Heidi Adkins

· Ability and comfort typing; 85 + WPM.

· Utilize nursing background and critical thinking to triage patients according to medical necessity.

· Simultaneously navigates 10 + platforms and applications to perform documentation during calls.

· Utilizes Schmitt-Thompson Protocols for 10 + clients; triaging and referring patients per protocol.

· Communicates with multi-level team members, physicians, pharmacists', case management and lab technicians as needed.

· Effectively handles high stress, inbound/outbound calls in a fast-paced environment.

· Communicate with patients and families with empathy while also maintaining adherence to client protocols.

· Works as Nurse Consultants between Heath Care Providers and School District Staff to ensure safe management of students' medica needs during the school day.

· Serves as the Single fixed Point of Responsibility (SFPR) to perform case management and for the coordination of care for students with disabilities case referral to case closure.
Collaborates effectively with Community Health Nursing Supervisors, the Assistant Community Health Director, the Director of Florida Community Health and The State of Florida Department of Health Administrator to ensure appropriate level of care at the appropriate time.

· Organize, establish, integrate, update, modify and document resources necessary to accomplish the goals established in case management plan.

· All case management activities to maintain a member's confidentiality and privacy, ensuring member safety, adherence to advocacy ethics as well as legal and accreditation/regulatory standards.

· Develops network of trusted contacts within organizations in which to refer and coordinate care.

· Participates in multidisciplinary team meetings including but not limited 504 team, IEP team, Health Care Providers, DCF, etc. via TEAMS, Zoom, and/or face to face meetings, ensuring ADA compliance for students with disabilities.

· Branch compliance with federal, state, Accreditation regulations regarding Workers Compensation, OSHA, CHAP, ACHC, Medicare and/or Medicaid.

· Monitors clinical status of 38 patients and ensures coordination of patient care.

· Manage, supervise approximately 80 nurses and office staff, evaluating 90 day and yearly reviews.

· Established weekly, quarterly, or yearly goals for financial statements, activity reports, and other Key Performance Indicator Data to measure productivity, goal achievement and to determine areas needing cost reduction and program improvement.

· Oversight of internal billing and collection efforts to generate clean claims; planning and implementing branch growth strategies.

· Participated in management team meetings to discuss patient status, census changes, and patient complaints or concerns.

· Oversaw operations and provided corrective feedback to achieve daily and long-term goals.

· Monitored office workflow and administrative processes to keep operations running smoothly.

· Educating individuals on disease process; identifying at risk populations and refer to physicians appropriately.

· Developing relationships with individuals to assess their service needs and respond with appropriate referrals and linkages to resources.

· Helping individuals' access community resources, such as shelter, housing, entitlements, medical care, etc.

· Referring eligible individuals to more intensive community programs when indicated.

· Develop effective relationships with shelters and other programs that provide direct services to the homeless population.

· Identify gaps and barriers in available community resources advocating for systemic changes to improve the quality and coordination of care.

· Manage, assign, supervise and direct large free community health events including health screenings and analyzing data obtained.

· Executed strategies to generate qualified leads through outreach sales calls to professional referral sources.

· Created and implemented print and digital public awareness campaign to increase awareness of Community and Public Health.

· Monitors patient care to ensure quality, appropriateness of services and staffing patterns, aligning with NCQA and

· Medicare/Medicaid guidelines.

· Concurrent, Pre and Post Utilization Management review to ensure services are appropriate.

· Coordinates admission process by facilitating communication between physicians, insurance companies, pharmacies, staff, and other ancillary services.

· Coordinates case management with insurance company representatives to ensure eligibility for services and pre-authorization of care as required by insurance companies to facilitate payment of claims.

· Coordinates the care of the patient through the admission process utilizing ICD coding, concurrent and post review; advises interdisciplinary team of patient needs and documentation.

· Assures that pending referrals are updated with written documentation to accept, pend or deny new patients.

· Medicaid, Medicare, and private insurance-related prospective, concurrent, and retrospective Utilization Management Review and prior authorization, aligning with NCQA and Milliman guidelines/recommendations.

· Provides continuity of care between discharge from hospital/rehab and home setting, reducing readmissions

· Communicates with an interdisciplinary team as to patient status and/or needs, providing referrals as necessary to other physicians, home care needs, and at-risk population for readmission into hospital setting.

· Managed support services and fostered communication among social workers, therapists, hospital staff, and patients.

· Developed and modified patient care plans and assisted interdisciplinary team in identifying client needs and goals to determine priorities of care.

· Analyzed patient responses to medications, therapies, and variances in plans of care.

· Implemented aspects of patient care under physician orders and sought clarification when needed to promote safety, quality, and cost-efficient care.

· ACLS , TNCC, CCRN, NRP certifications obtained.

· Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing conditions.

· Administered medications via oral, IV, and intramuscular injections and monitored responses.

· Communicated openly and collaboratively with all healthcare staff to organize successful patient care.

· Answered codes quickly and orchestrated efficient, skilled medical care.

Educated patients and answered questions about health condition, prognosis, and treatment.