Debra Coleman
Harrisburg,NC
Summary
Dedicated Registered Nurse with over 10 years of experience in the Charlotte community, including 5+ years specializing in high-risk first-time pregnancies. Expertise in maternal health, care coordination, and patient advocacy drives a commitment to improving health outcomes through effective care planning and addressing social determinants of health. Passionate about empowering expectant mothers with essential knowledge and support for healthy pregnancy and postpartum journeys. Seeking to contribute these skills as a Care Manager II at AmeriHealth Caritas.
Overview
24
24
years of professional experience
1
1
Certification
Work History
Care Manager
Atrium Health
Charlotte, NC
05.2024 - Current
- Provide effective Care Management education and services based on case management standards
- Complete comprehensive assessment for members enrolled in Medicaid managed care programs, considering the total individual, inclusive of medical, biopsychosocial, behavioral, spiritual, and cultural needs to enrolled population
- Develop, review, and evaluate the member care plan in partnership with the member, caregiver/family members, providers, and Care Management team members, as applicable
- Work with members to identify behavioral, social determinants of health, cultural, and environmental strengths, and challenges as it relates to his/her diagnosis, treatment, and access to care
- Educate and help members understand their health conditions
- Identify and address barriers that impede health outcomes
- Implement Care Management interventions per the member’s care plan
- Provide prior authorization assistance
Travel Registered Nurse
GLC Group
Weston, Fl
12.2023 - 03.2024
- Perform professional integrated nursing care to patients with mental health, substance abuse and medical disorders using the nursing process
- Administering medications as prescribed by psychiatrists or other healthcare providers and monitoring patients for any adverse reactions or side effects
- Assigned patient care to nurses and other nursing staff according to their skill levels and patient acuity
- Initiated admission paperwork which included medication reconciliation, surgical history, family history and HIPPA
- Verified and initiated physician orders written during the shift
- Monitored documentation in patient charts to ensure accuracy
Care Manager
Atrium Health
Charlotte, NC
01.2023 - 12.2023
- Provide effective Care Management education and services based on case management standards
- Complete comprehensive assessment for members enrolled in Medicaid managed care programs, considering the total individual, inclusive of medical, biopsychosocial, behavioral, spiritual, and cultural needs to enrolled population
- Develop, review, and evaluate the member care plan in partnership with the member, caregiver/family members, providers, and Care Management team members, as applicable
- Work with members to identify behavioral, social determinants of health, cultural, and environmental strengths, and challenges as it relates to his/her diagnosis, treatment, and access to care
- Educate and help members understand their health conditions
- Identify and address barriers that impede health outcomes
- Implement Care Management interventions per the member’s care plan
- Provide prior authorization assistance
Utilization Review Nurse
Alliance Health
Mooresville, NC
11.2021 - 12.2022
- Responsible for conducting UM reviews for adults and children with mental health and developmental diagnosis through telephonic or written review
- Responsible for providing concurrent and retrospective reviews of clinical documentation
- Prepared and wrote medical necessity reviews and authorizing requests for inpatient and outpatient hospitalization and services
- Develop relationships with physicians, healthcare service providers, and internal and external customers; to help improve health outcomes for members
- Applied clinical knowledge to work with facilities and providers for care coordination
- Access and consult with peer clinical reviewers, Medical Directors and/or delegated clinical reviewers to help ensure medically appropriate, quality, cost effective care throughout the medical management process
- Educate the members about plan benefits and contracted physicians, facilities, and healthcare providers
- Refer treatment plans/plan of care to peer clinical reviewers in accordance with established criteria/guidelines and does not issue medical necessity non-certifications
- Facilitate accreditation by knowing, understanding, and accurately applying accrediting and regulatory requirements and standards
Care Manager II
Anthem
Indianapolis, IN
02.2021 - 10.2021
- Provide effective Care Management education and services based on case management standards
- Complete member assessments considering the total individual, inclusive of medical, biopsychosocial, behavioral, spiritual, and cultural needs to enrolled population
- Develop, review, and evaluate the member care plan in partnership with the member, caregiver/family members, providers, and Care Management team members, as applicable
- Work with members to identify behavioral, social, cultural, and environmental strengths and challenges as it relates to his/her diagnosis, treatment, and access to care
- Identify and address barriers that impede health outcomes
- Implement Care Management interventions per the member’s care plan
- Educate members on their healthcare benefits and resources
- Provide prior authorization assistance, and denial appeal assistance
Care Manager
Community Care North Carolina
Cary, NC
03.2020 - 02.2021
- Provide effective Care Management services based on case management standards of practice to enrolled populations
- Complete member assessments considering the total individual, inclusive of medical, biopsychosocial, behavioral, spiritual, and cultural needs to enrolled population, throughout the continuum of care
- Develop, review, and evaluate the member care plan in partnership with the member, caregiver/family members, providers, and Care Management team members, as applicable
