Kelly Pelletz
Charlton,MA
Summary
Experienced and dedicated professional with over 20 years of expertise in care coordination, disease management, discharge planning, and resource utilization. Demonstrated ability to navigate complex healthcare systems and ensure optimal patient outcomes. Skilled in efficiently coordinating care plans, collaborating with interdisciplinary teams, and advocating for patients\' needs. Passionate about making a positive impact on the lives of those served and eager to contribute skills and knowledge to a dynamic healthcare organization. Possesses versatile skills in project management, problem-solving, and collaboration. Brings fresh perspective and strong commitment to quality and success. Recognized for adaptability and proactive approach in delivering effective solutions.
Overview
34
34
years of professional experience
Work History
Hospital Case Manager
Metrowest Medical Center
10.2024 - Current
- Ensure an efficient discharge plan that will provide continuity and effective post-acute transition for patients
- Resolved social determinants of health barriers to facilitate patient discharge.
- Collaborates with nursing, physicians, and healthcare professionals regarding plan of care variances in care plan modification and outcomes or expected outcomes
- Maintained effective communication with referral liaisons to optimize use of patient resources.
- Works in partnership with community case managers and other health care advisors to ensure a seamless and safe continuum of care plan
- Assist with any appeals process and or need for guardianship or conservatorships
Supervisor, Clinical Care Programs
Commonwealth Care Alliance
11.2022 - 10.2024
- Strategic collaborator driving innovation during a period of significant growth for an expanding team
- Provides strategic direction for a cross-functional unit.
- Facilitates daily huddle and weekly team meetings, and RCA case reviews
- Effectively provided vital feedback by delivering presentations to key stakeholders
- Ensures staff adheres to both state and federal regulations through proper guidance.
- Daily phone and chart audits ensuring quality standards
- Executed accountability strategies to enhance team performance metrics.
- Optimizes PowerPoint, Tableau, Looker, and Excel to deliver KPI goals and opportunities for improvement
Community Registered Nurse
Commonwealth Care Alliance
06.2021 - 11.2022
- Provides clinical care and education to members in-person, virtual, and telephonic visits with a high focus on hospital post-discharge assessments to ensure member needs are met upon discharge
- Active and prior involvement in Process Improvement work groups including change of Model of Care
- Mentoring new hires
- Participated in a dedicated team focused on enhancing the merger process between CCA Primary Care and Clinical Groups.
RN Care Partner
Commonwealth Care Alliance
11.2018 - 06.2021
- Effectively managed a member panel of 200+ members with complex medical, behavioral health, and SDOH needs
- Performed quarterly, annual, and post-discharge telephonic assessments and referred for further follow up as needed
- Performed medication reconciliation with use of multiple EMRs (Remedia, Epic, ECW, Guiding Care)
- Implemented a member-centered Care Plan and reviewed it with members on a quarterly basis to ensure patient goals and interventions were appropriate and agreed upon by the member
- Assisting with HEDIS Measures Gap Closures by discussing with member and researching EMR
RN Case Manager
Encompass Home Health
11.2016 - 11.2018
- Facilitated patient education on effective wound management.
- Managed a continuous caseload of approximately 30 patients
- Provided extensive education to patients and families on disease management with the goal to reduce rehospitalizations
- Ensured insurance approval for visits and managed own scheduling of patients
- Served as a preceptor for new employees
- Provided cross-functional coverage in office when needed
Clinical Manager
Baystate Home Health
05.2016 - 11.2016
- Management of an Interdisciplinary team of 14 which covered the East region of BMC overseeing a census of 200-250 clients
- Lead interdisciplinary team meetings reviewing utilization and care plans while promoting reduction of hospitalization admissions
- Participated in Process improvement activities to promote optimum patient outcomes
- Utilized Management Systems such as Excel, PowerPoint and Cerner to optimize quality outcomes and provide education
- Reviewed OASIS and quality measures to ensure appropriate training and PIPs were created if needed
- Provided feedback to team and individuals to promote a highly efficient and outcome driven team
- Involved in assisting DPH audits and CMS level 2 reviews
- Served as a healthcare manager for East branch office in the provision of quality, safety, and cost-effective health services
RN Case Manager
Overlook Visiting Nurse Association
06.2013 - 05.2016
- Managed a caseload of 30-45 adult patients provided skilled comprehensive nursing care including wound care therapies including wound vac management
- Preceptor for UMass Amherst and MCPHS Nursing students as well as other new nursing staff
- Developed specific, individualized care plans with patients and family members
- Provided wound care, IV Therapy, medication administration, provided Disease Management education to family and patients
- Cross-trained to provide office coverage for clinical manager
RN Staff Educator - Clinical Manager
Auburn VNA Health Network
06.2012 - 03.2013
- Facilitated orientation for new clinical staff on Standards of Practice, EMR system, and how to create and manage Care Plans
- Provided new nursing hires appropriate education and verified competency including wound care management
- Provided day-to-day support of scheduling and intake as well as review of documentation to provide feedback to staff
- Performed supervisory visits and collaborated with the Director of Nursing to complete performance reviews
