Joann Walker

• Conducted thorough assessments of patients'' physical, psychosocial, and financial needs to inform appropriate interventions and resources.
• Coordinated individualized discharge plans to manage safe transition back into community and home environments.
• Coordinated patient discharge planning and follow-up care.
• Provided patient and family education on available resources and self-care strategies.
• Reduced hospital readmission rates through meticulous follow-up and ongoing support for patients transitioning to home or community settings.
• Managed complex cases involving multiple chronic conditions while balancing competing demands on time-sensitive projects such as discharge planning.

• Maintained accurate documentation on all cases, ensuring compliance with regulations and confidentiality requirements.
• Conducted thorough assessments of clients'' situations, identifying issues, goals, and necessary interventions.
• Documented treatments delivered, medications and IVs administered, discharge instructions, and follow-up care.
• Educated clients on available programs, benefits, and services, empowering them to make informed decisions about their care needs.
• Referred clients to appropriate team members, community agencies and organizations to meet treatment needs.
• Reduced hospital readmission rates through effective case management and patient education on self-care techniques.
• Current working knowledge of discharge planning, utilization management, case management, performance improvement and managed care reimbursement

• Reduced hospital readmissions through diligent monitoring of patients'' progress and timely interventions in-home settings.
• Promoted a safe living environment for patients by conducting thorough home safety evaluations and recommending necessary modifications or equipment upgrades.
• Prevented complications from chronic illnesses like diabetes or heart failure through targeted patient education initiatives tailored to individual needs.
• Monitored vital signs, developed and implemented care plans, and documented patient progress.
• Administered different therapies and medications in line with physician orders and treatment plan.
• Educated family members and caregivers on patient care instructions.
• Documented treatments delivered, medications and IVs administered, discharge instructions, and follow-up care.

Same duties as previous home health

• Managed complex caseloads efficiently by prioritizing tasks, delegating responsibilities to support staff, and maintaining detailed records.
• Determined and addresses individual home care needs by completing detailed assessments and reviewing documentation.
• Promoted a safe living environment for patients by conducting thorough home safety evaluations and recommending necessary modifications or equipment upgrades.
• Conducted comprehensive assessments to identify patient risks, establish baseline health status, and determine appropriate intervention strategies.
• Educated patients and families on disease processes, medications and treatments.
• Provided physical assessments, medication, and chronic disease management to home health patients.

• Responded sensitively and competently to service customers with diverse cultural backgrounds.
• Managed multiple priorities simultaneously while maintaining focus on providing exceptional patient-centered care within a fast-paced critical care environment.
• Documented treatments delivered, medications and IVs administered, discharge instructions, and follow-up care.
• Referred clients to appropriate team members, community agencies and organizations to meet treatment needs.
• Facilitated patient transitions between different levels of care, ensuring continuity of services and minimizing disruptions in treatment plans.