Summary
Overview
Work History
Education
Skills
Affiliations
Timeline
Generic

Diane Nims

Flushing,MI

Summary

Patient-oriented Nurse with 38 years of diverse experience in direct patient care, staff supervision and department operations. Skilled at multitasking and prioritizing patient needs and daily assignments. Offering expertise with Hospice and Home care experience.

24 years of experience of work in upper management. Expertise in areas of home healthcare and hospice management, including budgeting, program planning, project management and staff training and development. Very inspirational in improving morale that can make a substantial impact on the future of your organization. Have an understanding of claims administration, including CPT-4 codes, revenue codes, HCPCS codes, DRGs. Experience and knowledge of HMO, PPO, TPA, PHO, administration, medical delivery, regulatory compliance, claims processing, membership/eligibility, contracting and risk arrangements). Am experienced and skilled in software that include: HCHB, Point Click Care, Homecare Homebase, Kinnser, Healthcare First, and OASIS system.

Overview

16
16
years of professional experience

Work History

RN Case Manager

Harmony Hospice And Home Health Care
08.2021 - Current

Developed, implemented, and reviewed healthcare plans. Along with advocating for patients and their families, focusing on providing efficient and effective healthcare while managing treatment costs.

  • Trained new nurses in proper techniques, care standards, operational procedures and safety protocols.
  • Administered physical examinations and documented history of current and previous conditions, illnesses and injuries.
  • Initiated appropriate preventive and rehabilitative nursing procedures.
  • Authored initial assessments of patients and family to develop plans for individual home care needs.
  • Advocated for patients by communicating care preferences to practitioners, verifying interventions met treatment goals and identifying insurance coverage limitations.
  • Conducted regular re-evaluations to address changes in needs and conditions, introducing revisions to care plans as needed.
  • Took active role in patient and family planning process, detailing instructions and responding appropriately and effectively to questions and concerns.
  • Effectively communicated with physicians regarding patient needs, performance, medications and changes.

RN Case Manager

McLaren Bay Region Hospital
07.2021 - 06.2022
  • Verified legibility of patient clinical notes and updates prior to review by primary physicians.
  • Authored initial assessments of patients and family to develop plans for individual home care needs.
  • Advocated for patients by communicating care preferences to practitioners, verifying interventions met treatment goals and identifying insurance coverage limitations.
  • Conducted regular re-evaluations to address changes in needs and conditions, introducing revisions to care plans as needed.
  • Examined patients and documented history of current and previous conditions, illnesses, injuries and current medications.
  • Identified care needs of individual patients and coordinated responses based on physician advice, insurance limitations and procedural costs.
  • Took active role in patient and family planning process, detailing instructions and responding appropriately and effectively to questions and concerns.
  • Negotiated with suppliers and vendors to procure medical equipment, supplies and services.
  • Prepared clinical notes and updates for review by primary physician.
  • Coordinated rehabilitative and preventive nursing processes and procedures.
  • Responded promptly and professionally to patient questions and concerns.

Administrator

The CareTeam Hospice
07.2020 - Current

Case Manager

Brookdale Home Care Services- 90 Day Assignment
03.2020 - 07.2020

Manager Of Transitional Care Unit

McLaren Lapeer Regional
02.2018 - 10.2020
  • Maintained good communication between department heads, medical staff and governing boards by attending board meetings and synchronizing interdepartmental functions.
  • Participated in facility surveys and inspections made by authorized governmental agencies.
  • Oversaw financial operations, producing invoices, processing payments and preparing deposits.
  • Conducted monthly patient case conferences, in-services and staff meetings to educate staff and facilitate good communication.
  • Supervised and managed daily activities of clinical team consisting of physicians, nurses and support staff.
  • Demonstrated ability to lead and motivate outstanding healthcare teams.
  • Participated in unit-based Quality Assurance Program.
  • Initiated audit process to evaluate thoroughness of documentation and maintenance of facility standards.
  • Led clinical team in delivering care services that promoted optimal resident health
  • Achieved high staff morale and retention through effective communication, prompt problem resolution, proactive supervisory practices and facilitating proactive work environment.
  • Skillfully developed departmental goals, objectives, standards of performance, policies and procedures.
  • Managed and directed fiscal operations, including planning budgets, authorizing expenditures, accounting, establishing service rates and coordinating financial reporting.
  • Oversaw private and MCR billing, payroll, AP, and AR and verified that proper procedures were followed.
  • Confidently managed overall operation of nursing services and patient care, including financial management, quality assurance, patient care, safety risk management, teammate satisfaction, quality index scores and facility maintenance.

