Ellen Caulcrick
Richmond,TX
Summary
A case management professional with extensive experience in nurse leadership at an acute care health system specializes in discharge planning and interdisciplinary collaboration. I have a proven track record of optimizing care processes and enhancing clinical quality through critical thinking and regulatory compliance. My focus is on achieving successful patient outcomes and fostering high-performance teams in healthcare delivery.
Overview
18
18
years of professional experience
1
1
Certification
Work History
Manager – Case Management
Memorial Hermann Health System
Houston, T.X
10.2023 - Current
- Oversee and develop systems and processes for care/utilization management and discharge planning at the hospital level.
- Manage the department’s activities related to discharge planning and clinical quality improvement.
- Responsible for leading a high-performance team of “system thinkers” who incorporate leadership principles and vision in performing the functions of case management.
- Forecasts and accurately projects expenses.
- Acts as liaison to facilitate communication and collaboration between all care partners (physicians, hospitalists, community care managers, nurses, community resources, etc.)
Case Manager - Utilization Review
Houston Methodist
Sugarland, T.X
02.2021 - Current
- Collaborates with other departments and serve as a liaison to improve communication and service delivery.
- Review medical necessity using Milliman criteria within 2 business days of admission and will be based on medical record documentation on chart within 48 hours of admission and document using the appropriate UR form.
- Assisting with Pre-admission referral reviews, concurrent, and discharge criteria review, as needed.
- Provides clinical updates to third party payors after admission within stated time frames to obtain continued stay authorization.
- All interactions and results of interactions with third party payors are documented in the EMR system.
Snr Case Manager – Discharge Planning
Memorial Hermann Health System
Houston, T.X
02.2019 - 10.2023
- Oversee outliers’ rounds for patients exceeding recommended GMLOS.
- Supervises Case Managers to ensure admission and continued stay reviews are conducted according to established procedures.
- Supervise case managers in assessing any discharge needs to facilitate timely discharge, initiate, and train case managers on creative discharge planning.
- Track inpatient statistics to identify outliers.
- Maintains current working knowledge of regulatory requirements/criteria.
- Overseeing a team of case managers and social workers, guiding, and training personnel, developing policies and workflow for the department.
- Establishing and adhering to budgets, communicating with a multidisciplinary care team, providing educational resources to case managers, and managing related in-facility projects.
- Responsible for facilitating an environment that supports professional care management practice and empowering the team to provide safe, smooth, and sustainable discharge plan in collaboration with all health care disciplines.
Hospice Registered Nurse Case Manager
Elysian Hospice
Stafford, TX
04.2017 - 02.2021
- Listened to patients and loved ones, offering emotional support and kindness to help with end-of-life transition.
- Responded to emergency situations with speed, expertise and level-headed approaches to provide optimal care, support and life-saving interventions.
- Modified patient treatment plans as indicated by patients' responses and conditions.
- Medication reconciliation to optimize care.
- Helped patients and families feel comfortable during challenging and stressful situations, promoting recovery and reducing compliance issues.
Care Manager- Field Coordination
WellCare Health Plans
Houston, T.
07.2017 - 02.2019
- Coordinates delivery of needed services/supports for Physical Health, Social Determinant of Health and value-added benefits.
- Coordinates across the transdisciplinary care team (at a minimum the PCP) and transitions of care.
- Facilitated communication between members of health care delivery while involving clients in decision-making processes to minimize service fragmentation.
- Performs telephonic and face to face assessments and evaluations of the member’s needs to achieve and/or maintain an optimal wellness state by guiding members/families toward the appropriate resources for the care and overall wellbeing of the member.
Health Coach Consultant
Aetna Health & Life Insurance
Sugarland, T.X
06.2014 - 04.2017
- Gathered health data from clients using self-assessment tools.
- Enhanced awareness of health resources and worked to connect individuals with programs.
- Conducted evaluations and diagnostic studies to assess quality and performance of health education programs.
- Collected data through field documentation, identifying specific needs of targeted populations and develop health care plans tailored to each client’s needs.
- Educate member about chronic diseases and help with SMART goals to achieve realistic outcomes.
Nursing Instructor
Pima Medical Institute
Houston
04.2013 - 06.2014
- Guided and supervised nursing students in classroom, lab and clinical learning activities through hands-on training.
- Observed and evaluated student performance in meeting course objectives and student learning outcomes through assignments, projects, and examinations.
Charge Nurse
Quality Lifestyle Corporation
Houston, Tx.
04.2010 - 05.2014
- Assessed and assisted patients with diverse range and comorbid chronic diagnoses.
