BSN, RN with 11 years of nursing experience including 5 years in rural health, family practice and quick care setting, 1 year in assisted living facility and over 5 years in out patient care coordination/ case management.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Outpatient Care Coordinator Nurse
Health Alliance A Subsidiary Of Carle Health
07.2018 - 12.2023
Manage very high risk and complex out patient patients who are identified by their insurance benefit utilization and engage in outpatient care coordination program.
Managed patients in Washington state, Illinois, Iowa, Indiana, Missouri and other nurse compact states as needed in Pacific, Central and Eastern time zone.
Complete comprehensive health assessments face to face in patients homes and telephonically, reviewing patients health history, current conditions, medications, social determinants of health and risk assessments.
Partner with patient to help set health and wellness goals and develop individualized plan of care.
Develop care plan to help guide and monitor patients progress towards health goals.
Assess patient needs and connect them with appropriate resources such as; social workers, providers, pharmacists, dietitians and community resources to ensure optimal health outcome
Coordinate patient care and assist patient with questions or barriers to follow treatment plan.
Utilize health plan to help patient save money.
Review value based care gaps approach to educate patient on gaps in care that may help improve their health or conditions.
Assist members with completion of advanced care planning.
Managed patient caseloads effectively, ensuring timely follow-up and appropriate interventions
Participated in weekly patient care conference meetings to review case studies to help improve cost savings.
Monitored progress towards patient goals, adjusting care plans as needed to achieve desired results
Provided emotional support for patients and families during difficult times or struggles as they work toward wellness goals.
Participated in Network Optimization Program to outreach to patients who had referral denials or out of network approvals to help
Registered Nurse, BSN
Kirby Medical Group, Kirby Quick Care
10.2012 - 07.2018
Taking and recording vitals signs.
Medication reconciliation in person and telephonically.
Enter and process specialist referrals, imaging orders, lab orders, and medications for patients into EMR per provider verbal orders.
Retrieve, address and return phone calls to patient's regarding questions or concerns.
Liaison between patient and their providers in clinic, patient family members or caretakers, insurances, pharmacies, nursing homes, hospice, home health, medical supply, and anyone else involved in patient's overall plan of care.
Initiate, process and follow prior authorizations with patient insurance to achieve coverage of medical procedures and medications.
Provide patient education related to pain management, post procedural instructions, vaccine administrations, medication administration and other educational needs as they arise in clinical setting.
Contact patients in regards to their anticoagulation results, completing mandatory questions, updating flow sheets and return calendars.
Co-leader of Illinois State funded vaccine program VFC. This includes monitoring clinic refrigerator temperatures and functionality, enter data into state VFC website and balancing use and distribution of all state funded vaccine stock.
Triage patient's telephonically or in person as they present to Kirby Quick Care walk in clinic. Make clinical decisions for appropriate patient care between emergency room or walk in clinic based on patient's symptoms and complaints.
Assist providers with office procedures. Oversee medical and surgical asepsis throughout treatment. Perform wound care as ordered by provider.
Dispense sample medications and educate patient as ordered by provider.
Administer injectable, inhalation and oral medications as ordered by providers and monitored responses.
Trained new nurses in proper techniques, care standards, operational procedures, and safety protocols
Collected blood, tissue, and other laboratory specimens and prepared for lab testing.
Performed venipuncture to collect blood specimens from patients for labs as ordered by providers.
Foley cath insertion and removal occasionally as needed in clinical setting
Schedule patient appointments.
Registered Nurse Part-time
Maple Point
03.2015 - 05.2016
Served as signing RN to facilities full time LPN, in 30 apartment assisted living facility.
Reviewed assessments and service plans for residents as completed by LPN. This included resident interviews and assessments to determine if any adjustments needed to be made prior to state submission.
Reviewed residents status and updated medical situations on weekly basis.
Medication reconciliation on new residents or those who were responsible for their own medications.
Assisted with overseeing care implementation by supportive staff and recognize any changes that needed to be addressed throughout residents daily care.
Aided with assessments of residents and their ability to performs ADL's or self administer medications
Liaison between residents, staff, residents family, medical facilities, pharmacies, insurances and other healthcare services as needed to assist full time LPN.
Registered Nurse, BSN
Illinois Heart Specialist (IHS)
05.2012 - 09.2012
Greeted patients, took and recorded vitals signs, reviewed required medical questions in electronic medical record (EMR).
Performed EKG's as ordered by physician.
Performed medication reconciliation in person and telephonically
Entered and processed orders for cardiac testing, labs and medications for patients into EMR per clinic protocol or verbal orders by provider.
Retrieved, addressed and returned phone calls to patient's regarding questions or concerns.
Liaison between patients and providers in clinic, patient family members or caretakers, insurances, pharmacies, and other educational needs as they arise clinical setting.
Dispensed sample medications and provide education to patients.
Telephonic triage to determine patient's need for routine or emergent care.
Initiated billing process for physicians, proofread physician dictation.
Entered International classification (ICD9) codes in billing system for physician review.
Completed billing encounter forms and finalized clinical documents in EMR for physician signature.
Education
Bachelor of Science - Nursing
Millikin University
Decatur, IL
2011
Associate of Applied Science - Dental Hygiene
Parkland College
Champaign, IL
2000
Skills
Software Proficiency; Epic Tapestry, Microsoft (Word & Excel), Power Point, Outlook, EPIC electronic medical record (EMR)
HIPAA & OSHA Compliance
Hands on experience; wound care, medication administration, injections, Tuberculin skin testing, EKG test administration, phlebotomy
Strong leadership, organizational, communication and critical thinking skills
Familiar with variety of medical conditions, treatments, testing and medications
In person and telephonic nurse triage experience
Able to navigate and work through new situations
Easily acclimates to various unexpected patient needs
Efficient with providing patient education face to face and telephonically
Task Prioritization
Teamwork and Collaboration with multiple medical departments and professionals daily
Provider Network Manager Sr. at Carelon Behavior Health (Subsidiary of Elevance Health)Provider Network Manager Sr. at Carelon Behavior Health (Subsidiary of Elevance Health)