- Work with members to identify behavioral, social, cultural, and environmental strengths and challenges as it relates to his/her diagnosis, treatment, and access to care
- Identify and address barriers that impede health outcomes
- Implement Care Management interventions per the member’s care plan
- Monitor and evaluate effectiveness of the care management plan and modify, as necessary
- Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans
- Assists in problem solving with providers, claims, or service issues
Registered Nurse / Adolescent Behavioral Health
Alexander Youth Network- PRN
Charlotte, NC
04.2010 - 12.2020
- Provide nursing care services to children with autism and mental health diagnosis
- Administer medications and monitor for adverse reactions
- Assess, plan, implement, and document patient care via computerized charting
- Responsible for coordination of care and conducting assessment to identify individual needs and specific care management plan to address objectives and goals as identified during assessment
- Monitor and evaluate effectiveness of the care management plan and modify as necessary
- Interfaces with multidisciplinary treatment team and physician advisors on the development of care management treatment plans
- Provide education and support to patients and family
- Maintain patient confidentiality per HIPPA guidelines
- Transcribe doctor orders, Phlebotomy, Respond to all emergencies
- Ensure patient safety while providing care
Registered Nurse / Behavior Health/ Integrated Care
Novant Health
Charlotte, NC
11.2018 - 06.2019
- Perform professional integrated nursing care to patients with mental health, substance abuse and medical disorders using the nursing process
- Assigned patient care to nurses and other nursing staff according to their skill levels and patient acuity
- Initiated admission paperwork which included medication reconciliation, surgical history, family history and HIPPA
- Verified and initiated physician orders written during the shift
- Initiated IV lines, blood and blood products, dressing changes, administer medication and pain management with PCA pumps
- As charge nurse, performed various duties to include staffing (nurse to patient ratio), making assignment according to skill levels
- Maintaining a positive work environment and safe work area
- Provide teaching to staff, patient and family members
- Monitored documentation in patient charts to ensure accuracy
- Attend and complete required continuing education per hospital protocol
RN Acute Transitional Care Coordinator
Cardinal Innovations Healthcare
Charlotte, NC
04.2017 - 10.2018
- Provide integrated case management services for individuals with medical and mental health needs
- Conduct comprehensive assessment of patient’s health and psychosocial needs
- Develop, implement, and evaluate individualized care plans
- Facilitate coordination of healthcare services, communication and collaboration among the patient, family, and other stakeholders in order to achieve goals and maximize positive patient outcomes
- Developed evidence-based outcome and quality metrics criteria with goals to decrease hospital admission
- Educate the patient and family on health and well-being, safety, healthcare options, services, and community resources
- Provide patient referrals to meet specific healthcare needs
RN Coach / Care Coordinator - Telephonic
Novant Health
Charlotte, NC
01.2016 - 04.2017
- Provide coordination of care of patients discharged from inpatient care
- Make hospital discharge phone calls, review discharge instructions and medications, reduce hospitalizations by providing education, support, resources, ensure patients have follow up appointments, ensure patient have a Primary Care Physician
- Collaborate with physicians, and other health care professionals, including pharmacists and social workers to provide coordinator of care
- Provide patients with referrals to meet specific healthcare needs
- Meet quality metrics standards, producing positive outcomes by reducing hospital re-admissions
Registered Nurse / Case Manager
Atrium Health
Charlotte, NC
08.2011 - 05.2015
- Provide Case Management services based on case management standards, to individuals participating in the Smart Start Healthy Families Program
- Conduct comprehensive assessment of patient health and psychosocial needs
- Develop person centered care plans and assist client in meeting person centered goals
- Complete member assessments considering the total individual, inclusive of medical, biopsychosocial, behavioral, spiritual, and cultural needs to enrolled population, throughout the continuum of care
- Develop, review, and evaluate the member care plan
- Work with members to identify behavioral, social, cultural, and environmental strengths and challenges as it relates to his/her diagnosis, treatment, and access to care
- Provide education and link members with community resources
Registered Nurse / Med-Surgical
Atrium Health
Charlotte, NC
04.2009 - 04.2010
- Perform professional nursing care to adult medical-surgical patients using the nursing process
- Assigned patient care to nurses and other nursing staff according to their skill levels and patient acuity
- Initiated admission paperwork which included medication reconciliation, surgical history, family history and HIPPA
- Verified and initiated physician orders written during the shift
- Initiated IV lines, blood and blood products, dressing changes, administer medication and pain management with PCA pumps
- Managed nasal-pharyngeal and gastric suction
- Coordinated with physicians and ancillary services to ensure comprehensive patient care
- As charge nurse, performed various duties to include staffing (nurse to patient ratio), making assignment according to skill levels
- Maintaining a positive work environment and safe work area
- Provide teaching to staff, patients, and family members
- Monitored documentation in patient charts to ensure accuracy