Executive Director

Heart to Heart Hospice
01.2014 - 01.2018
  • Led planning and achievement of goals and objectives consistent with agency mission and philosophy.
  • Organized department in accordance with administrative guidelines in order to provide specified nursing services to meet legal, organizational and medical staff guidelines.
  • Developed systems of staff communication that ensured proper implementation of treatment plans and comprehensive patient care.
  • Knowledgeable with National Committee for Quality Assurance (NCQA), Centers for Medicare and Medicaid (CMS), as well as other regulatory bodies.
  • Consistently complied with applicable laws and regulations and ensured facility adhered to Medicare and Medicaid regulations.
  • Educated staff on state and federal statutes, rules and regulations governing home care services.
  • Established and oversaw implementation of effective budgeting and accounting system that improved efficiency and reduced costs.
  • Oversaw private and MCR billing, payroll, AP, and AR and verified that proper procedures were followed.
  • Developed and achieved financial and growth goals.
  • Strategically planned methods to achieve operational goals and targets.
  • Continually maintained and improved company's reputation and positive image in markets served.
  • Led facility management staff and consultants in producing business plan that focused on all aspects of facility operations, including setting priorities and job assignments.
  • Encouraged creative thinking, problem solving, and empowerment as part of facility management group to improve morale and teamwork.
  • Reviewed customer survey information to prioritize areas of improvement.
  • Achieved high staff morale and retention through effective communication, prompt problem resolution, proactive supervisory practices and facilitating proactive work environment.
  • Weekly collaborated with department managers to correct problems and improve services.
  • Investigated, provided and submitted information to Quality Department about special incidents, events and complaints.
  • Assisted in resolving and satisfying client requests and internal operational issues.
  • Conducted monthly patient case conferences, in-services and staff meetings to educate staff and facilitate good communication.
  • Confidently managed overall operation of nursing services and patient care, including financial management, quality assurance, patient care, safety risk management, teammate satisfaction, quality index scores and facility maintenance.
  • Participated in facility surveys and inspections made by authorized governmental agencies.
  • Created and maintained computerized record management systems to record and process data and generate reports.
  • Established staff schedules and assignments based on facility needs and equipment availability.

Case Management

At Home Hospice
03.2012 - 03.2014
  • Established and maintained systems that safely met residents' needs.
  • Developed system of staff communication that ensured proper implementation of treatment plans and comprehensive patient care.
  • Consistently complied with applicable laws and regulations and ensured facility adhered to Medicare and Medicaid regulations.
  • Represented and interpreted agency's functions and services to other institutions, public, government agencies and other organizations.
  • Developed and achieved financial and growth goals.
  • Strategically planned methods to achieve operational goals and target
  • Coordinate and monitor care of Health Plan members and develop nursing plan of care.
  • Reviewed customer survey information to prioritize areas of improvement.
  • Participated in interdisciplinary conferences to review clinical assessments, update care plans and determine follow-up frequency
  • Investigated, provided and submitted information to Quality Department about special incidents, events and complaints.
  • Advocate for members and their families linking them to other members of teams to help them gain knowledge of their disease process and to identify community resources for continued growth toward maximum level of independence
  • Identified vulnerable populations and special needs members through completion of health screens and other resources.
  • Facilitated on-going assessment of patient/family needs and implementation of interdisciplinary team care plan.
  • Investigated and reported issues relating to patient care or conditions that might hinder patient well-being.
  • Cooperated and communicated effectively with physicians to ensure client satisfaction and compliance with set standards.
  • Conducted monthly patient case conferences, in-services and staff meetings to educate staff and facilitate good communication.
  • Certified that equipment and supplies were properly maintained for quality patient care and safety.
  • Continually improved knowledge, skills and performance based on feedback and self-identified professional developmental needs.
  • Analyzed patient and family feedback to identify opportunities for staff recognition as well as areas for improvement.

Executve Director

Genesee County Sheriff Department-Elder Abuse Program
01.2008 - 02.2012
  • Skillfully developed departmental goals, objectives, standards of performance, policies and procedures.
  • Assess needs of elderly adult population in community, and advocates for needs of elderly in community.
  • Examine, analyze, and evaluate facts and circumstances surrounding individual problems, situations or transactions, and determining actions to be taken within limits of standard or accepted practice
  • Maintains required certifications and organizes conferences and seminars relative to field of gerontology and provision of department-sponsored elder service programs or services.

Education

Case Management Certificate

State of Michigan
East Lansing, MI/Academy Of CM Certificate
11.2021

Master of Arts - Masters of Science in Nursing

University of Phoenix - Detroit Main Campus
Southfield, MI
2016

Associate of Science - Gerontological Nursing Certification

American Nurses Credentialing Center
East Lansing, MI
2010

Bachelor of Arts - Bachelors of Science in Nursing

Nazareth College
Rochester, NY
1981

Skills

  • Accomplished leader
  • Independent judgment and decision making
  • Budgeting proficiency
  • Analytical thinker and problem solver to resolve issues that may interrupt excellent services
  • Strong oral and written communication skills
  • Ability to interact at all levels of organization and with external contact
  • Able to prioritize, plan, and handle multiple tasks simultaneously
  • Knowledge of Medicaid and Medicare statutes and regulations
  • Aggressive in making sure Policy and Procedures are updated regularly and educated to staff
  • Quality improvement competency
  • Marketing skill to grow and develop company
  • Computer knowledgeable (MS Word & Excel) with excellent typing skills

Affiliations

  • Geriatric professional organization
  • American Nurses Association
  • National hospice and palliative care organization

Timeline

RN Case Manager

Harmony Hospice And Home Health Care
08.2021 - Current

RN Case Manager

McLaren Bay Region Hospital
07.2021 - 06.2022

Administrator

The CareTeam Hospice
07.2020 - Current

Case Manager

Brookdale Home Care Services- 90 Day Assignment
03.2020 - 07.2020

Manager Of Transitional Care Unit

McLaren Lapeer Regional
02.2018 - 10.2020

Executive Director

Heart to Heart Hospice
01.2014 - 01.2018

Case Management

At Home Hospice
03.2012 - 03.2014

Executve Director

Genesee County Sheriff Department-Elder Abuse Program
01.2008 - 02.2012

Case Management Certificate

State of Michigan

Master of Arts - Masters of Science in Nursing

University of Phoenix - Detroit Main Campus

Associate of Science - Gerontological Nursing Certification

American Nurses Credentialing Center

Bachelor of Arts - Bachelors of Science in Nursing

Nazareth College
Diane Nims