Kawanda Reid-Hamilton

• In this management position I am responsible for following the RAI process, assessing residents behavioral, psychological, clinical, nutritional, and physical strengths
• Developing care plans, follow OBRA schedule, admission UDA, readmission entry MDS’s
• I work closely with nursing, therapy, dietitian and the medical director
• Attend CMI meetings, triple check, IDT meetings, care management strategy meetings, daily clinical and managing the restorative therapy department

• I go into patients’ home and provide total care, providing clinical documentation, g-tube care, trach care, perform all ADL’s, communicate effectively with the patients, families and physicians.

• Manage and teach nurse assistants to become CNA in the state of MO
• Teaching the appropriate and approved way to perform all ADL’s to care for the elderly residents in LTC facilities.

• Coordination of decisions for all services requiring medical necessity reviews
• Communicate with medical directors, management, physicians, office staff and members to assist with providing the best care for members
• Conducted daily review of authorization request for outpatient services, inpatient request, DME, medication management, and home health services
• Additional duties include review the case management inbox, provider portal, review claim cases, assist with training new employees, and test/ trial of new systems, department policies, and programs
• Educate providers on utilization and medical management processes Provide clinical knowledge and act as a clinical resource to non-clinical team staff Enter and maintain pertinent clinical information in various medical management systems
• Worked in phone and fax queues.

• Provided Coordination of decisions for all services requiring a medical necessity review including: inpatient and outpatient hospital services, diagnostic imaging, out of network services, high cost medication and injectable drugs, and the holistic care for all my members on the insurance side
• Interact with the medical director for Molina Health Care and communicate with providers in a professional manner to ensure the delivery of high quality, cost effective healthcare
• Utilize clinical skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations
• Responsible and proficient in communication, leadership, keyboard skills, and the ability to navigate through multiple computer systems at once while operating on dual screens
• Worked in phone and fax queues.

• Responsible for the care of 40-50 patients through the direct supervision of 4-5 CNA's and 1 CMT, encompassing: administering medications, vital signs, IV therapy administration, oxygen therapy, tracheotomy /colostomy care, catheter insertion, caring for dialysis patients pre-post procedure, and g-tube care Operates as the wound care nurse, changing dressings an applying wound vacs, taking preventive measures, communicating with outside entities, complete weekly wound reports, continuously assess patients hydration status, food consumption, medications, lab results, and healing process.

Responsible for the direction of licensed and non-licensed personnel who provided health care and nursing services to
residents on a 24 hours 7 days per week basis.
Complementing the DON in planning, developing and supervising the activities of licensed and non-licensed staff, assist
with the development of implementation of nursing services, objectives, policies, and procedures in accordance with
Federal and State regulations.
Conducted walking rounds with physicians and the medical director, conduct interviews for potential staff, orientation, inservices, pharmacy reviews, quality assurance meetings and reports, dietary consultations, oversee the wound program,
complete weekly wound reports, close communication with the medical director and DON and administrator.