Diana MacGuire-Carson
Grand Junction,CO
Summary
Committed RN with clinical and leadership experience working with patients and families navigating acute and chronic illness, aging, the healthcare system and changing care needs. Progressive career history in direct patient care, triage and care coordination of diverse patient populations. Consistently develops strong relationships with patients and families through empathetic communication, respectful attitude and excellent customer service. Ability to work independently and on a multi-disciplinary team while always striving to ensure individualized care. Aptitude for working collaboratively with multiple disciplines, departments and other organizations to cultivate strong, synergistic relationships. Consistently request constructive feedback to optimally meet the needs of Veterans and team members to improve outcomes. Utilize critical thinking to assess Veteran needs, prioritize care, determine what is most important to them and organize treatment.
Overview
39
39
years of professional experience
1
1
Certification
Work History
RN Discharge Coordinator
Grand Junction VAMC
10.2022 - Current
- Perform comprehensive assessments of Veterans to determine what their goals and discharge needs are and how best possible to meet those goals and needs to promote optimal outcomes.
- Skilled at working independently and collaboratively within a team environment.
- Adaptable and proficient in quickly learning new concepts.
- Collaborates with interdisciplinary team to create, coordinate, and implement successful discharge plans for inpatient Veteran to set them up for success and prevent readmissions.
- Patient education on disease processes, outpatient resources, treatments and medications.
- Utilize critical thinking to solve complex discharge issues considering Veteran input, needs and safety.
- Educate patients on disease management and self-care techniques, promoting lifestyle changes for improved health.
Director of Access
HopeWest Hospice
03.2022 - 10.2022
- Responsibility for assuring timely and professional response to referrals and information inquiries.
- Assess complex patient situations and come up with a plan of action to meet patient and family needs.
- Brainstorm creative approaches to patient care to meet patients and families where they are and support self-determined life closure.
- Evaluate productivity of staff, eliminate inefficiencies and streamline processes.
- Oversaw operations and provided feedback and solutions to achieve daily and long-term goals.
- Reviewed documentation and mentored nurses on capturing pertinent data to support Hospice eligibility.
Assistant Director - Ferris Care Center
HopeWest Hospice
05.2020 - 10.2022
- Monitored and ordered drugs for inpatient pharmacy to ensure adequate supply following strict DEA guidelines, tracking all controlled medications that came in and were dispersed.
- Managed RN and CNA schedules to ensure coverage to meet patient and family needs.
- Participated in review of applications and interview process as well as hiring decisions for new staff.
- With CNA output, revamped their documentation to provide a clearer picture of all they did for patient and families.
- Educated and mentored new and existing staff on assessing non-verbal signs and symptoms of discomfort and how to address physical, psychological, social and spiritual distress/suffering.
- Provided coverage and a leadership presence to both shifts.
Director of the Hospice Inpatient Unit
HopeWest Hospice
10.2018 - 05.2020
- Cultivated a positive work environment that fostered employee engagement, increased retention rates, and boosted overall team morale.
- Revamped MARs to decrease medication administration omissions/errors and implemented a process to regularly review orders against MARs to ensure accuracy.
- Conducted regular staff meetings to disperse and gather information to ensure that all disciplines were heard and their concerns were addressed.
- Evaluated all employees at the inpatient unit and shared findings during annual performance evaluations, providing feedback, setting goals and celebrating successes.
Director of Medical Affairs
HopeWest Hospice
09.2016 - 10.2018
- Tracked metrics for visit statistics for each provider, the types of visits they did and productivity.
- Worked collaboratively with the Medical Director to assist in administrative tasks related to oversight of physician practice.
- Oversaw scheduling of physician visits and credentialing of physicians.
Assistant Director - Medical Affairs
HopeWest Hospice
07.2015 - 09.2016
- Payroll entry and monitoring for all physicians.
- Managed physician schedules to ensure that all regulatory, new patient and emergent visits were completed.
- Reviewed difficult cases with Access/Admission nurses to determine eligibility, obtain additional records as needed and provide education on what information the physicians need to approve admissions.
Clinical Support Specialist - Medical Affairs
HopeWest
03.2014 - 07.2015
- Provided RN support to physician group so they could focus on physician responsibilities.
- Managed physician visit schedules to ensure compliance with Medicare regulations, adjusting for urgent visits as needed.
- Reviewed long length of stay patients for ongoing eligibility and presented findings to the physician group.
- Delivered high-quality clinical support services by adhering strictly to guidelines, policies, and procedures set forth by the organization.
Discharge Planner
Community Hospital
02.2013 - 03.2014
- Advocated for patients' best interests, working closely with healthcare providers to develop appropriate discharge plans.
- Reviewed patient stays to determine if they met criteria for the level of care they were admitted under.
- Evaluated patient progress throughout their hospital stay, adjusting discharge plans accordingly to ensure successful reintegration into the community setting or placement in suitable long-term care facilities when necessary.
Access/Admissions/Hospital Liaison
HopeWest Hospice
05.2010 - 02.2013
- Reviewed patient records, interviewed patients and families to determine patient eligibility before presenting to Hospice physician.
