Heather Liafsha, RN, MHA

• Conducts COVID-19 case investigation, contract tracing, disease education
• Conducts new hire training on disease, electronic medical record, lab entry
• Performs case reviews for quality improvement, documentation integrity, data validation.
• Audits charts and reviews clinical documents to verify accuracy.
• Operates computer-based EMR systems to retrieve and store information and records.
• Complies quality metrics reports to maintain high standards of virtual care.
• Uses advanced health informatics knowledge and judgment to promote colleague involvement in planning, decision-making and evaluating outcomes.
• Researches and validates clinical data.
• Eliminates process gaps by implementing new methods of standardized training.
• Mentors new hires, resulting in stronger staff development and increased productivity.

• Performed comprehensive patient assessments, collaborated with multi-disciplinary care team (PT, OT, ST, MSW, and paraprofessionals) and other health care professionals to develop/modify and implement individualized patient plan of care as per physician orders that ensured quality, proper discharge planning and achieved desired outcomes and goals
• Completed OASIS assessment upon admission, discharge, transfer, and change in condition to ensure patient needs were met and appropriate reimbursement was obtained.
• Promoted and maintained patient health and independence through teaching and appropriate rehabilitative measures, assisting patients in learning appropriate self-care techniques.
• Advocated and ensured patient participation in care planning and goals of care.
• Identified care needs of individual patients and coordinated responses based on physician advice, insurance limitations and procedural costs.
• Increased referral rates by providing excellent service and building meaningful relationships with patients and caregivers.
• Consulted with clinicians to devise and manage ongoing care plans for at-risk patients.
• Evaluated treatment plans against individual goals and healthcare standards.
• Educated patients and loved ones about different treatment options and outside care approaches to reduce burden on hospital resources.
• Reduced care costs without sacrificing quality through service coordination and multidisciplinary collaboration.
• Managed caseload of 40-60 patients, and interdisciplinary team of RNs, LPNs, CNAs across four rural zip codes.

• Performed admission, concurrent, and post-service utilization review using InterQual and Milliman Care Guidelines, severity of illness, and intensity of service to determine medical necessity.
• Facilitated continuity of care by ensuring that needs of patients, including observation patients, were recognized and addressed through coordination with other health care team members to bring about best possible cost-effective quality and clinical outcome.
• Collaborated with physician and members of interdisciplinary team to obtain input regarding discharge plan.
• Identified care needs of individual patients and coordinated responses based on physician advice, insurance limitations and procedural costs.
• Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
• Obtained authorizations from multiple insurance carriers for various levels of care.
• Queried physicians regarding missing or unclear health record documentation and requested further information for clarification purposes.
• Used first-hand knowledge and clinical expertise to advocate for patients under care and enacted prescribed treatment strategies.
• Arranged durable medical equipment, transportation, and other day-of-event needs.

• Reduced hospital re-admissions by 47%
• Managed members throughout 30-day program from hospital admission through transitions from acute setting to other settings, including nursing facility placement and private home, with goal of reduced readmissions
• Ensured member transitions to setting with adequate caregiving and functional support, as well as medical and medication oversight as required.
• Arranged for patient home visits from visiting nurse or intensive rehabilitation from inpatient facility after discharge from hospital.
• Mitigated patient discharge delays by coordinating tests, therapy and other treatments.
• Coordinated program referrals for community-based resources.
• Updated treatment plans on monthly basis with latest intervention strategies and progress notes.
• Provided ongoing counseling to help patients deal with conditions and processes
• Organized clinical documentation, treatment plans, and referrals.
• Worked with medical teams, patients and families to implement effective treatment plans.
• Coordinated individualized discharge plans to manage safe transition back into community and home environments.

RICHLAND COUNTY HEALTH DEPARTMENT

• Planned, implemented, and directed all clinical operations, to include Preventive Health, STD/HIV, Family Planning, Immunizations, and WIC, to provide quality-focused environment for delivery of health services in efficient and cost-effective manner utilizing multi-disciplinary staff.
• Monitored, coached and supervised multi-disciplinary team of 60+ employees.
• Monitored site expenditures and communicated resources needed to Regional management staff; provided continual feedback to site staff and Regional management; used scientific data to proactively identify areas of concern and their solutions.
• Compiled program utilization data for site and developed targeted caseload goals and plans for accomplishing set goals.

HEALTH FACILITIES LICENSING

• Triaged healthcare complaint allegations and incident/accident reports, determined scope of complaints.
• Investigated complaints against Skilled Nursing Facilities and Assisted Living Facilities deemed high priority and involving complicated care issues.
• Identified conditions that did not meet standards/regulations; advised persons in charge of facility of need to modify conditions.
• Consulted with facility to develop corrective action plan to prevent reoccurrence.

• Facilitated continuous quality improvement in patient safety initiatives and timely resolution of significant occurrences.
• Identified opportunities for improvement in patient safety and lead multi-disciplinary teams of physicians, nurses, pharmacists, department directors, risk management, and legal team to develop improved processes and implement appropriate action plans.
• Assured action plans were completed and positive improvements were made to reduce patient risks and hospital liability.
• Developed and implemented performance improvement strategies and plans to promote continuous improvement.
• Increased patient satisfaction by resolving issues as evidenced by increased Press Ganey scores.
• Resolved conflicts and negotiated mutually beneficial agreements between parties.
• Used critical thinking to break down problems, evaluate solutions and make decisions.

• Created business plan and launched non-medical home care company
• Implemented and managed all aspects of company, including over 40 employees
• Assessed clients, created care plans, and coordinated care with physicians and community agencies
• Crisis management, family mediation, client advocate as Certified Care Manager
• Focused on maintaining clients in home by providing assistance, RN care management, medication monitoring, and physician visit coordination
• Developed and updated policies and procedures, maintaining compliance with statutory, regulatory and local, state and federal guidelines relating to HIPAA, benefits administration and general liability.
• Fostered excellence by example, and being hands on mentor to clinical staff.