Roberta Hackworth-Mimms
New Salisbury,IN
Summary
Goal is to obtain a work from home position in Utilization Review or Case Management from Southern Indiana . I am a dependable Utilization Review Nurse promoting over 28 years of expertise in healthcare industry. I am knowledgeable in Utilization Management, Case Management, and Pre- Certification for Medicare, I am considered a critical thinker and problem-solver due to dynamic patient care planning and understanding of Medicare guidelines. My previous managers have complimented me for having great rapport with providers and patients. I have experience with knowing what a person will need when they return home after a hospital stay and rehabilitation. I am able to asses a situation just by talking with a patient and their caregiver. I pride myself on being honest, having good morals, and my willingness to do what is right by patient, providers, and health insurance companies.
Overview
27
27
years of professional experience
Work History
RN Utilization Nurse
CarePlus Health Plans
Tampa , FL
03.2014 - 11.2021
- Providing case management and utilization review for hospital and SNF members.
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Performed admission reviews based on medical necessity
- Performed prior authorization review of services requiring notification.
- Submitted cases for criteria failures and helped facilitate resolutions and approvals.
- Devise or identify solutions for irregular requests and issues.
- Served as subject matter resource, providing information related to Microsoft One Note program, Excel programs, CSC documentation program, and general practices related to Skilled Nursing Utilization
- Worked with healthcare team to develop new documentation templates for Skilled Nursing Concurrent Stay reviews, improving clinical documentation and accountability.
- Promoted patient and family education and comfort during challenging recoveries .
- Leveraged feedback and process improvement opportunities to create safer and healthier environment and increase patient satisfaction.
- Participated in improvement committees to discuss policies and practices and propose revisions to the Skilled Nursing Utilization review processes.
- Sustained quality standards by upholding and teaching internal and industry best practices.
- Strengthened training and nursing knowledge by taking part in continuing education programs and inter-rating reliability testing.
RN Case Manager/ Admission Nurse/ Triage/ Infusion RN/ Clinical Team Leader
Good Shepherd Hospice Polk County Florida
Lakeland, FL
03.2003 - 03.2014
- Worked both autonomously and as part of interdisciplinary team to provide end of life care to patients and support and education to families
- Chart auditing related to Medicare review
- Assisted in development of EMR at Good Shepherd Hospice. Participated in Performance Improvement plans for Education, Communication, Electronic Medical Records, Agency to Agency transfers, infusion program, and after hours care
- Provided direct patient care, stabilized patients and determined next course of action.
- Managed care from admission to discharge.
- Administered medications via oral, IV and intramuscular injections and monitored responses.
- Educated patients, families and caregivers on diagnosis and prognosis, treatment options, disease process and management and lifestyle options.
- Advocated for patients by communicating care preferences to practitioners, verifying interventions met treatment goals and identifying insurance coverage limitations.
- Contributed substantially to successful state accreditation by consistently operating to highest standards of care.
- Organized and managed care of patients undergoing various therapies and procedures.
- Trained new nurses in proper techniques, care standards, operational procedures and safety protocols as team preceptor.
- Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing conditions.
- Minimized hospital returns with palliative centered approaches.
- Conferred with physicians to discuss diagnoses and devise well-coordinated treatment approaches.
- Led successful team comprised of RNs, LPNs and ancillary staff as Clinical Team Leader for Admissions and Hospital team.
- Prioritized urgent needs and redirected staff to those areas.
- Controlled costs through chart audits and implementing changes that reduces length of hospital stay.
- Delivered feedback to decision-makers regarding employee performance and training needs.
- Cross-trained existing employees to maximize team agility and performance.
- Evaluated employees' strengths and assigned tasks based upon experience and training.
- Reviewed performance data to monitor and measure productivity, goal progress and activity levels.
- Approved regular payroll submissions for employees.
- Accomplished multiple tasks within established timeframes.
- Compiled data highlighting key metrics to report information, determine trends and identify methods for improving patient outcomes.
- Established and updated work schedules to account for changing staff levels and expected workloads.
RN
Lakeland Regional Medical Center
Lakeland, FL
08.1999 - 03.2003
- Worked as an LPN in medical surgical from 1999 until 2001. In 2001 obtained RN licensure and transferred to cardiac floor. In 2002 returned to med surg.
- Administered medications via oral, IV and intramuscular injections and monitored responses.
- Provided direct patient care, stabilized patients and determined next course of action.
