Joy Michelle Lowe

Work History

RN Case Manager

Pikeville Medical Center

06.2021 - Current

Performs care coordination duties to include primary care physician follow up appointments, home health, outpatient wound care clinic appointments, home IV antibiotics coordination.
Works with physicians, patients, and their families to assist in facilitating a safe discharge plan to home or other levels of care
Medical equipment ordering/coordination for home use such as wound vacs, hospital beds, mobility aides. as directed by the physician.
Facilitates long term care facility admissions, short term rehab, inpatient rehab referrals.
Collaborates with physicians and other healthcare providers to ensure appropriate resource utilization for complex cases.
Evaluates patient progress and adjusted care plans accordingly, ensuring continuity of care across all healthcare settings.
Streamlines care coordination processes to reduce hospital readmissions and emergency department visits.
Conduct's comprehensive assessments of patients'' physical, emotional, and social needs in order to develop individualized care plans that facilitated optimal health outcomes.
Mentors new nursing professionals during orientation periods, fostering a collaborative team dynamic that supported the delivery of high-quality care.
Facilitates drug rehab referral/admission

Registered Nurse, Interventional Radiology

Pikeville Medical Center

12.2020 - 06.2021

Worked in pre op, post op, and circulator nursing role in suite cases giving conscious sedation medications, patient monitoring, and assisting with procedures in Ultrasound and CT.
Assisted anesthesiologist with cryoneurolysis procedures
Comfortable working in fast-paced environment that requires flexibility, with ability to move from case to another in moments notice.
Maintained sterile environment during procedures by adhering to strict infection control guidelines and protocols.
Streamlined workflow within department by effectively managing multiple tasks simultaneously, prioritizing urgent cases as needed.
Ensured patient safety and comfort while positioning them appropriately for imaging studies and procedures.
Provided quality patient education about the purpose, benefits, and risks of specific interventional radiology treatments before performing them.
Assisted with training new nursing staff members on proper techniques and best practices within the interventional radiology setting.
Effectively addressed any concerns or questions posed by patients or their families, providing thorough explanations about the nature of their interventional radiology procedures and expected recovery timelines.
Contributed to positive patient experiences through compassionate care, empathy, and active listening during consultations and followups.
Improved patient outcomes by accurately assessing and monitoring their health status during interventional radiology procedures.
Documented treatments delivered, medications and IVs administered, discharge instructions, and follow-up care.
Educated family members and caregivers on patient care instructions.
Evaluated patient histories, complaints, and current symptoms.
Monitored patient reactions after administering medications and IV therapies.
Managed patients recovering from medical or surgical procedures.

RN Practice Transformation Specialist

Imperium Health Management

04.2017 - 12.2020

Employed by an Accountable Care Organization working as a consultant for assigned practices managing their population health/preventative care quality HEIDIS measures
Assisted assigned clinics in managing patients preventative care regarding HEDIS and quality measure closure
Educated physicians in risk coding
Quarterly, performs targeted quality assurance reviews of provider's documentation giving feedback regarding best practices
Performed quality audits to close HEDIS measures and quality gaps and train staff regarding workflows to close them during patient encounter.
Fostered strong relationships with providers, facilitating communication regarding patients'' preventative care needs and contributing to improved continuity of care.
Supported the development of provider education materials focused on HEDIS measures and best practices in patient care.
Maintained thorough documentation of audit findings, providing valuable insights for the continuous enhancement of quality initiatives.
Served as a subject matter expert on HEDIS measures within interdisciplinary teams working on quality improvement initiatives.
Trained new team members on HEDIS measures, clinical documentation requirements, and quality improvement strategies.
Participated in regular meetings with management to discuss progress toward goals, challenges encountered, and potential solutions for enhancing performance outcomes.
Improved the accuracy of HEDIS measures by meticulously reviewing medical records and identifying gaps in care.
Ran quality metrics reports to maintain high standards of virtual care.
Analyzed electronic health records to identify areas for care improvement and cost reduction.
Worked in this position until March 20, 2020 and was transferred to a chronic care management position as the result of COVID
Managed preventative care for Medicare and Commercial patient population as a chronic care management nurse for assigned practices
Provided staff training at assigned clinics in chronic care management and transitional care management as per CMS guidelines

Corporate Compliance Clinical Auditor

Pikeville Medical Center

05.2015 - 04.2017

Responsible for performing annual, periodic or other focused medical record audits to assess quality and accuracy of documentation
Conducted compliance related audits and monthly monitoring audits including EMTALA and narcotic prescribing for all PMC physicians to ensure PMC policy as well as CMS regulations were being followed
Completed management and employee interviews, PMC policy review as well all CMS, state and federal guidelines review in order to complete assigned audits
Provided detailed documentation on audit findings, facilitating swift corrective action when necessary.
Mentored junior auditors, sharing knowledge and best practices to foster their professional growth within the team.
Performed observations and evaluated supporting documents to supplement audit findings.
Managed multiple concurrent audit engagements, prioritizing tasks to meet deadlines without compromising quality.
Prepared written reports of the results of the audits along with proposed action plan
Meets with management and executives to review audit reports, discuss findings, and request corrective action plans.

Nurse Auditor

Williamson Memorial Hospital

09.2000 - 05.2015

Completed medical record review daily to ensure documentation supported procedures billed and for charge capture
Performed defense audits representing the hospital when payers would deny charges
Monitored alert reports for bills that would not drop due to coding and or billing errors and worked with billing department to correct errors
Assisted the Risk department in monitoring records for employee or physician documentation omission as well as timely H&P submission by providers
Reviewed coding practices for consistency and accuracy, promoting appropriate reimbursement levels for services provided.
Improved billing accuracy by conducting thorough medical record audits and identifying discrepancies in documentation.
Enhanced compliance with healthcare regulations by diligently reviewing clinical records and ensuring adherence to guidelines.
Assisted risk management in the appeals process when inpatient and observation hospital stays were denied
Audited surgical records for charge capture, correct time for surgery and anesthesia as well as all medications.

Summary

Overview

Work History

RN Case Manager

Registered Nurse, Interventional Radiology

RN Practice Transformation Specialist

Corporate Compliance Clinical Auditor

Nurse Auditor

Education

Master of Science -

Bachelor of Science - Nursing

Associate - nursing

Certified Professional Coder - Medical Coding

Certified Professional Medical Auditor - Medical Record Auditor

Skills

Timeline

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