Jacqueline Hill
Scott Depot,WV
Summary
Experienced RN Case Manager with background in providing high-quality patient care and effective case management. Strengths include strong decision-making skills, efficient coordination of care plans, and effective communication with multidisciplinary teams. Previous work has demonstrated significant impact on improving patient outcomes through the development and implementation of comprehensive care strategies.
Overview
32
32
years of professional experience
1
1
Certification
Work History
RN Case Manager
Travelers Insurance
Charleston, WV
06.2015 - 10.2021
- Conducted weekly interdisciplinary team meetings to review case management activities for assigned caseloads.
- Collaborated with physicians, nurses, and other healthcare professionals to ensure optimal patient outcomes.
- Reviewed clinical data including lab results, radiology reports and vital signs to assess appropriateness of treatments.
- Facilitated transitions between levels of care through effective coordination of resources within a managed care environment.
- Attended continuing education seminars relevant to case management practices.
- Maintained accurate documentation of patient progress in the electronic health record.
- Ensured compliance with regulatory standards concerning utilization review, ethical decision making and legal aspects of case management practice.
- Monitored and evaluated effectiveness of treatment plans and interventions.
- Reviewed reports from workers compensation claims adjusters regarding employee injury cases.
- Applied knowledge of applicable laws governing workers compensation cases.
- Evaluated workers compensation cases for appropriateness of care, cost effectiveness and compliance with state regulations.
- Managed employee engagement and communication activities, guiding employee safety and workers' compensation activities.
- Researched and resolved complex Workers' Compensation issues.
- Participated in training sessions with attorneys, adjusters and other professionals involved in the claims process.
- Facilitated dispute resolution between parties involved in Workers' Compensation cases.
- Advised employers on appropriate measures to reduce claims costs.
- Developed individualized return-to-work plans for injured workers.
RN Case Manager
York Risk Services
Charleston, WV
06.2008 - 06.2015
- Identified high-risk cases requiring intensive monitoring or specialized interventions.
- Ensured compliance with regulatory standards concerning utilization review, ethical decision making and legal aspects of case management practice.
- Attended continuing education seminars relevant to case management practices.
- Reviewed clinical data including lab results, radiology reports and vital signs to assess appropriateness of treatments.
- Maintained accurate documentation of patient progress in the electronic health record.
- Actively participated in multidisciplinary rounds discussing complex cases with members of the healthcare team.
- Assessed patient's physical, mental, and psychosocial health status to develop individualized care plans.
- Coordinated with healthcare team to establish, enact and evaluate patient care plans.
RN Case Manager
Sedgwick CMS
Charleston, WV
08.2006 - 06.2008
- Participated in training sessions with attorneys, adjusters and other professionals involved in the claims process.
- Assessed injured workers' medical records and reports to determine eligibility for benefits.
- Monitored progress of injured workers through medical treatment, rehabilitation and job retraining programs.
- Developed individualized return-to-work plans for injured workers.
- Maintained detailed case files documenting all pertinent information related to the claim.
RN
Thomas Memorial Hospital
South Charleston, WV
02.1990 - 05.1997
- Provided compassionate care for patients with chronic illnesses or terminal conditions.
- Collaborated with interdisciplinary teams to ensure optimal patient outcomes.
- Maintained accurate records of patient care services including medications given and response to treatments.
- Participated in continuing education programs to stay current with best practices in nursing care.
- Responded quickly and effectively to life-saving situations using nursing standards and protocols for treatment.
- Evaluated effectiveness of interventions and modified as needed according to evidence-based practice guidelines.
- Ensured compliance with all regulatory agency policies governing safe delivery of healthcare services.
- Performed physical examinations, diagnostic tests, and other procedures to assist physicians during treatment of illness or injury.
- Counseled patients regarding health maintenance, lifestyle modifications, nutrition, and self-care skills related to their diagnosis.
- Monitored, recorded, and reported symptoms and changes in patients' conditions.
- Provided emotional support for patients experiencing pain or stress due to illness or hospitalization.
- Observed vital signs such as temperature, pulse rate, blood pressure, respiration rate, weight and height measurements; documented results accurately in medical record system.
- Educated patients about their condition and the importance of following a treatment plan.
Education
Associate of Science - Nursing
University of Charleston
Charleston, WV02-1990
Skills
- Healthcare regulations
- Community Resources
- HIPAA Compliance
- Palliative Care
- Medication Management
- Quality Improvement
- Utilization review
- Case Management
Certification
- Case Management Certification
- Multi-state RN licensure
Timeline
RN Case Manager
Travelers Insurance
06.2015 - 10.2021
RN Case Manager
York Risk Services
06.2008 - 06.2015
RN Case Manager
Sedgwick CMS
08.2006 - 06.2008
RN
Thomas Memorial Hospital
02.1990 - 05.1997
Associate of Science - Nursing
University of Charleston