Summary
Overview
Work History
Education
Skills
Licensure
Timeline
Generic

Darleny Torres

Lexington,NC

Summary

Compassionate and dedicated RN care manager with a strong background in providing exceptional patient care. Seeking a challenging role that allows me to utilize my skills in care coordination, patient advocacy and team leadership to positively impact the lives of patients and their families.

Overview

12
12
years of professional experience

Work History

RN Care Manager- DSNP

Belong Health
12.2023 - Current
  • Conduct comprehensive assessments of members' health status, social determinants of health and care needs.
  • Develop and implement individualized care plans based on members' goals, preferences, and healthcare needs.
  • Coordinate and collaborate with interdisciplinary healthcare team members including, primary care physicians, specialists, social workers, and community resources to ensure seamless and coordinated care delivery.
  • Provide ongoing education and support to members and their families regarding chronic disease management, medication adherence, preventive care, and health lifestyle choices.
  • Conduct regular follow-up and care coordination activities to monitor members' progress, address barriers to care, and promote optimal health outcomes.
  • Advocate for members' needs and rights, ensurance that they receive appropriate and timely healthcare services.
  • Document all care management activities accurately and timely in electronic health record system.
  • Stay up to date with the latest evidence-based practices and guidelines related to DSNP care management.

RN Care Manager- Transition of Care

Oscar Health
05.2022 - 10.2023
  • Demonstrated strong communication and organizational skills to effectively manage caseload and coordinate care for patients.
  • Coordinated and facilitated seamless transitions of care for patients between different healthcare settings to ensure continuity of care and improved health outcomes.
  • Collaborated with interdisciplinary teams including physicians, case managers, social workers, and other healthcare providers to develop and implement comprehensive care plans.
  • Conducted patient assessments and developed individualized care plans to address their healthcare needs and goals.
  • Provided education and support to patients and their families to promote self-management and improve their overall health and well-being.
  • Educated patients and their families on post discharge care instructions, medication management, and necessary follow up appointments.
  • Monitored and tracked patient outcomes and documented care coordination activities in electronic health records.
  • Identified and addressed barriers to care and ensured patients had access to appropriate resources and services.
  • Participated in quality improvement initiatives to enhance patient care and optimize healthcare delivery.
  • Kept up-to-date with healthcare regulations and policies related to care transitions and patient safety.
  • Maintained positive relationships with healthcare partners and community resources to support patient care needs.

MLTSS RN Care Manager

Aetna Better Health Of NJ
05.2020 - 03.2022
  • Coordinated and managed care for members in a managed long-term services and supports (MLTSS) program through assessment, planning, intervention, and evaluation of their healthcare needs.
  • Developed and implemented care plans in collaboration with interdisciplinary teams including physicians, social workers, case managers, and other healthcare providers.
  • Conducted comprehensive assessments of members' health status and needs and developed individualized care plans to address their physical, emotional, and social needs.
  • Provided ongoing education, support, and guidance to members and their families to promote self-management and optimal health outcomes.
  • Monitored and managed members' healthcare utilization and worked to reduce hospital readmissions and emergency room visits.
  • Ensured members had access to appropriate and cost-effective services and resources.
  • Maintained accurate and timely documentation of care coordination activities in electronic health records.
  • Participated in quality improvement initiatives to enhance care delivery and patient outcomes.
  • Collaborated with community resources and healthcare partners to support care needs and provide a holistic approach to care management.
  • Engaged in ongoing professional development to stay current with healthcare regulations and policies related to MLTSS and care coordination.

MLTSS RN Care Manager

Wellcare
01.2016 - 10.2019
  • Provided high-quality, person-centered care and support to the MLTSS program participants.
  • Served as the central point of contact and advocate for program participants, ensuring seamless coordination of services across various healthcare providers, social services, and community resources.
  • Provided holistic, person centered care that addressed not only the participants' medical needs but also their emotional, social, and environmental factors impacting their overall well-being.

Registered Nurse- Per Diem

Alaris Health
03.2017 - 08.2018
  • Administered medications via oral, IV, and intramuscular injections and monitored responses.
  • Utilized critical thinking skills to prioritize nursing interventions based on patients'' acuity levels and individual needs.
  • Conducted thorough patient assessments to identify changes in condition, promptly notifying physicians and initiating appropriate interventions when necessary.
  • .Provided compassionate and skilled nursing care to residents, ensuring their well-being and quality of life.
  • Supported an average load of 20-30 patients in both subacute and acute floors.
  • Responsible for medication administration, patient assessments, wound care, and collaborating with the healthcare team to create individualized care plans.
  • Devoted to delivering high-quality care aimed at improving the lives of the residents and maintaining the highest standards of nursing practice.

Visiting Nurse Case Manager

Promise Care NJ
10.2012 - 12.2015
  • Conducted comprehensive health assessments of patients in their homes, identifying their needs for medical, social, and emotional support
  • Worked in collaboration with physicians, nurses, and other healthcare providers to develop and implement patient-centered care plans that met the patients' short- and long-term goals
  • Assisted patients and caregivers in understanding and managing their illnesses, providing education and resources to promote self-management and improved health outcomes
  • Administered medications, wound care, and other treatments as prescribed by physicians
  • Coordinated services and resources from community agencies to provide a seamless continuity of care for patients, including referrals for physical therapy, home health aide services, durable medical equipment, and more
  • Monitored patients' vital signs and other health indicators, identifying and acting on changes in their conditions
  • Documented care coordination activities, ensuring timely and accurate documentation of patients' care in their electronic health records
  • Communicated regularly with physicians, patients, and caregivers to ensure collaboration and timely interventions
  • Educated patients and caregivers on medication management, symptom management, and other topics related to their illness or condition
  • Managed patient care transitions, ensuring a safe discharge and continuity of care across healthcare settings
  • Participated in quality improvement initiatives to improve patient outcomes and optimize healthcare delivery
  • Adhered to all regulatory and ethical guidelines related to nursing practice and patient care.

Education

Bachelor of Science in Nursing -

Capella University
06.2024

Associate of Science - Nursing

Hudson Community College School of Nursing
Jersey City, NJ
06.2012

Skills

  • Bilingual [English, Spanish]
  • Microsoft Suite, Google Workspace
  • Critical thinking & Problem Solving
  • Excellent communication
  • Patient/Family Advocacy and empowerment
  • Electronic Health Records
  • Care Coordination & Care Planning
  • Patient Assessment and Care Management
  • Clinical judgment
  • Discharge Planning

Licensure

Registered Nurse: North Carolina, Multistate, License #: 347033

Registered Nurse: New York, License #: 920081-01

Timeline

RN Care Manager- DSNP

Belong Health
12.2023 - Current

RN Care Manager- Transition of Care

Oscar Health
05.2022 - 10.2023

MLTSS RN Care Manager

Aetna Better Health Of NJ
05.2020 - 03.2022

Registered Nurse- Per Diem

Alaris Health
03.2017 - 08.2018

MLTSS RN Care Manager

Wellcare
01.2016 - 10.2019

Visiting Nurse Case Manager

Promise Care NJ
10.2012 - 12.2015

Bachelor of Science in Nursing -

Capella University

Associate of Science - Nursing

Hudson Community College School of Nursing

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Darleny Torres