Holly Bird
Manila,AR
Summary
Dynamic RN Case Manager with Aetna, skilled in chronic disease management and patient advocacy. Proven track record in developing comprehensive care plans and enhancing interdisciplinary collaboration, resulting in reduced hospital readmissions. Strong clinical judgment and expertise in accurate documentation ensure compliance and optimal patient outcomes. Committed to fostering trust and communication among healthcare teams.
Overview
15
15
years of professional experience
Work History
RN Case Manager
Aetna
01.2022 - Current
- Managed complex cases involving multiple comorbidities, requiring close monitoring and coordination of various healthcare services.
- Enhanced patient care by developing comprehensive care plans and coordinating with interdisciplinary healthcare teams.
- Promoted adherence to treatment plans by conducting regular follow-up visits and providing ongoing support to patients.
- Advocated for patients'' rights and preferences, working diligently to align care with individual values and goals.
- Conducted thorough assessments of patients'' needs, enabling more accurate diagnoses and targeted interventions.
- Developed strong relationships with patients and their families, providing support and education on health management.
- Reduced hospital readmission rates with proactive follow-up care and patient education on self-management techniques.
MDS Coordinator Consultant
Monette Manor
01.2023 - 10.2024
- Set schedules for staff to start and complete MDS assessments and care plan meetings.
- Ensured timely completion of all MDS assessments, maintaining full compliance with federal and state regulations.
- Maintained up-to-date knowledge on CMS guidelines and changes to ensure accuracy in reporting and reimbursement processes.
- Assessed electronic medical record for required documentation to support MDS coding.
- Provided ongoing education for nursing staff regarding MDS best practices, contributing to a knowledgeable and skilled workforce.
- Completed minimum data set assessments with strong collaboration across business, provider and clinical disciplines.
- Developed a comprehensive system for tracking MDS completion deadlines, ensuring timely submissions and minimizing the risk of financial penalties.
School Nurse
Buffalo Island Central School
08.2020 - 05.2022
- Administered medication to students as prescribed by physicians to provide necessary treatment and manage health conditions.
- Monitored ongoing medical conditions such as asthma or diabetes, adjusting care plans accordingly to maintain optimal student wellness levels.
- Supported students with special needs by coordinating individualized healthcare plans and working closely with the interdisciplinary team.
- Managed immunization compliance within the school population to prevent the spread of communicable diseases.
- Served as liaison between families, school personnel, and other healthcare providers on behalf of students.
MDS Coordinator
Monette Manor
03.2010 - 01.2022
- Enhanced patient care quality by implementing comprehensive MDS assessments and care plans.
- Verified prompt and accurate completion of MDS activities for billing.
- Collaborated with nursing staff to provide accurate and timely clinical assessments for each resident, leading to improved overall care.
- Monitored changing regulations related to RAI/MDS requirements, keeping staff informed about updates that impact their daily work routines.
- Implemented interdisciplinary meetings focused on individualized care plan development, resulting in more targeted interventions and improved resident outcomes.
- Established regular review processes to evaluate the accuracy and completeness of MDS records, leading to proactive identification of potential issues before they escalate.
- Developed strong relationships with interdisciplinary team members to facilitate efficient collaboration on resident care planning.
- Provided guidance to nursing staff on accurate completion of Section GG assessments, enhancing overall documentation quality and supporting appropriate Medicare/Medicaid reimbursement rates.
- Complied with federal and state regulations for completion and coordination of RAI process.
Credentialing Specialist
Medely
08.2019 - 06.2020
- Remote Position
- Managed multiple priorities effectively, resulting in the on-time completion of credentialing tasks for Healthcare Professionals
- Conducted audits of provider files, ensuring all necessary documents were up-to-date and compliant with regulatory requirements.
- Safeguarded confidential provider information by adhering to strict data privacy regulations and company policies.
- Received and evaluated applications to look for missing and inaccurate information.
Education
Associate of Science - Nursing
Arkansas Northeastern College
Blytheville, AR05-2009
Bachelor of Science - Psychology
Blue Mountain Christian University
Blue Mountain, MSSkills
- Chronic disease management
- Discharge planning
- HIPAA compliance
- Multidisciplinary approach
- Case evaluation
- Strong clinical judgment
- Microsoft office
- ICD-10
- Accurate documentation
- Patient and family advocacy
- Clinical assessment
- Case management
Timeline
MDS Coordinator Consultant
Monette Manor
01.2023 - 10.2024
RN Case Manager
Aetna
01.2022 - Current
School Nurse
Buffalo Island Central School
08.2020 - 05.2022
Credentialing Specialist
Medely
08.2019 - 06.2020
MDS Coordinator
Monette Manor
03.2010 - 01.2022
Associate of Science - Nursing
Arkansas Northeastern College
Bachelor of Science - Psychology
Blue Mountain Christian University
Similar Profiles
AMANDA MORROWAMANDA MORROW
Claims Processor at AetnaClaims Processor at Aetna
Tiffany RisnerTiffany Risner
Director of Case Management at AetnaDirector of Case Management at Aetna
Karen WardKaren Ward
Customer Service Team Lead at AetnaCustomer Service Team Lead at Aetna
PARKER WILLMONPARKER WILLMON
First Helper at Hybar Steel LLCFirst Helper at Hybar Steel LLC
Alexander ColeAlexander Cole
Secondary History Teacher at Trumann High SchoolSecondary History Teacher at Trumann High School