KELLY OGBORN
Clifton Park,NY
Summary
Compassionate, dedicated, experienced, and motivated Registered Nurse with 18+ years experience in behavioral health and substance abuse in a variety of settings including hospital, office, and managed care environments. Well-organized and forward-thinking in managing member/patient needs. Works well with diverse member/patient populations and fosters trusting relationships to improve outcomes. Efficiently coordinates with other healthcare professionals to advance member/patient care outcomes.
Overview
19
19
years of professional experience
1
1
Certification
Work History
UM Behavioral Health Clinician
Aetna
01.2023 - Current
- Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program
- Applies critical thinking and is knowledgeable in clinically appropriate treatment, evidence based care an clinical practice guidelines for Behavioral Health and/or medical conditions based upon program focus
- Utilizes clinical experience and skills in a collaborative process to assess appropriateness of treatment plans across levels of care, apply evidence based standards and practice guideline to treatment where appropriate.Coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members
- Gathers clinical information and applies the appropriate clinical judgment to render coverage determination/recommendation along the continuum of care facilities including effective discharge planning
- Coordinates with providers and other parties to facilitate optimal care/treatment
- Identifies members at risk for poor outcomes and facilitates referral opportunities to integrate with other products, services and/or programs
- Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization
- Participated in interdisciplinary staff meetings to implement research-based changes and assess treatment plans
Quality Management Nurse Consultant
Aetna
08.2021 - 12.2022
- Review and evaluate clinical information and documentation
- Interpret data obtained from clinical systems or records and apply appropriate clinical criteria and policies in line with regulatory and accreditation requirements for member and/or provider issues
- Works on potential quality of care cases and patient safety events across all lines of business (Commercial, Medicare
- Medicaid)
- Coordinates clinical resolution with internal/external clinician support as required
- Gathers data via navigating through multiple system applications as well as contacting providers of record, vendors, or internal Aetna departments to obtain additional information as needed
- Condenses complex information into clear and precise clinical and reports audit or clinical findings to appropriate staff or others to ensure appropriate outcome/follow up for improvement as indicated
- Enters and maintains all required data elements in appropriate data base.
Clinical Team Lead, RN
Aetna
10.2019 - 08.2021
- Offer expertise around evidence-based treatment
- Outreach clients who have overdosed, are at risk for overdose, or are being prescribed medications putting them at risk for overdose
- Educate on medication assisted treatment and address misconceptions
- Schedule appointments and provide appointment reminders
- Encourage clients to visit PCP
- Educate on Narcan and other harm reduction strategies
- Identify additional clinical needs and coordinate with enterprise clinical programs
- Provide ongoing support to members
- Dispose of personal biases and remain open and empathetic when talking with and educating clients
- Participated in presentation educating behavioral health programs on how clients are supported
- Demonstrates effective communication, documentation, and speaking skills
- Navigates multiple systems for benefit, claims, and resource information.
UM Nurse Consultant
Aetna
10.2018 - 10.2019
- Obtain authorizations from multiple insurance carriers for various levels of care
- Perform admission reviews based for medical necessity based upon MCG specification
- Submit cases to medical director when case failed to meet specific criteria in effort to get them approved
- Review documentation for compliance with requirements and accuracy of information.
Addiction Medicine Program, Addictions Nurse
Saratoga Hospital Integrative
04.2017 - 08.2018
- Organizes and administers individualized professional patient care to serve needs of addiction clients
- Document patient information obtained from interviews
- Counsel and educate patients about health issues and wellness
- Liaison between patients and physicians to ensure patient comprehension of treatment plans
- Demonstrates ability to lead and motivate team.
Behavioral Health Care Advocate
United Health Group
01.2015 - 04.2017
- Precertification and retroactive review of all requests for behavioral health and substance abuse treatment
- Document all determinations, notifications, interventions, and telephone encounters in accordance with regulatory guidelines
- Help cross-train/train new and existing employees
- Immediately address issues with customers to successfully resolve
- Perform initial client assessment and analysis to begin authorization process
- Manage appeals and grievances report and document outcomes
- Review retrospective review requests, determine coverage, and manage outcome report.
