DEBRA MADDEN PAYNE RN, BSN

• Coordinating and managing all nursing and assisted living team members providing direct care of assisted living services
• Determined daily assignments to assure residents needs are met
• Assures compliance with all Federal and State regulations
• Conducts assessments, as often as necessary based on changes in residents condition
• Serves as a liaison to families, families, health care agencies, emergency response teams, hospitals and rehab centers.
• Orders, stores,administers, documents, and disposes of medication as per Federal, State and Agency protocols
• Provides competency training for all client care aides with return demonstrationo

• Perform the six essential activities of case management
• Planning, implementation,,coordination, monitor and reassess through the continuum of care
• Facilitated safe discharge to most appropriate post acute level of care
• Collaboration with patient, families, physicians, therapists, insurance case managers to develop and implement discharge plans
• Knowledge of community supports, commercial , Medicare and Medicaid criteria
• Performed Utilization review ,appeals and denials
• Facilitated smooth transitions between levels of care by coordinating necessary services and providing appropriate referrals when needed.
• Obtained authorizations from multiple insurance carriers for various levels of care.

• Provided exceptional care to high-acute patients needing complex care such as ventilator management, extensive wound care and rehabilitation.
• Implemented care plans for patient treatment after assessing physician medical regimens.
• Managed quality care for patients with heart failure, end-stage renal disease and coronary artery disease.
• Collaborated with interdisciplinary teams for comprehensive patient care plans, resulting in better health outcomes.
• Collaborated with leadership to devise initiatives for improving nursing satisfaction, retention and morale.
• Contributed substantially to successful department JCAHO accreditation by consistently operating to highest standards of care.
• Delivered high level of quality care to diverse populations while overseeing patient admission and triaging based on acuity and appropriate department admission.
• Conveyed treatment options, diagnosis information and home care techniques to patients and caregivers to continue care consistency.
• Provided emotional support to patients and their families.
• Enhanced patient satisfaction through effective communication, empathy, and timely response to their needs.
• Educated patients, families and caregivers on diagnosis and prognosis, treatment options, disease process, and management and lifestyle options.

• Identification and out reach to high risk, high cost patients with goal to assess and initiate necessary supports, education, disciplines to manage safely at home avoiding unnecessary admissions Assess and initiate referrals for palliative care, hospice, SNF (3 day waiver) based of criteria Collaboration with physicians, health care team, patient and families to formulate plan of care to meet all needs
• Coordinated care with external agencies to best support resident needs.
• Communicated with patients, ensuring that medical information was kept private.
• Audited charts and medication to check compliance.
• Established and maintained effective communication with staff, physicians and community organizations to promote high quality patient care.

• Collaboration with hospital case managers, patients, families, physicians, therapies to assess, screen, recommend , the most appropriate post acute setting to address patients needs
• Preparation of clinical synopsis of past and current health care needs and referral to most appropriate setting
• Streamlined the referral process for smoother patient transitions into post-acute care settings through meticulous documentation and timely communication.
• Served as a liaison between patients and their insurance providers, advocating for coverage of necessary treatments and services.

• Utilization review for all out of Country acute admissions, all Veteran Hospital admissions, SNFs and Home care
• Case management and utilization review for all MEDEX prime patients Case management to high risk and oncology population
• Obtained authorizations from multiple insurance carriers for various levels of care.
• Improved patient care quality by implementing utilization review processes and ensuring adherence to industry standards.
• Performed prior authorization review of services requiring notification.
• Reduced hospital costs through efficient management of medical resources and implementation of cost-effective strategies.
• Submitted cases for criteria failures and helped facilitate resolutions and approvals.
• Implemented evidence-based practices in the utilization review process, improving overall decision-making accuracy and effectiveness.
• Enhanced regulatory compliance with thorough documentation and timely reporting of utilization review findings.
• Launched quality assurance practices for each phase of development
• Contributed to multidisciplinary meetings discussing appropriate level of care determinations, discharge planning and post-acute care services.
• Used industry expertise, customer service skills and analytical nature to resolve customer concerns and promote loyalty.
• Cultivated positive rapport with fellow employees to boost company morale and promote employee retention.
• Facilitated productive relationships with stakeholders including physicians, nursing staff, case managers, social workers, payers, patients, families to promote a collaborative approach towards care coordination.
• Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
• Defined clear targets and objectives and communicated to other team members.

• Primary case management to a diverse population, including Hospice, Geriatrics and Alzheimer's – 2003–2005

Hospice 2009-2011

• Participated in evidence-based practice project implementation, nursing competency development and nursing simulation activities.
• Performed triage on incoming patients and determined severity of injuries and illnesses.
• Educated family members and caregivers on patient care instructions.
• Conducted thorough assessments of patients'' needs, enabling more accurate diagnoses and targeted interventions.
• Coordinated care conferences with interdisciplinary team members, ensuring all perspectives were considered in the development of comprehensive treatment plans.
• Managed patients recovering from medical or surgical procedures.
• Developed and modified patient care plans and assisted interdisciplinary team in identifying client needs and goals to determine priorities of care.
• Performed frequent checks on life support equipment and made necessary adjustments to preserve optimal patient conditions.
• Provided skilled, timely and level-headed emergency response to critically-ill patients.

• Staff nurse in neurology step down unit, utilizing critical care skills
• Communicated with healthcare team members to plan, implement and enhance treatment strategies.
• Promoted a culture of safety by strictly adhering to infection control measures and reporting any potential hazards or concerns.
• Implemented medication and IV administration, catheter insertion, and airway management.
• Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
• Implemented care plans for patient treatment after assessing physician medical regimens.
• Reduced medication errors through meticulous charting and double-checking dosages.
• Participated in regular staff meetings to share best practices, address challenges, and foster collaboration among team members.
• Administered medications via oral, IV, and intramuscular injections and monitored responses.
• Promoted patient and family comfort during challenging recoveries to enhance healing and eliminate non-compliance problems.
• Evaluated the effectiveness of care plans regularly, making adjustments as needed based on individual patient needs and progress toward goals.
• Assisted physicians with diagnostic procedures, ensuring accurate results for optimal treatment planning.
• Sustained quality standards by performing routine medication audits and upholding internal and industry best practices.
• Assessed physical, psychological, physiologic, and cognitive status of patients.
• Monitored patients' conditions and reported changes in physical presentation, appearance, and behavior to discuss treatment with physicians.
• Provided exceptional care to high-acute patients needing complex care such as ventilator management, extensive wound care and rehabilitation.
• Explained course of care and medication side effects to patients and caregivers in easy-to-understand terms.