- Oversaw medication administration, monitored distribution, and documented responses.
- Order, interpret and evaluate diagnostic tests to assess a patient’s condition.
Charge Nurse
The Concierge, Rehabilitation Center
Houston, T.
03.2009 - 03.2010
- Facilitated patient admission, transfer, and discharge processes.
- Conducted patient assessments and diagnostic tests to provide physician with important patient health information.
- Trained other nurses on patient care and daily tasks, supporting growth and professional development.
- Coordinate with health care team members to evaluate, plan, and implement patient care plans.
Charge Nurse
Peninsula General Hospital Center, Extended Care & Rehab
, N.Y.
11.2007 - 03.2009
- Collaborated with multidisciplinary healthcare specialists, to devise, implement, and modify plans of care defining patient outcome goals.
- Followed protocols regarding quality assurance, biohazards, infection control, charting and emergency response.
- Medication reconciliation.
- Monitor and adjust specialized electronic equipment such as cardiac monitors, respirators, ventilators, and oxygen pumps.
- Monitoring, assessment, vital sign monitoring, ventilatory management, medication administration, intravenous insertion and infusion, central line care, and patient status recordkeeping.
- Interpreted and evaluated diagnostic tests to identify and assess patient's condition.
Education
MBA - Health Administration
Lamar University
Beaumont, TX05.2023
Bachelors - nursing
UT Arlington
Arlington, Tx12.2020
Graduate Certificate - Biomedical Informatics in Medical Informatics
UT Health Houston TMC
Houston, TX05.2018
Associate of Science - Nursing
Lamar State College
Port Arthur, TX05.2012
MDS Coordinator Certificate Program (MDS CCP) - Nursing Practice
MDS Training Institute
Houston, TX01.2011
Certificate - Practical Nursing
New York City Board of Education, Brooklyn Adult Learning Center
Brooklyn, NY05.2007
Bachelor of Science - Business and Insurance
University of Lagos
LagosSkills
- Interdisciplinary collaboration
- Discharge planning
- Utilization review
- Collaboration skills
- Critical thinking
- Care analysis
- Procedure optimization
- Records review
- Reviewing standards of care
- Case management
- Performance tracking
- Program development
- Decision making
- Organization and multitasking
- Problem solving
- Quality assurance
- Regulatory compliance
Certification
- ACII, Chartered Insurance Institute London, Active
- CCM, Certified Case Manager, Active
- RN License, State of Texas, Active
Additional Information
Worked on hospital projects such as the RED Project lead, Red to Green, LOS task force and Readmission task force, Magnet Designation and a member of hospital councils including the MH Experience team., Schwartz Round Committee member, Multi Visit Patient (MVP) Method lead., Ethic's Committee, Kata Practitioner and the Kaizen team., Provide analytical support, change management, and process improvement., Use data to drive decisions and performance improvement strategies.
Accomplishments
- Leader of the year nominee
- Daisy Award recipient
- ACMA Greater Houston Chapter Education Chair
- Project Lead for hospital Initiatives e.g The RED project. Touchpoint redesign, MDDR redesign etc
Professional Affiliation
- Commission For Case Manager Certification
- The Chartered Insurance Institute (CII)
- American Case Management Association
References
References available upon request.
Timeline
Manager – Case Management
Memorial Hermann Health System
10.2023 - Current
Case Manager - Utilization Review
Houston Methodist
02.2021 - Current
Snr Case Manager – Discharge Planning
Memorial Hermann Health System
02.2019 - 10.2023
Care Manager- Field Coordination
WellCare Health Plans
07.2017 - 02.2019
Hospice Registered Nurse Case Manager
Elysian Hospice
04.2017 - 02.2021
Health Coach Consultant
Aetna Health & Life Insurance
06.2014 - 04.2017
Nursing Instructor
Pima Medical Institute
04.2013 - 06.2014
Charge Nurse
Quality Lifestyle Corporation
04.2010 - 05.2014
Charge Nurse
The Concierge, Rehabilitation Center
03.2009 - 03.2010
Charge Nurse
Peninsula General Hospital Center, Extended Care & Rehab
11.2007 - 03.2009
MBA - Health Administration
Lamar University
Bachelors - nursing
UT Arlington
Graduate Certificate - Biomedical Informatics in Medical Informatics
UT Health Houston TMC
Associate of Science - Nursing
Lamar State College
MDS Coordinator Certificate Program (MDS CCP) - Nursing Practice
MDS Training Institute
Certificate - Practical Nursing
New York City Board of Education, Brooklyn Adult Learning Center
Bachelor of Science - Business and Insurance
University of Lagos
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