Clinic Manager
VA Primary Care Clinic
06.2014 - 04.2015
- Direct clinic personnel, assign duties and provide support for joint goals
- Organize department in accordance with administrative guidelines in order to provide specified nursing services to meet legal, organizational and medical staff guidelines
- Interpret and communicate new or revised policies to staff
- Routine collaboration with department managers to correct problems and improve services
- Certify that equipment and supplies are properly maintained for quality patient care and safety
- Maintain good communication between department heads, medical staff and governing boards by synchronizing interdepartmental functions
- Leveraged patient feedback and performed continuous process improvements to streamline day-to-day business operations and patient satisfaction
- Conducted frequent clinic walk-throughs to maintain safe work environment
- Monitored duties assigned to personnel to promote high levels of patient care and job efficiency
Charge Nurse
St Margaret's Center
05.2013 - 05.2014
- Assess clients for specific, individual needs and arrange for appropriate services
- Collaborate with other health care personnel and resources to ensure best treatment
- Oversee nursing staff responsibilities training, and supervise responsibilities
- Maintain accurate and complete documentation of treatment and processes
- Build rapport with patients and family members in effort to deliver exceptional care
- Perform patient assessments and adjust care plans accordingly
- Train new nursing staff.
Supervisor of Medical and Nursing
Capital District Secure Juvenile Detention
04.2011 - 05.2013
- Services
- Manage daily operations for medical and nursing departments
- Monitor ongoing medical care and treatment for all inmates
- Maintain equipment and medical supplies to ensure availability and functioning
- Communicate clearly and effectively between medical providers, staff, and director
- Assess need for, order, obtain and interpret appropriate lab tests
- Document patient information obtained from interviews
- Carried out day-day-day duties accurately and efficiently
- Devoted special emphasis to punctuality and worked to maintain outstanding attendance record, consistently arriving to start immediately
Registered Nurse Crisis Unit/ER
Ellis Hospital
05.2007 - 05.2013
- Strong leader for nursing personnel assigned to unit/shift
- Maintain accurate records and documentation of patient histories, and test results
- Counsel and educate patients
- Assist doctors with non-invasive procedures
- Perform lab tests and communicate results
- Instruct patients and family members on proper discharge care.
Inpatient Substance Abuse Charge Nurse
Conifer Park Alcohol And Drug Rehabilitation Ctr
04.2005 - 01.2009
- Carry out nursing assessments for new clients to provide correct services
- Administer medication and educate patients for best treatment results
- Perform triage on medical and psychiatric conditions efficiently
- Monitor care for adolescents as well as adults on detox and rehabilitation units
- Performed duties in accordance with applicable standards, policies and regulatory guidelines to promote safe working environment
- Completed paperwork, recognizing discrepancies and promptly addressing for resolution
- Quickly learned new skills and applied them to daily tasks, improving efficiency and productivity.
Registered Nurse
Conifer Park Drug And Alcohol Rehabilitation Ctr
- Experiences:
- Charge nurse on inpatient adult and adolescent behavioral health unit
- Outpatient behavioral health nurse working with adults and adolescents
Assistant Nursing Supervisor
Schoharie County ARC
- In Residential Treatment Facility for adolescents
- Registered nurse with ARC working in community homes
- Resolved problems, improved operations and provided exceptional service
- Prepared variety of different written communications, reports and documents to ensure smooth operations
- Improved operations through consistent hard work and dedication
- Developed and maintained courteous and effective working relationships
- Used coordination and planning skills to achieve results according to schedule
Education
ASSOCIATE OF APPLIED SCIENCE - Nursing
SUNY Delhi
Skills
- Adept at prioritizing/managing deadlines
- High level of autonomy
- Problem resolution capability
- Team leadership
- Strong clinical judgment
Certification
Registered Nurse in New York, License number 509325-1, 1999.
Timeline
UM Behavioral Health Clinician
Aetna
01.2023 - Current
Quality Management Nurse Consultant
Aetna
08.2021 - 12.2022
Clinical Team Lead, RN
Aetna
10.2019 - 08.2021
UM Nurse Consultant
Aetna
10.2018 - 10.2019
Addiction Medicine Program, Addictions Nurse
Saratoga Hospital Integrative
04.2017 - 08.2018
Behavioral Health Care Advocate
United Health Group
01.2015 - 04.2017
Clinic Manager
VA Primary Care Clinic
06.2014 - 04.2015
Charge Nurse
St Margaret's Center
05.2013 - 05.2014
Supervisor of Medical and Nursing
Capital District Secure Juvenile Detention
04.2011 - 05.2013
Registered Nurse Crisis Unit/ER
Ellis Hospital
05.2007 - 05.2013
Inpatient Substance Abuse Charge Nurse
Conifer Park Alcohol And Drug Rehabilitation Ctr
04.2005 - 01.2009
Registered Nurse
Conifer Park Drug And Alcohol Rehabilitation Ctr
Assistant Nursing Supervisor
Schoharie County ARC
ASSOCIATE OF APPLIED SCIENCE - Nursing
SUNY Delhi