Karen Burke
Las Vegas,NV
Summary
Nurse with extensive experience in case management , skilled in coordinating care for diverse populations across community and clinical environments. Demonstrated success in managing complex cases and facilitating patient recovery through evidence-based practices and teamwork. Strong ability to enhance patient outcomes through effective communication and collaboration with multidisciplinary teams.
Overview
15
15
years of professional experience
Work History
Behavioral Health Case Manager
Elevance Health
Las Vegas
05.2022 - 07.2025
- Conducted comprehensive psychosocial assessments to evaluate clients' behavioral health status and needs.
- Coordinated with healthcare providers, social service agencies, and family members to develop and implement comprehensive care plans.
- Monitored client adherence to treatment plans and medication regimens, providing education and support as needed.
- Advocated for clients to access mental health services, housing, employment, and social support systems.
- Developed individualized behavioral health interventions based on client needs and clinical assessments, resulting in improved treatment outcomes.
Contract Lead RN
Medasource
Las Vegas
08.2021 - 01.2022
- Managed COVID-19 vaccination logistics across diverse community sites, such as public schools and colleges.
Multiple Contracts in Case Management
CHN Network
Holliston, Massachusetts
07.2019 - 03.2020
- Facilitated comprehensive behavioral health case management services across multiple contracts, maintaining consistent quality and compliance.
Medical Records Review Nurse
VNA of Eastern Massachusetts
Somerville, Massachusetts
07.2017 - 07.2019
- Reviewed Medicare Outcome and Assessment Information Set (OASIS) for accuracy prior to payment submission.
- Prepared and successfully submitted appeals for care denials, ensuring compliance with regulations.
- Conducted comprehensive medical record reviews for accuracy and adherence to established standards.
- Educated clinicians on clinical documentation and OASIS requirements to enhance quality.
Home Health RN Case Manager
VNA of Eastern Massachusetts
Somerville, Massachusetts
07.2017 - 07.2019
- Delivered high-quality care in home settings, focusing on patient compassion and integrity.
- Obtained comprehensive medical histories and medication regimes for accurate patient profiling.
- Utilized assessment skills to identify necessary nursing interventions.
- Developed and implemented tailored nursing care plans for patients.
- Educated patients and families on chronic care, pain management, diabetes, and wound care.
- Recorded precise information in electronic medical records to ensure data accuracy.
- Completed Medicare OASIS documentation for admissions, recertifications, resumption of care, and discharges.
Utilization review nurse/Appeals
SBSC Medical and Behavioral Health Business Services
Newton, Massachusetts
10.2014 - 01.2016
- Evaluated patient progress and updated insurance providers accordingly.
- Performed utilization reviews in compliance with state and federal regulations.
- Coordinated inpatient and outpatient care arrangements to optimize patient outcomes.
- Attended medical staff meetings to finalize discharge plans for patients.
- Responded promptly to calls and emails from insurance providers to facilitate communication.
- Traveled to Kentucky and New Jersey to deliver documentation training for clinicians at Recovery Works facilities.
RN Case Manager
Angels at Home Healthcare
Newburyport, Massachusetts
06.2012 - 09.2014
- Delivered high-quality, compassionate in-home care to patients daily.
- Obtained accurate medical histories and current medication regimens for effective treatment.
- Utilized strong assessment skills to determine appropriate nursing care requirements.
- Developed and implemented comprehensive nursing care plans tailored to patient needs.
- Educated patients and families on chronic care management, pain control, diabetes, and wound care.
- Recorded patient information accurately in electronic medical records for compliance.
- Completed Medicare OASIS documentation for admissions, recertifications, and discharges.
- Maintained positive relationships with community partners to enhance service delivery.
Registered Nurse on Sub-acute floor
Bostonian Nursing and Rehab Center
Dorchester, Massachusetts
02.2011 - 05.2012
- Administered comprehensive nursing care, adhering to plans and safety protocols on a sub-acute floor.
- Led patient assessments, developing individualized care plans with multidisciplinary teams.
- Managed and mentored CNA staff to enhance care delivery and maintain compliance.
- Coordinated discharge planning and education for seamless transitions from sub-acute care.
- Ensured patient safety by strictly following established protocols and guidelines.
- Collaborated with diverse healthcare professionals for optimal patient outcomes.
- Oversaw successful patient transfers to home or alternative healthcare settings.
Assistant Nurse Manager
Bay Cove Human Services
Boston, Massachusetts
06.2010 - 02.2012
- Oversaw coordination of nurse and MD clinics, assessing client readiness for detoxification.
- Managed medication monitoring and ordering to ensure proper clinic operations.
- Coordinated monthly blood work clinics to maintain comprehensive patient care.
- Developed and implemented medication management protocols to enhance administration efficiency.
- Facilitated interdisciplinary team collaboration among social workers, mental health clinicians, and physicians for improved case management.
- Supervised nursing staff while managing daily operations of the behavioral health clinic.
- Optimized resource allocation and clinic workflow through effective scheduling and staffing strategies.
Education
Master of Science - Health Informatics
University of Limerick
Limerick09.2019
Bachelor of Science - Nursing
University of Massachusetts
Boston, Massachusetts01.2013
Associates Degree - Nursing
Quincy College
Quincy, Massachusetts05.2010
M.D. - Public Health
The University of Nevada Reno
NevadaSkills
- ICD-10 coding expertise
- Client advocacy
- Compliance management
- Case management
- Behavioral health
- Electronic medical records proficiency
- Insurance claims management
- Care coordination
- Time management
- Strategy development
- Addictions and substance abuse
- Family support
- Co-occurring disorders
- Record keeping
- Relapse prevention
- Mental health treatment
- Care plan assessment
- Community resources
Timeline
Behavioral Health Case Manager
Elevance Health
05.2022 - 07.2025
Contract Lead RN
Medasource
08.2021 - 01.2022
Multiple Contracts in Case Management
CHN Network
07.2019 - 03.2020
Medical Records Review Nurse
VNA of Eastern Massachusetts
07.2017 - 07.2019
Home Health RN Case Manager
VNA of Eastern Massachusetts
07.2017 - 07.2019
Utilization review nurse/Appeals
SBSC Medical and Behavioral Health Business Services
10.2014 - 01.2016
RN Case Manager
Angels at Home Healthcare
06.2012 - 09.2014
Registered Nurse on Sub-acute floor
Bostonian Nursing and Rehab Center
02.2011 - 05.2012
Assistant Nurse Manager
Bay Cove Human Services
06.2010 - 02.2012
Master of Science - Health Informatics
University of Limerick
Bachelor of Science - Nursing
University of Massachusetts
Associates Degree - Nursing
Quincy College
M.D. - Public Health
The University of Nevada Reno