37066
03.2017 - 06.2022
  • Provided direct nursing care to patients, including administering medications, wound care, providing assessments, and IV therapy.
  • Educated patients on health maintenance, disease prevention, and treatment options.
  • Responded quickly to life-threatening situations by providing appropriate interventions.
  • Provided emotional support and counseling to patients dealing with chronic illness or end-of-life issues.
  • Assessed patient medical records to determine the appropriateness of requested services and procedures.
  • Conducted reviews of inpatient utilization for compliance with admission criteria and concurrent review requirements.
  • Collaborated with multidisciplinary teams on developing strategies for improving care quality and controlling costs.
  • Maintained up-to-date knowledge of health plan benefits, policies, procedures, regulations, coding guidelines.
  • Developed case management plans based on individual patient needs and eligibility criteria.
  • Performed discharge planning including referrals for post-acute care services when appropriate.
  • Participated in provider meetings to discuss cases involving complex medical conditions or difficult authorization decisions.
  • Managed observations reviews twice daily and submitted to some payor sources

LPN Nurse Supervisor

NHC Healthcare
Sparta, TN
02.2015 - 06.2017
  • Provided direct patient care and monitored vital signs.
  • Assessed patient needs, developed individualized plans of care, and implemented treatments accordingly.
  • Monitored and evaluated the effectiveness of medications and treatments administered to patients.
  • Performed wound dressing changes, catheterizations, tube feedings, assessments of physical condition, and other nursing interventions as required.
  • Conducted health teaching sessions for residents on topics such as nutrition, disease processes, and preventive health measures.
  • Collaborated with physicians to develop treatment plans that addressed the medical needs of each resident.
  • Administered medication in accordance with physician's orders and state regulations.
  • Demonstrated excellent communication skills when interacting with residents, families, visitors, staff members, and other healthcare professionals.
  • Ensured accurate documentation of all patient-related activities in a timely manner according to established standards and procedures.
  • Maintained a safe environment for both residents and staff by adhering to infection control policies and procedures throughout the facility.

LPN Geri Psych

Saint Thomas RiverPark
McMinnville, TN
03.2015 - 01.2016
  • Medication Administration, IV therapy, routine nursing care
  • Participated in interdisciplinary team meetings to discuss treatment plans and goals for each patient.
  • Maintained accurate documentation of patient care services provided in accordance with agency policy and procedures.
  • Provided emotional support to family members of psychiatric patients during difficult times.
  • Instructed individuals on how to cope with their mental health conditions through lifestyle changes, such as diet or exercise regimens.
  • Advised family members on available community resources that can help them manage their loved one's condition.
  • Developed education materials about psychiatric illnesses for use by staff and clients.
  • Assessed client responses to medication regimes and reported any adverse reactions.

LPN Office Nurse

TLC Pediatrics and Internal Medicine
Sparta, TN
10.2006 - 03.2015
  • Organized medical supplies and equipment to maintain a safe and efficient work environment.
  • Assisted physicians with patient care, including administering injections and medication.
  • Conducted physical assessments of patients, such as measuring vital signs, height, weight.
  • Provided education and counseling on health-related topics to patients and their families.
  • Performed basic laboratory tests, such as urinalysis or blood draws.
  • Recorded patient information in electronic medical records system accurately and efficiently.
  • Coordinated with other healthcare professionals to ensure optimal patient outcomes.
  • Monitored pre-authorization requests to ensure that all necessary information was received prior to approval or denial of services.
  • Maintained up-to-date knowledge of health plan benefits, policies, procedures, regulations, coding guidelines.
  • Facilitated communication between payers, providers and patients concerning authorization issues or concerns.
  • Contacted insurance carriers to obtain authorizations for services delivered to patients.

LPN, Alzheimer and Assisted Living Supervisor

LifeCare Center of Sparta
Sparta, TN
04.2012 - 07.2013
  • Monitored quality assurance programs to ensure that care was delivered according to established standards.
  • Responsible for Medication Administration, Wound Care, and behavioral support for Dementia patients
  • Also supported and monitored Nurse’s aide care to the patient.
  • Conducted assessments of residents' physical and mental health, safety needs, and living arrangements.
  • Maintained accurate records of all resident activities, services provided, and changes in condition.
  • Assessed and monitored patient health conditions, including vital signs such as temperature, pulse rate and blood pressure.
  • Provided nursing care for patients with various medical diagnoses and treatments.

LPN Nurse Supervisor

NHC Health Care
McMinnville, TN
08.2011 - 02.2012
  • Assisted physicians with patient care by taking vital signs, administering injections and performing other nursing duties.
  • Provided direct physical and emotional support to patients and their families.
  • Performed routine laboratory tests including urinalysis, blood glucose monitoring and others.
  • Maintained accurate medical records of each patient's health condition.
  • Ensured that all medications were administered accurately and on time as prescribed by the physician.
  • Observed patients for any changes in their condition or behavior, reported findings to the supervisor or physician in charge.
  • Instructed patients and their families about disease prevention, proper nutrition, medication management and other health related topics.

Education

Bachelor of Science - Nursing

Chamberlain University
Downers Grove, IL
02-2020

Associate of Science - Nursing

Fortis College
Nashville, TN
07-2017

LPN - LPN

Tennessee Technology Center
McMinnville, TN
08-2009

Master of Science - Nursing Leadership

Chamberlain University
Downers Grove, IL

Skills

  • Utilization reviews
  • Policy Adherence
  • Discharge Planning
  • HIPAA Compliance
  • Care Coordination
  • Community Resources
  • Insurance knowledge
  • Community Resource Referrals
  • Medication Management
  • Referral Generation
  • RN Case Management
  • Interdisciplinary Collaboration
  • Proficient in microsoft office, epic, Meditech, and teams

Certification

  • CCM certified
  • BLS certified

Timeline

RN Case Manager

Vanderbilt Wilson County Hospital
07.2020 - Current

RN, Pediatric/ Med Surg Floor, Case Manager

Sumner Regional Medical Center
03.2017 - 06.2022

LPN Geri Psych

Saint Thomas RiverPark
03.2015 - 01.2016

LPN Nurse Supervisor

NHC Healthcare
02.2015 - 06.2017

LPN, Alzheimer and Assisted Living Supervisor

LifeCare Center of Sparta
04.2012 - 07.2013

LPN Nurse Supervisor

NHC Health Care
08.2011 - 02.2012

LPN Office Nurse

TLC Pediatrics and Internal Medicine
10.2006 - 03.2015

Bachelor of Science - Nursing

Chamberlain University

Associate of Science - Nursing

Fortis College

LPN - LPN

Tennessee Technology Center

Master of Science - Nursing Leadership

Chamberlain University

Similar Profiles

CREATE PROFILE
Cora Williams