Registered nurse with extensive experience in community-based care, insurance claims review, and medical record auditing. Proven track record in compliance with state and federal regulations, with strong documentation and communication skills. Demonstrated ability to enhance patient outcomes through effective care plan development and multidisciplinary team management. Committed to delivering high-quality, cost-effective care with minimal supervision.
Overview
17
17
years of professional experience
1
1
Certification
Work History
Home Health Case Manager
Blue Cross Blue Sheild
Somerville
01.2019 - Current
Supported process improvement and medical cost reduction initiatives to enhance organizational profitability.
Identified and disseminated best practices across authorization services and the wider enterprise.
Educated providers on BlueCare processes during direct provider interactions.
Developed individualized service plans based on client assessments and monitored progress.
Implemented new operational processes to align with CRA updates and membership changes.
Collaborated with external care partners to facilitate coordinated care efforts.
Conducted home visits to evaluate medical needs and service adequacy.
Case Manager
Amedisys Home Health Care
Bartlett
06.2018 - 10.2018
Facilitated an on-going assessment of patient/family needs and implementation of interdisciplinary team care plan.
Developed patient care plans, including assessments, evaluations and nursing diagnoses.
Assessed patients and documented their medical histories.
Provided patient education.
Confirmed accurate completion of forms/reports for the admission, transfer and/or discharge of each resident.
Made appropriate interventions by reading and interpreting fetal heart monitors.
Director of Performance Improvement and Quality Improvement
Home Health Care of West Tennessee, Inc.
Bartlett
09.2009 - 06.2018
Represented and interpreted the agency's functions and services to other institutions, the public, government agencies and other organizations.
Educated staff on state and federal statutes, rules and regulations governing home care services.
Cooperated and communicated effectively with physicians to ensure client satisfaction and compliance with set standards.
Accurately documented all elements of nursing assessment, treatments, medications, discharge instructions, and follow-up care.
Ensured efficacy of treatments through monitoring of treatment regimens and utilizing evidence-based criteria.
Coordinated Quality Improvement Activities (QIA's) to identify performance areas for improvement.
Evaluated patient care needs, prioritized treatment, and maintained patient flow.
Documented and communicated all workers comp claim activity in a timely and effective manner, while supporting the outcome of claim files.
Handled claims consistent with client and corporate policies, procedures, best practices and regulations.
Developed new process for employee evaluation which resulted in marked performance improvements.
Obtained documents, clearances, certificates and approvals from local, state and federal agencies.
Labor and Delivery Nurse
Saint Francis Hospital-Bartlett
Bartlett
11.2008 - 09.2009
Facilitated an on-going assessment of patient/family needs and implementation of interdisciplinary team care plan.
Developed patient care plans, including assessments, evaluations and nursing diagnoses.
Assessed patients and documented their medical histories.
Provided patient education.
Confirmed accurate completion of forms/reports for the admission, transfer and/or discharge of each resident.
Made appropriate interventions by reading and interpreting fetal heart monitors.
Labor and Delivery Nurse
Methodist North Hospital
Memphis
Performed patient assessments and adjusted care plans accordingly.
Collaborated with doctors and staff members to ensure quality care.
Monitored nursing care, including process assessment and implementation.
Delegated staff nurse duties.
Accurately documented all elements of nursing assessment, treatments, medications, discharge instructions, and follow-up care.
Assisted doctors in monitoring baby and mother health during labor.
Checked in patients quickly with adequate information.
Made appropriate interventions by reading and interpreting fetal heart monitors.
Education
Bachelor of Science - Nursing
University of Tennessee at Martin
Martin, Tennessee
01.2003
Skills
Leadership and management skills
Organizational expertise
Healthcare billing and compliance
Policy development
Clinical judgment
Patient care focus
Data management
Oral and written communication
Microsoft Office proficiency
Certification
CCM
Timeline
Home Health Case Manager
Blue Cross Blue Sheild
01.2019 - Current
Case Manager
Amedisys Home Health Care
06.2018 - 10.2018
Director of Performance Improvement and Quality Improvement