- Managed care from admission to discharge.
- Evaluated healthcare needs, goals for treatment and available resources of each patient and connected to optimal providers and care.
- Minimized hospital stays with recovery-centered approaches, reducing average in-patient stay length.
- Advocated for patients by communicating care preferences to practitioners, verifying interventions met treatment goals and identifying insurance coverage limitations.
- Implemented medication and IV administration, catheter insertion and airway management.
- Educated patients, families and caregivers on diagnosis and prognosis, treatment options, disease process and management and lifestyle options.
- Maintained quality care and comfort for patients with heart failure, pulmonary hypertension and other conditions.
- Oversaw delivery of care for patients on medical-surgical unit, providing direct care, delegating nursing assignments, and supervising team comprised of nurses, LPNs, technicians and unit clerks.
- Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing conditions.
- Administered medications and treatment to patients and monitored responses while working with healthcare teams to adjust care plans.
- Kept optimal supply levels in treatment rooms, triage and other areas to meet typical patient loads.
- Collected blood, tissue and other laboratory specimens and prepared for lab testing.
- Secured controlled narcotics and distributed medication on schedule to meet patient needs and minimize misuse opportunities.
- Participated in nursing simulation activities, evidence-based practice project implementation and competency development to further nursing education.
- Reviewed post-operative orders and continuously monitored patients' post-operative vitals, set up PCA and fluids and oriented patients to unit.
- Provided didactic and clinical instructions to orient new nurses and potential student nurses to achieve training outcomes.
- Advised patients and caregivers of proper wound management, discharge plan objectives, safe medication use and disease management.
- Managed quality care for patients with heart failure, end-stage renal disease and coronary artery disease.
Reuse tech
Watson Clinic Kidney Center
, Fl.
10.1994 - 08.1999
- LPN
- Administering dialysis treatments to patients
- Developing and maintaining patients plans of care,
- Maintaining dialysis equipment
- Patient Education
- Administering of Blood and Blood Products
- Administer IV meds
Education
Master of Science - Health Care Administration And Nursing Education
University of Phoenix
Phoenix Arizona2015
Bachelor of Science - Nursing
University of Phoenix
Phoenix Arizona02.2008
Associate of Science - Nursing
Hillsborough Community College
Tampa, FL12.2000
Certification - LPN
Travis Technical Center
Lakeland FLorida06.1997
Skills
- Creative Problem Solving
- Specialized Healthcare Referrals
- Critical Thinking
- Compassionate and Caring
- Clear Patient Communication
- New Staff Precepting
- Treatment Plan Modification
- Needs Assessment
- Microsoft Office, outlook, One Note, Word, Teams and Excel
- Utilization review
- Concurrent reviews
- Patient and Family Education
Accomplishments
- LPN, RN, BSN
- First all SNF Utilization Nurse at Careplus 3 time employee of the Quarter at Careplus Health Plans
- Subject matter expert for One Note
- Assisted with overhauling the SNF Utilization process at Careplus
- PICC certification
- First nurse preceptor in GSH admissions department
- Electronic Medical Record Super user
- Neww Program development for on boarding of new nurses at Good Shepherd Hospice
Personal Summary
I have been married for 21 years. Together we have an adult daughter, adult son, and a 14 year old son. We recently relocated from Central Florida to Southern Indiana to be closer to my elderly father. I home school my 14 year old (support is online schooling). My hobbies are any type of paper crafting, camping trips, and reading a good book.
References
- Natalie Miller - Associate Director of Utilization Management at Careplus Health Plans- phone 813-842-8447
- Catherine Simon- Utilization review Nurse at Careplus HEalth Plans- Phone 813-966-7732
- Brandi Howarth - Utilization Review NUrse at Careplus Health Plans - Phone 863-205-0056
Timeline
RN Utilization Nurse
CarePlus Health Plans
03.2014 - 11.2021
RN Case Manager/ Admission Nurse/ Triage/ Infusion RN/ Clinical Team Leader
Good Shepherd Hospice Polk County Florida
03.2003 - 03.2014
RN
Lakeland Regional Medical Center
08.1999 - 03.2003
Reuse tech
Watson Clinic Kidney Center
10.1994 - 08.1999
Master of Science - Health Care Administration And Nursing Education
University of Phoenix
Bachelor of Science - Nursing
University of Phoenix
Associate of Science - Nursing
Hillsborough Community College
Certification - LPN
Travis Technical Center