Denise Daley

• Utilization review from this large health system on a per diem basis. Apply recognized level of care, evidenced based criteria for the purpose of determining the appropriate level of care.
• Able to accurately complete 25-30 (average) initial reviews, as well as 10-15 concurrent reviews daily.
• Initiate PA review for discrepancies and participated in the denials process as needed.

• Achieved positive client outcomes by developing and implementing.
• Able navigate high demand within an ED which operatives in Internal Disaster status daily in this level 2 Trauma Center
• Redirection of inappropriate admission to a different level of care
• Collaborated with multidisciplinary teams to address client needs and formulate tailored support strategies.
• Conducted thorough assessments of clients' situations, identifying issues, goals, and necessary interventions.
• Facilitated successful transitions between levels of care by developing detailed discharge plans and coordinating resources.
• Maintained accurate documentation on all cases, ensuring compliance with regulations and confidentiality requirements.
• Improved client satisfaction by efficiently addressing concerns or grievances in a timely manner.
• Identified care needs of individual patients and coordinated responses based on physician advice, insurance limitations, and procedural costs.

• Responsible for managing the Meditech patient tracker, and review of each patient occurrence for the appropriate level of care.
• Negotiation and/ or education, for providers to reach the correct level of care
• Building a rapport with each stakeholder as key skill for this successful ED Case Manager position.
• Initiated early assessment and crafted a discharge plan with the goal of implementation from the outset of admission.

• Utilization Review for THP Senior Products (TMP/SCO)
• Worked in both CCMS and Medhawk systems
• Applied InterQual criteria to ensure appropriate use of

resources

• Facilitated interdisciplinary teamwork and communication, with the physician groups to trend and analyze group readmission metrics.
• Delivered actionable data to PCP's to identify opportunities and execute initiatives to improve outcomes.
• Managed metrics and presented to assigned IPA's for the achievement of clinical and financial goals

• Per diem utilization review for Emergency Care Center, evenings and weekends,
• Review of clinical documentation and appropriate application of InterQual Criteria.
• Assisted in the development of an internal physician review process, for this newly established emergency room Case Management program.

• Large, level 1 Trauma Center
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• Multiple cultural and social needs for CM to navigate.
• Per Diem ED Case Manger evenings and weekends
• Utilization Review via InterQual criteria for ED patients
• Ensure MD orders coincide with level of care.
• Care Transitions referrals for the continuity of care and management of chronic disease in an often under serviced population of patients.

• Improved patient outcomes by effectively collaborating with interdisciplinary healthcare teams to develop comprehensive care plans.
• Streamlined communication between nurses, physicians, and other healthcare professionals for better coordination of patient care.
• Enhanced the quality of patient care by providing clinical expertise to nursing staff and implementing evidence-based practices.
• Reduced hospital readmissions by closely monitoring at-risk patients and providing timely interventions.

• Identification of patients eligible for hospice care based on Medicare Hospice Guideline criteria.
• Collaborated with families and the physician goals to achieve comfort via symptom management.
• Established detailed, precise, documentation which supported Medicare eligibility requirements from the day of hospice election/admission,
• Initiated interventions which optimized comfort which aligned with the patient's goals of care.
• Ongoing clinical documentation which would support and ensure recertification and reimbursement.

• Enhanced patient care by implementing evidence-based nursing practices and protocols.
• Reduced medication errors through meticulous charting and double-checking dosages.
• Collaborated with interdisciplinary team members for comprehensive patient assessments and treatment plans.
• Improved patient satisfaction scores by providing empathetic, compassionate care to diverse populations.
• Advanced my education from LPN licensure to RN