Gomathi Ramamurthy
Lewisville,Texas
Summary
Seasoned Registered Nurse with 23 years of experience, geared towards Managed Care Organizational Operation, quality improvement and enhancing Medicare experience for the medicare providers, recipients, develop and strengthen medicare partnership and delivery of care.
Overview
25
25
years of professional experience
1
1
Certification
Work History
Care Manager RN
Centene, Superior Health Plan
12.2018 - Current
- As a Registered Nurse Care Manager at Star-plus Nursing Facility Medicaid Plan
- My proficiency spans across all three divisions of the facility: Nursing Facility for institutionalized members, MFP for relocation transitioning from the nursing facility to community settings and Assisted Living (AL) which offers a semi-structured environment
- I conduct comprehensive medical necessity assessments and various other evaluations to determine and facilitate services for both facility-based and community-based members
- Examples of these assessments include PAS (Personal Assistance Services) assessment under codes H2060 and H6516
- I also conduct MNLOC (Medical Necessity Level of Care) evaluations for waiver benefits, and coordinate waiver services including home-delivered meals, Emergency Response Alerts, Durable Medical Equipment (DME), CPWC, and other adaptive aids
- Additionally, I aid members in establishing connections with LIDDA (Local Intellectual and Developmental Disability Authority) and other community support resources.
MMP
Centene, Superior Health Plan
01.2016 - 12.2018
- I began my journey at Centene as an RN care manager within the SHP/MMP Dallas Team
- My role involves facilitating care coordination and overseeing individuals with chronic health conditions
- This entails conducting Health Risk Assessments (HRA) and devising personalized care plans to address their specific challenges and objectives
- I actively participate in interdisciplinary ICT meetings, collaborating with professionals like pharmacists, primary care physicians (PCPs), specialists, behavioral care coordinators, and others to bridge gaps in care
- My responsibilities extend to aiding members in locating essential resources including PCPs, specialists, community support, housing, necessary equipment, and any other requirements linked to their medical conditions.
Senior Oncology Registered Nurse
UTSW Medical Center
06.2009 - 12.2015
- As an oncology registered nurse specializing in chemotherapy at the Simmons's Cancer Center
- I completed specialized training in oncology nursing, earning the O.C.N
- Certification and the title of Senior Oncology Certified Nurse (Charge Nurse)
- My responsibilities included conducting thorough patient assessments, providing effective telephone triage, reporting patient symptoms to physicians, contributing to the development of collaborative care plans, returning patient calls regarding various health concerns, offering patient education on symptom management and chemotherapy procedures, and guiding patients through their cancer journey towards healing and improved well-being.
Home Health Nurse and Director of Nursing
Kingsley Home Health Agency
07.2010 - 11.2015
- Worked as a Home Health Nurse in the field and Nursing Director of Home health services in the office in leadership role in training staff members for field work, auditing/review of patients charts for compliance and reimbursement regulations of Medicaid and Medicare Health plans
- Nursing assessment of patients who need home health services and various other disabilities
- Determining the special needs and act as a liaison between the patient and the team to help proactively achieve their needs
- Performing admission assessment, patient education and promote independence and self -care at home
- Conducting initial evaluations upon admission, physical assessment, monitoring vital signs, pre-fill med Box, educating patients, and fostering self-sufficiency and self-care in their home environment Reducing recurrent hospital admission and retaining patients at the comfort of their home and provide medical, nursing, and various other services as warranted by the medical condition.
Home Health Nurse and Nurse Compliance/Audit
Omni Home Health Agency
05.2012 - 11.2014
- Home Health Nursing services and Compliance Chart review/audits, assessing patients requiring home health services and managing diverse disabilities
- Identifying unique requirements and serving as a bridge between patients and the team to actively fulfill their needs
- Conducting initial evaluations upon admission, physical assessment, monitoring vital signs, pre-fill med Box, educating patients, and fostering self-sufficiency and self-care in their home environment
- Minimizing readmissions, ensuring patients remain in the familiarity of their homes, and delivering appropriate medical, nursing, and additional interventions based on medical necessity.
Oncology Registered Nurse
Baylor Medical Center
01.2009 - 05.2009
- I worked as a nurse on the Medical Oncology Floor, where I conducted thorough patient assessments and administered various medications through different routes such as oral, intravenous, intra-muscular, and sub-cutaneous
- My responsibilities also included monitoring vital signs, delivering IV fluids, and dispensing prescribed medications under the doctor's orders
- Thanks to my specialized training and certification in chemotherapy and biotherapy, I was able to confidently administer chemotherapy medications to hospitalized patients undergoing cancer treatments.
