Eleanor Calderone
Stoughton,MA
Summary
Seasoned nursing professional offering proven clinical knowledge, natural interpersonal strengths and technical abilities. Knowledgeable about EMR charting, medication administration and interdisciplinary collaboration focused on optimizing patient care and support. Quality-focused and efficiency-driven leader.
Overview
23
23
years of professional experience
Work History
Outpatient Utilization Nurse Reviewer
Molina Healthcare
07.2019 - Current
- Improved patient outcomes by conducting thorough case reviews and offering clinical recommendations.
- Enhanced care quality by collaborating with healthcare providers to determine appropriate treatments and interventions for patients.
- Streamlined workflow processes by identifying inefficiencies in medical review procedures and implementing necessary improvements.
- Ensured compliance with regulatory requirements through meticulous documentation of cases, findings, and recommendations.
- Promoted a collaborative work environment by fostering strong relationships with colleagues, support staff, and healthcare providers to ensure optimal patient care.
- Increased efficiency in case processing times by utilizing advanced software systems for case management and documentation purposes.
- Facilitated accurate decision-making in complex cases by consulting with medical specialists when needed.
Prior Authorization Nurse
Dana-Farber
04.2019 - 07.2019
- Enhanced patient care by assessing insurance coverage and obtaining prior authorization for off label chemotherapy.
- Streamlined the prior authorization process, reducing wait times and improving overall efficiency.
- Assisted in maintaining compliance with changing regulations and policies by staying up-to-date on industry trends and best practices.
- Participated in interdisciplinary team meetings, collaborating with other healthcare professionals to ensure seamless coordination of care for patients requiring prior authorizations.
Registered Nurse Case Manager
Neighborhood Health Plan
09.2013 - 07.2018
- Improved patient outcomes by consistently providing comprehensive assessments and developing tailored care plans.
- Enhanced interdisciplinary team communication through regular case conferences, promoting effective collaboration for optimal patient care.
- Streamlined care coordination processes to reduce hospital readmissions and emergency department visits.
- Evaluated patient progress and adjusted care plans accordingly, ensuring continuity of care across all healthcare settings.
- Collaborated with physicians and other healthcare providers to ensure appropriate resource utilization for complex cases.
- Completed initial assessments of patients and family to determine and address individual home care needs. ·
Registered Nurse
Beth Isreal Deaconess Medical Center
09.2000 - 09.2012
- Improved patient outcomes by implementing evidence-based nursing practices and providing individualized care.
- Enhanced patient safety by conducting thorough assessments, identifying potential risks, and addressing concerns promptly.
- Promoted teamwork and collaboration with interdisciplinary teams for optimal patient care planning and implementation.
- Served as a strong advocate for patients'' rights, ensuring that their needs were met in accordance with ethical guidelines and regulatory requirements.
- Achieved timely medication administration by utilizing effective time management skills and prioritizing critical tasks.
- Consistently maintained accurate documentation of all relevant information related to patient progress, treatments administered and other pertinent data.
- Facilitated smooth transitions of care for patients by effectively communicating with other healthcare providers.
- Effectively prioritized assignments, executing care based on each patient's relative condition and delegating tasks to available personnel deliver safe and efficient care.
- Trained new nurses in proper techniques, care standards, operational procedures, and safety protocols.
- Precepted student nurses and oriented new hires, providing guidance and mentorship when teaching on hospital policies, emergency procedures, and nursing best practices.
Education
Bachelor of Science - Nursing
Curry College
Milton, MASkills
- Problem Solving
- Team Collaboration
- Nursing Documentation
- Clinical Assessment
- Critical Thinking
- Medical Record Review
- Case Management
Timeline
Outpatient Utilization Nurse Reviewer
Molina Healthcare
07.2019 - Current
Prior Authorization Nurse
Dana-Farber
04.2019 - 07.2019
Registered Nurse Case Manager
Neighborhood Health Plan
09.2013 - 07.2018
Registered Nurse
Beth Isreal Deaconess Medical Center
09.2000 - 09.2012
Bachelor of Science - Nursing
Curry College
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