FRANCES REYES
Jersey City,NJ
Summary
Dynamic Telephonic Nurse Case Manager with a proven track record of delivering appropriate and cost-effective healthcare services for medically rehabilitated individuals through the development of patient-centered case management plans. Expertise in leveraging independent nursing judgment and evidence-based clinical decision-making to optimize health outcomes across the care continuum, complemented by extensive experience in chronic disease management and collaborative care planning. Recognized for strong capabilities in quality assessment and planning, along with a demonstrated ability to lead cross-functional teams effectively. An outgoing, people-oriented approach fosters connections with diverse groups while maintaining exceptional organizational and communication skills to support upper management initiatives.
Overview
24
24
years of professional experience
2
2
Certification
Work History
UAS Assessor
Gotham Companies
02.2023 - Current
- Utilized critical thinking skills to prioritize nursing interventions based on patients'' acuity levels and individual needs.
- Conducted thorough patient assessments to identify changes in condition, promptly notifying physicians and initiating appropriate interventions when necessary.
- Skillfully managed challenging patient situations using de-escalation techniques, crisis intervention strategies, and therapeutic communication skills.
- Facilitated patient transitions between different levels of care, ensuring continuity of services and minimizing disruptions in treatment plans.
- Implemented evidence-based fall prevention strategies, resulting in a significant decrease in patient falls within the unit.
- Educated family members and caregivers on patient care instructions.
- Observed and documented patient factors such as diets, physical activity levels, and behaviors to understand conditions and effectively modify treatment plans.
- Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
UAS RN (Per Diem)
Rockaway Home Care
08.2023 - 08.2025
- Visit ML TC members receiving long term care
- Conduct face to face UAS assessments according to state and plan guidelines.
- Perform assessments in the home setting and/or video conference
- Act as intermediary between providers, LHCSA and members
- Assess eligibility of Medicaid members in need of managed long term care using a comprehensive web based system.
- Review medical records and medications to support assessment outcomes.
- Conduct needs assessment by utilizing UAS-NY/DOH tool to determine consumers’ qualifications and appropriateness for Long Term Care Services.
- Utilizing Lenavi and/or QCCS Analyzer for recommendations for finalization.
Clinic RN Certified Community Behavioral CONTRACT
Tandy M Group
07.2023 - 11.2023
- Performed Medical Assessment on clients with comorbidities to ensure that appropriate medical support is provided
- Provided IM injections for psychiatric clients.
- Provided ongoing teaching on mental health, drug abuse, and nutrition counseling.
- Interviewed patients and collected medical histories
- Developed patient care plans based on assessments
- Provided counseling and followed up with patients via phone or in person
- Monitored patients for medication side effects and adherence
- Collaborated with psychiatrists, psychologists, social workers, and other professionals
- Helped patients with activities of daily living and improving coping skills
- Advocating for patients and connecting them to resources and support services
Quality Assurance Specialist FULLTIME
Maximus
03.2022 - 12.2022
- Utilize the NYS UAS Assessment as needed in the home or via telehealth to develop a person center service plan to meet the member's needs.
- Identify and initiate referrals for social service programs, including financial, psychosocial, community and state supportive services.
- Conduct monitoring activities for quality assurance purposes
- Responsible for evaluating staff members on the quality of work performed as measured against project standards
- Proposing measures to correct or improve an organization's final products in order to meet established quality standards.
Telephonic Nurse Case Manager FULLTIME
Senior Whole Health
05.2017 - 05.2021
- Telephonic Quality Calls performed daily to meet daily quota of 7-9 calls per day by assessing current treatment plan to identify barriers, clarify or determine realistic goals and objectives and seek potential alternatives. Total monthly calls 100-125 calls.
- Patient Service Care Plans evaluated daily for patients referred for case management to determine physical, mental, financial and psychosocial status by utilizing comprehensive, standardized criteria to identify existing and potential needs.
- Utilization Review conducted daily with collaboration with other health care professionals, regarding plan of care and variances in plan implementation and its appropriateness in order to achieve best health outcomes and cost efficiency.
- Grievance and Appeals were generated daily through participants requests and scaled its priority to 3 day responses depending on the appropriateness and patient's urgency.
- Quality Assurance maintained by screening medical information for Medicaid/Medicare compliance and STATE/FEDERAL guidelines
Nursing Supervisor/Instructor FULLTIME
Heart to Heart Home Care
01.2017 - 04.2017
Assessment Nurse/Aide Supervisor PER DIEM
Royal Care Home Care
10.2016 - 01.2017
Infusion Nurse PER DIEM
Walgreens/Trinity Infusion
12.2014 - 04.2016
Pt Service Mgr Telehealth/WOUND CARE RN PER DIEM
Montefiore Hospital Homecare
02.2013 - 12.2013
Visiting Nurse FULLTIME
Visiting Nurse Service of New York
02.2011 - 12.2013
Education
Master of Public Administration - Nursing Administration
Baruch College, Allen G. Aaronson
MANHATTAN06.2018
Bachelor of Science - Professional Nurse
New Jersey City University
Jersey City06.2008
Associate of Applied Science - Registered Nurse
Christ Hospital Nursing School
Jersey City01.2001
Skills
- Quality Assessments
- Utilization Review Authorizations
- Competency in Case management
- Supervisory Skills
- Administrative Support
- Conceptual Skills
- Effective Communication
- Decision-making Skills
- Organization & Presentation Skills
- Staff Management
- Critical Thinking Skills
- Time Management
- Attention to details and accuracy
- Team Work
- Care Planning
- Wound Care
- Chronic Disease Management
- Case Management
- Health Care Consultation
- Medical Assessment
- Culturally Sensitive
- Spanish Fluency
- IV and Venipuncture Certified
- Patient Discharging
Certification
UAS Assessor 2017
CPR Instructor 2024
Languages
Spanish
Native or Bilingual
Timeline
UAS RN (Per Diem)
Rockaway Home Care
08.2023 - 08.2025
Clinic RN Certified Community Behavioral CONTRACT
Tandy M Group
07.2023 - 11.2023
UAS Assessor
Gotham Companies
02.2023 - Current
Quality Assurance Specialist FULLTIME
Maximus
03.2022 - 12.2022
Telephonic Nurse Case Manager FULLTIME
Senior Whole Health
05.2017 - 05.2021
Nursing Supervisor/Instructor FULLTIME
Heart to Heart Home Care
01.2017 - 04.2017
Assessment Nurse/Aide Supervisor PER DIEM
Royal Care Home Care
10.2016 - 01.2017
Infusion Nurse PER DIEM
Walgreens/Trinity Infusion
12.2014 - 04.2016
Pt Service Mgr Telehealth/WOUND CARE RN PER DIEM
Montefiore Hospital Homecare
02.2013 - 12.2013
Visiting Nurse FULLTIME
Visiting Nurse Service of New York
02.2011 - 12.2013
Bachelor of Science - Professional Nurse
New Jersey City University
Associate of Applied Science - Registered Nurse
Christ Hospital Nursing School
Master of Public Administration - Nursing Administration
Baruch College, Allen G. Aaronson