- Education to patients and families on Hospice services and coverage, complete admissions as appropriate.
- Evaluated patient needs upon admission to prioritize coordination efforts effectively while providing a warm handoff to the assigned team.
- Developed and maintained relationships with key personnel at local hospitals.
- Communicated with family, pharmacies, DME and O2 providers, discharge planners, and other professionals to complete seamless transitions.
On-Call/Weekend Triage RN
HopeWest
09.2004 - 05.2010
- Wrote a proposal to staff on-call Monday through Thursday from 5p - 8am and triaging every weekend from 8 am - 5 pm that was accepted and utilized for 6+ years to respond to all after-hours patient needs.
- Established trust with patients and families/caregivers to identify and meet physical, emotional and psycho-social needs through education and self management.
- Collaborated with physicians to quickly assess patients and deliver appropriate interventions while managing rapidly changing conditions.
- Triage for 150+ patients, scheduling/coordinating 10-12 staff members making scheduled and emergent visits.
- Independently responded to all incoming calls, triaging and making visits to patients in crisis, utilizing sound decision making and judgment to deliver appropriate care.
Case Manager
HopeWest
08.2002 - 09.2004
- Maintained accurate and timely documentation for all patients, ensuring compliance with regulations and confidentiality.
- Conducted thorough assessments of patient situations, identifying issues, goals, necessary interventions and updating care plans as appropriate.
- Managed team of 12-14 patients including ongoing patient assessments, plans and goals of care and multi-discipline coordination.
- Fostered open lines of communication with patients, families and their support networks, involving them in the case management process.
- Responsible for all elements of the nursing process and assessing appropriateness of interventions based on patient age and effectiveness when providing patient care.
- Conducted supervisory visits with team CNA every 14 days to ensure Medicare compliance.
Float Nurse
HopeWest Hospice
04.2002 - 08.2002
- Demonstrated flexibility in accommodating short notice scheduling changes due to fluctuating staffing and census.
- Made emergent and comprehensive patient visits, seeing four to six patients a shift; reviewing care plans to ensure seamless continuity of care.
- Maintained strong communication with patients, families and other members of the interdisciplinary team, fostering trust and rapport.
Staff Nurse - Medical Oncology/Outpatient Surgery
St. Mary's Hospital & Medical Center
05.1999 - 04.2002
- Charge nurse experience.
- Responsible for RN schedule on Medical/Oncology unit.
- Skilled in caring for multiple complex patients with various complicated diagnoses.
- Pre and post-op care including recovery of patients after anesthesia.
- Patient and family teaching from admission through discharge
Claims Processor
Rocky Mountain Health Plans
02.1996 - 05.1999
- Utilized excellent analytical and problem-solving skills to quickly and accurately assess insurance claims and release for payment.
- Followed up with customers on unresolved issues.
- Reviewed applications and supporting documents to verify claims eligibility and accuracy.
- Managed workload and priorities to meet claims processing deadlines.
Secretary
City of Grand Junction Fire Department
06.1985 - 02.1996
- Ordered and tracked all station uniforms, managed the clothing budget.
- Assisted with all training and assessment centers sponsored by the GJFD.
- Provided clerical support to company employees by copying, faxing, and filing documents.
- Managed executive calendars, scheduling appointments and meetings to optimize time management.
Education
Bachelor of Science - Nursing
Mesa State College
Grand Junction, CO05.1999
Bachelor of Business Administration -
Mesa State College
Grand Junction, CO05.1991
Certification
Colorado RN License - 1999 to current
BCLS - current
Certified Hospice & Palliative Care Nurse - September 2004
Additional Information
References available upon request.
Timeline
RN Discharge Coordinator
Grand Junction VAMC
10.2022 - Current
Director of Access
HopeWest Hospice
03.2022 - 10.2022
Assistant Director - Ferris Care Center
HopeWest Hospice
05.2020 - 10.2022
Director of the Hospice Inpatient Unit
HopeWest Hospice
10.2018 - 05.2020
Director of Medical Affairs
HopeWest Hospice
09.2016 - 10.2018
Assistant Director - Medical Affairs
HopeWest Hospice
07.2015 - 09.2016
Clinical Support Specialist - Medical Affairs
HopeWest
03.2014 - 07.2015
Discharge Planner
Community Hospital
02.2013 - 03.2014
Access/Admissions/Hospital Liaison
HopeWest Hospice
05.2010 - 02.2013
On-Call/Weekend Triage RN
HopeWest
09.2004 - 05.2010
Case Manager
HopeWest
08.2002 - 09.2004
Float Nurse
HopeWest Hospice
04.2002 - 08.2002
Staff Nurse - Medical Oncology/Outpatient Surgery
St. Mary's Hospital & Medical Center
05.1999 - 04.2002
Claims Processor
Rocky Mountain Health Plans
02.1996 - 05.1999
Secretary
City of Grand Junction Fire Department
06.1985 - 02.1996
Bachelor of Science - Nursing
Mesa State College
Bachelor of Business Administration -
Mesa State College
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