- Attend and complete required continuing education per hospital protocol
Registered Nurse / Adult Med-Surgical
The University Hospital
Newark, NJ
03.2008 - 04.2009
- Perform professional nursing care to adult medical-surgical patients using the nursing process
- Assigned patient care to nurses and other nursing staff according to their skill levels and patient acuity
- Initiated admission paperwork which included medication reconciliation, surgical history, family history and HIPPA
- Verified and initiated physician orders written during the shift
- Initiated IV lines, blood and blood products, dressing changes, administer medication and pain management with PCA pumps
- Managed nasal-pharyngeal and gastric suction
- Coordinated with physicians and ancillary services to ensure comprehensive patient care
- As charge nurse, performed various duties to include staffing (nurse to patient ratio), making assignment according to skill levels
- Maintaining a positive work environment and safe work area
- Provide teaching to staff, patient and family members
- Monitored documentation in patient charts to ensure accuracy
- Attend and complete required continuing education per hospital protocol
Registered Nurse / Staff Nurse
Correctional Medical Services
Avenel, NJ
09.2006 - 10.2008
- Function as charge nurse on medical unit in a correctional facility
- Assess, plan, evaluate and implement medical care to residents
- Responsible for coordination of care and providing acute and chronic care medical care
- Verify and transcribe doctor orders, administer medications as ordered
- Respond to all medical emergencies
- Maintain and monitor for safe environment
Registered Nurse / Public Health Case Manager
Atrium Health
Charlotte, NC
08.2005 - 08.2006
- Provide Case Management services based on case management standards, to individuals participating in the Smart Start Healthy Families Program
- Conduct comprehensive assessment of patient health and psychosocial needs
- Develop person centered care plans and assist client in meeting person centered goals
- Complete member assessments considering the total individual, inclusive of medical, biopsychosocial, behavioral, spiritual and cultural needs to enrolled population, throughout the continuum of care
- Develop, review, and evaluate the member care plan
- Work with members to identify behavioral, social, cultural, and environmental strengths and challenges as it relates to his/her diagnosis, treatment, and access to care
- Provide education and link members with community resources
RN /School Nurse
Lady Liberty Academy Charter School
Newark, NJ
08.2001 - 06.2005
- Work as a school nurse providing preventive health services to Pre-K through eighth grade students
- Responsible for facilitating the student’s optimal physical, mental, emotional, and social growth
- Possess strong assessment skills and critical thinking judgement
- Ability to work independently, excellent time management skills
- Develop and implement student health plans
- Screens and evaluates findings for deficits in vision, hearing, scoliosis, and growth
- Initiates referrals to parents, school personnel or community health resources for interventions, remediation and follow-ups as needed
- Promotes and assists in the control of communicable diseases
- Review immunization records and notify parents about discrepancies
- Provides training to staff as needed – Diabetic, Asthma, etc
- Administer medications, Communicates appropriately and effectively with students, parents, administrators, and other school personnel
- Collaborates with school staff, Child Protective Services etc
Registered Nurse / Med Surg
Raritan Bay Medical Center
Perth Amboy, NJ
09.2000 - 08.2001
- Perform professional nursing care to adult medical-surgical patients using the nursing process
- Assigned patient care to nurses and other nursing staff according to their skill levels and patient acuity
Education
Bachelor of Science - Nursing
Winston Salem State University
Winston Salem, North Carolina01.2016
Associate of Applied Science -
Union County College
Cranford, New Jersey01.1999
Diploma -
Elizabeth High School
Elizabeth, New Jersey01-1986
Skills
- Case assessments
- Medical chart documentation
- Treatment management
- ADL support
- Outcome assessment
- Workflow coordination
Certification
- Certified Case Manager (CCM)
Affiliations
- Community Service Volunteer with Caring Non Profit Organization and the Nurse Family Partnership Program
Credentials
- North Carolina Nursing Licensure (RN) Compact State
- New Jersey Nursing Licensure (RN)
- Pennsylvania Nursing Licensure (RN)
- New York Nursing Licensure (RN)
References
References available upon request.
Timeline
Care Manager
Atrium Health
05.2024 - Current
Travel Registered Nurse
GLC Group
12.2023 - 03.2024
Care Manager
Atrium Health
01.2023 - 12.2023
Utilization Review Nurse
Alliance Health
11.2021 - 12.2022
Care Manager II
Anthem
02.2021 - 10.2021
Care Manager
Community Care North Carolina
03.2020 - 02.2021
Registered Nurse / Behavior Health/ Integrated Care
Novant Health
11.2018 - 06.2019
RN Acute Transitional Care Coordinator
Cardinal Innovations Healthcare
04.2017 - 10.2018
RN Coach / Care Coordinator - Telephonic
Novant Health
01.2016 - 04.2017
Registered Nurse / Case Manager
Atrium Health
08.2011 - 05.2015
Registered Nurse / Adolescent Behavioral Health
Alexander Youth Network- PRN
04.2010 - 12.2020
Registered Nurse / Med-Surgical
Atrium Health
04.2009 - 04.2010
Registered Nurse / Adult Med-Surgical
The University Hospital
03.2008 - 04.2009
Registered Nurse / Staff Nurse
Correctional Medical Services
09.2006 - 10.2008
Registered Nurse / Public Health Case Manager
Atrium Health
08.2005 - 08.2006
RN /School Nurse
Lady Liberty Academy Charter School
08.2001 - 06.2005
Registered Nurse / Med Surg
Raritan Bay Medical Center
09.2000 - 08.2001
Bachelor of Science - Nursing
Winston Salem State University
Associate of Applied Science -
Union County College
Diploma -
Elizabeth High School
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