Julie Picou
Elizabethton,TN
Summary
Achieved reductions in hospitalizations and emergency room visits by implementing disease process education and targeted interventions in community health. Enhanced patient and provider communication, resulting in improved care coordination. Delivered high-quality assessments and leveraged clinical skills to optimize patient health outcomes. Authorized to work in the US for any employer.
Overview
17
17
years of professional experience
1
1
Certification
Work History
TOC/RN Case Manager
Cityblock Health-North Carolina
01.2022 - Current
- Facilitated real-time responses to member readmissions during the post-discharge period, aligning with organizational readmission rate goals and key performance indicators.
- Provided essential assistance to members facing increased challenges, focusing on the creation and assessment of member-centric, evidence-based interventions.
- Coordinated assistance for patients and families to address social factors impacting recovery and reduce risks of readmission and emergency department utilization.
- Ensured compliance with medical necessity CMS criteria to facilitate appropriate patient admissions and care transitions.
- Delivered comprehensive training to healthcare professionals on utilization review challenges to enhance decision-making regarding admissions and placements.
- Oversaw collection of patient clinical data to inform treatment plans. Developed educational resources for patients and families on disease management strategies. Facilitated arrangements for post-discharge support services to ensure continuity of care.
- Managed achievement tracking of clinical outcomes while coordinating with inpatient teams, specialty physicians, and community resources to address unexpected variances.
- Coordinated arrangements for post-discharge medical and community referrals to ensure comprehensive patient care.
- Performed comprehensive audits of clinical documentation to maintain compliance with CMS regulations and support quality assurance efforts.
- Led root cause analysis audits focused on readmissions and ER visits. Identified key trends and recommended strategic improvements to enhance patient outcomes.
RN Care Manager
UnitedHealth Group-Nashville, TN
09.2019 - 01.2022
- Ensured patient and family members received comprehensive information to actively engage in transition planning.
- Performed in-depth analysis of physical and psychosocial assessment data to inform patient care.
- Performed thorough evaluations of patient and family needs to facilitate effective transition and home care planning.
- Utilized financial and insurance resources to enhance patient care and support healthcare initiatives.
- Managed achievement tracking of clinical outcomes while coordinating with inpatient teams, specialty physicians, and community resources to address patient needs.
- Conducted comprehensive root cause analyses on 30-day readmissions to inform strategic improvements across programs and systems.
Primary Care Nurse
US Department of Veterans Affairs-Johnson City, TN
10.2016 - 09.2019
- Applied in-depth clinical knowledge to address age-related cognitive, physical, emotional, and developmental needs of adult and geriatric patients, ensuring tailored care strategies.
- Oversaw chronic disease management initiatives for patient panel in partnership with healthcare providers. Facilitated shared medical appointments and RNCM consultations to enhance patient care.
- Oversaw scheduling processes to align patient appointments with clinical requirements. Optimized resource allocation to enhance patient care delivery.
- Facilitated effective problem-solving and collaboration among patients, families, and teams through participation in interdisciplinary meetings aimed at achieving shared goals.
- Engaged with patients to evaluate needs and establish care objectives, utilizing motivational interviewing and teaching techniques to enhance health maintenance and wellness.
- Cultivated strong relationships with patients to support self-management initiatives by offering timely information on choices and resources. Championed patient-centered care that respects individual values, cultural diversity, and belief systems.
- Applied established protocols and guidelines to empower independent care provision.
- Administered patient care alerts in CPRS to enhance safety and efficiency in care delivery.
- Provided comprehensive guidance on patient and family rights and responsibilities to enhance informed decision-making.
- Engaged in systematic evaluation and revision of policies and procedures to support delivery of evidence-based, patient-driven care.
- Oversaw continuous professional development to align with current evidence-based practices. Championed expertise in chronic care and disease management strategies. Led initiatives in health promotion and disease prevention to enhance community well-being.
Field Care Manager
Humana - Work at Home-Slidell, LA
07.2014 - 08.2016
- Executed admissions and assessments to identify problems, ensuring appropriate service allocation.
- Provided comprehensive guidance and oversight to members on intricate medical requirements and diagnostic processes.
- Facilitated accurate and prompt documentation processes to ensure clarity in assessments and outcomes.
- Facilitated clear communication of care plan and financial implications to clients, families, and guardians.
- Facilitated interdepartmental communication to optimize service efficiency and effectiveness.
- Engaged in activities to enhance quality management and boost performance outcomes.
- Utilized a range of approaches to address and enhance member's physical, environmental, and psycho-social health status
- Conducted continuous evaluations and assessments to support patient progression towards health goals.
Home Health Nurse and Manager
St Tammany parish hospital-Covington, LA
01.2009 - 06.2014
- Evaluated patient and family conditions to establish tailored home care plans, ensuring optimal support.
- Conducted comprehensive evaluations of patient nursing needs to enhance treatment plans.
- Delivered prescribed medications and treatments to ensure patient care and recovery.
- Evaluated patient needs for discharge planning to facilitate comprehensive care plan development and ensured implementation before discharge.
- Orchestrated care coordination across diverse healthcare professionals to optimize treatment outcomes.
- Administered a range of therapeutic interventions, focusing on IV therapy and wound care to enhance patient recovery.
- Oversaw daily operations of nursing team and home health aides to enhance service delivery.
- Oversaw OASIS review processes and implemented ICD-9 and ICD-10 coding standards. Led training sessions for staff on OASIS assessments and coding methodologies.
- Conducted thorough chart audits to maintain adherence to CMS standards and regulations.
- Conducted thorough quality assessments and implemented improvement strategies to ensure compliance with company standards.
Education
Bachelor's degree - Nursing
Southeastern Louisiana University
Hammond, LA12.2010
Associate in Science (AS) - Nursing
Delgado Community College
New Orleans, LA12.2003
Skills
- Utilization management
- Quality Assurance
- Triage
- Telehealth
- Quality management
- EMR systems
- Case management
- Supervising experience
- ICD-9/10 Coding
- Managed care
Certification
- RN
- State: TN
- BLS Certification
- Multi state compact license
- Compact State Nurse License
- CPR Certification
Additional Information
Additional work history available upon request.
Timeline
TOC/RN Case Manager
Cityblock Health-North Carolina
01.2022 - Current
RN Care Manager
UnitedHealth Group-Nashville, TN
09.2019 - 01.2022
Primary Care Nurse
US Department of Veterans Affairs-Johnson City, TN
10.2016 - 09.2019
Field Care Manager
Humana - Work at Home-Slidell, LA
07.2014 - 08.2016
Home Health Nurse and Manager
St Tammany parish hospital-Covington, LA
01.2009 - 06.2014
Bachelor's degree - Nursing
Southeastern Louisiana University
Associate in Science (AS) - Nursing
Delgado Community College