Registered Nurse - Acute Medical Care Unit
Heartland Regional Medical Center
04.2007 - 12.2008
- Providing immediate care for adult patients dealing with a range of medical conditions including congestive heart failure, pneumonia, and deep vein thrombosis, as well as those with cancerous tumors in the pancreas, lungs, liver, etc
- Performing blood sample extractions for laboratory analysis using Medi port and overseeing its maintenance
- Completed specialized training and education offered by the hospital, fulfilling examination prerequisites, and achieving Certification in Chemotherapy and Biotherapy
- Administering blood transfusions, intravenous chemotherapy, and Biotherapy medications to oncology patients
- Skillfully managing treatment-related side effects like nausea, vomiting, and pain using oral and intravenous medications
- Instructing patients on symptom control and at-home care.
Operating Room Registered Nurse
St.Jame’s Hospital
06.2005 - 02.2007
- I worked as both a scrub nurse and circulatory nurse in operating rooms primarily focused on oncology, ENT (Ear, Nose, and Throat), and Gynecology cases
- I provided assistance during a range of endoscopic procedures, including bronchoscopy, laparoscopy, laparoscopic-assisted hysterectomy, and laparoscopic cholecystectomy
- Additionally, I supported various open gynecological procedures such as oophorectomy, ovarian cystectomy, as well as complex ENT procedures involving tumor excision in the larynx and other ENT tumors
- I also participated in lengthy reconstructive surgeries, including those lasting 6-8 hours, such as reconstructive surgery for the temporomandibular joint.
Registered Nurse - Operating Room
Christian Medical College and Hospital
06.2000 - 05.2005
- Functioned as scrub and circulatory nurse in Pediatrics and women surgical center
- Assisted in several pediatrics surgeries such as laparotomy, repair of epispadiasis/hypospadias, excision of wilm’s tumour, thoracotomy and decortication
- Assisted in several women’s/gynecology surgeries such as caesarian section, ovarian cystectomy, hysterectomy, vaginoplasty/reconstruction etc.
Registered Nurse and Registered Midwife
Rural Primary healthcare Center
06.1999 - 05.2000
- Upon graduating from the college of nursing, I was selected with great honor by the institution to join a rural healthcare setting, embracing a multifaceted nursing role
- The primary care center, although modest, housed around 80 inpatient beds during that period
- Commencing my nursing journey in this intricate environment, my responsibilities spanned a diverse spectrum
- These included tending to newborns in the nursery, overseeing blood transfusions for adults, being available for on-call emergency Cesarean Sections, organizing mobile vaccination clinics, conducting prenatal checkups, assisting in labor rooms, facilitating vaginal deliveries, and providing comprehensive care to individuals of all ages afflicted with various medical conditions like pneumonia, hernia, gastritis, and malnutrition.
Education
Bachelor of Science in Nursing -
Master's in Science in Healthcare Management -
Colorado Technical University
Colorado Springs, CO03.2024
Skills
- Extensive nursing background spanning over 23 years
- Comprehensive experience across various healthcare domains
- Proficiency in communication
- Strong organizational abilities
- Care Quality Assessments
- Case management
- ADL Support
Certification
- RUG-Resources Utilization Group
- MNLOC
Employer
Star -Plus Nursing Facility- Assisted Living Facility
Roles And Responsibilities
- Level 1 Complex Care Service Coordination
- Annual Reassessment (MNLOC) for Level-1 Waiver members
- Medical Necessity Level of Care.
Personal Information
Title: Care Manager | RN | BSN | MS – Healthcare Management (Feb-2024)
Awards
- Ask the CEO Initiative-How well you know the Medicaid managed care?, 09/2023, SHP, CEO Mark Sanders
- Mission-Driven Award, 2023, Centene CEO Sarah London
- Key Contributor Award - Excellent Performance, 2020, Star-Plus NF Team
References
- Nicole Pippins, Vice president of Marketing and communications
- Michael Cation, Director
Timeline
Care Manager RN
Centene, Superior Health Plan
12.2018 - Current
MMP
Centene, Superior Health Plan
01.2016 - 12.2018
Home Health Nurse and Nurse Compliance/Audit
Omni Home Health Agency
05.2012 - 11.2014
Home Health Nurse and Director of Nursing
Kingsley Home Health Agency
07.2010 - 11.2015
Senior Oncology Registered Nurse
UTSW Medical Center
06.2009 - 12.2015
Oncology Registered Nurse
Baylor Medical Center
01.2009 - 05.2009
Registered Nurse - Acute Medical Care Unit
Heartland Regional Medical Center
04.2007 - 12.2008
Operating Room Registered Nurse
St.Jame’s Hospital
06.2005 - 02.2007
Registered Nurse - Operating Room
Christian Medical College and Hospital
06.2000 - 05.2005
Registered Nurse and Registered Midwife
Rural Primary healthcare Center
06.1999 - 05.2000
Bachelor of Science in Nursing -
Master's in Science in Healthcare Management -
Colorado Technical University
- RUG-Resources Utilization Group
- MNLOC
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