- Utilized management systems such as Excel, PowerPoint to optimize data organization, streamline communication and enhance overall operational efficiency
- Assisted with Medicare and DPH audits
- Collaborated and created Process Improvement strategies to ensure efficiency and management of overdue documentation flagging
- Keeping accurate records of certifications/licensures as well as ensuring annual competencies were met
Telehealth Program Manager ǀ Clinical Manager
Holyoke VNA and Hospice Life Care
06.2007 - 07.2012
- Spearheaded Telehealth Chronic Disease Management Program- started with 11 monitors growing program to 112 monitors
- Effectively reducing HVNA Re hospitalization rate from initial 33% down to 11%
- Proficiently presented to key stakeholders using PowerPoint, Excel
- Initiated new Policy and Procedures for Heart Transplant and LVAD patients post discharge in conjunction with Beth Israel Hospital and New England Baptist Hospital
- Cross trained for Clinical Liaison discharge planning/ Intake
- Daily collaboration with PCPs, Cardiology office, hospital liaison intake and referral dept to provide information on new Chronic Disease Management Program
- Maintained detailed databases and performed new product research and made sure that all patient information was kept confidential
- STAAR Committee member – Four State Initiative to reduce hospital readmissions 2010-2012
- Tracked patient data utilizing EMR and Excel to maintain organization of data, and track quality outcomes
Clinical Instructor – Senior Instructor
American International College
09.2008 - 04.2012
- Mentoring and teaching senior nursing students in an acute med-surg 12-week leadership rotation
- Facilitated post-clinical case conferences and assisted nursing students with presenting patient summaries
- Obtained feedback from floor staff and management regarding students’ nursing practice
- Provided students on-going individual and group assistance with creating and adjusting Nursing Care Plans and Nursing Diagnosis using Millman Theory
- Provided crucial feedback to professors as well as students to ensure Standards of Care and best practices were used during patient care, documentation, collaboration as well as delegation duties were followed
RN Case Manager
Baystate Home Health
03.2002 - 10.2007
- Case Manager focused on education of chronic disease as well as complex wound care management in home settings
- Prioritized elevating standards and optimizing workflows consistently.
- Recognized as CHF Nurse and accepted wound care referrals to offer recommendations .
- Oasis-C Train the Trainer program completed
- Completion of PENTA Health Chronic Care Management 2010
- Educating members and families on use of Telehealth while installation of Philips Home Med Telehealth System
Neuro Med/Surg Registered Nurse
Baystate Medical Center
07.1999 - 08.2002
- Provided nursing care to medical and surgical patients on an acute care step down unit
- Performs nursing tasks included but not limited to patient focused care, timely and precise clinical assessments, appropriate and timely documentation, medication administration, IV therapy, supported discharge planning and patient/family teaching
- Delegated non nursing tasks to CNAs or Patient Techs and reviewed documentation as deemed appropriate
Medical Coder /Medical Biller
Medical West
06.1991 - 09.1997
- Review outpatient documentation completed by Health Assessment Providers for accuracy of medical records and compliance according to ICD-9 CM and ICD10-CM guidelines
- Delivered professional activities related to quality review and education to providers
- Assisted with third party audits
- Developed a training program to address inadequate trends or errors
Education
Healthcare Lean Six Sigma Yellow Belt - undefined
SSGI
05.2025
Project Management Course - undefined
UMass Isenberg School of Management
01.2022
Certified Case Manager -
Commission for Case Manager Certification
05.2020
Bachelor of Science - Nursing
Elms College
Chicopee, MA01.2006
Diploma Nursing - Nursing
Baystate Medical Center School of Nursing
Springfield, MA01.1999
Skills
Wound care
Clinical assessment
Case management
Complex chronic care
Team lead
Patient care
Case management
Utilization management
Transitions of care
Quality and process improvement
Documentation auditing
Community Service
- 2008-2022, Community Health Initiative – Haiti Medical Mission Volunteer traveling to Haiti twice to assist with ongoing health management of the underserved in several communities., http://www.chihaiti.org
- 2014, Honored by Boston Red Sox at Fenway Park for National Nurses Day - chosen by peers at Overlook VNA
- 2023, Commonwealth Care Alliance Spotlight Award Recipient
Personal Information
Title: RN BS CCM
Summary
Detail-oriented individual with exceptional communication and project management skills. Proven ability to handle multiple tasks effectively and efficiently in fast-paced environments. Recognized for taking proactive approach to identifying and addressing issues, with focus on optimizing processes and supporting team objectives.
Timeline
Hospital Case Manager
Metrowest Medical Center
10.2024 - Current
Supervisor, Clinical Care Programs
Commonwealth Care Alliance
11.2022 - 10.2024
Community Registered Nurse
Commonwealth Care Alliance
06.2021 - 11.2022
RN Care Partner
Commonwealth Care Alliance
11.2018 - 06.2021
RN Case Manager
Encompass Home Health
11.2016 - 11.2018
Clinical Manager
Baystate Home Health
05.2016 - 11.2016
RN Case Manager
Overlook Visiting Nurse Association
06.2013 - 05.2016
RN Staff Educator - Clinical Manager
Auburn VNA Health Network
06.2012 - 03.2013
Clinical Instructor – Senior Instructor
American International College
09.2008 - 04.2012
Telehealth Program Manager ǀ Clinical Manager
Holyoke VNA and Hospice Life Care
06.2007 - 07.2012
RN Case Manager
Baystate Home Health
03.2002 - 10.2007
Neuro Med/Surg Registered Nurse
Baystate Medical Center
07.1999 - 08.2002
Medical Coder /Medical Biller
Medical West
06.1991 - 09.1997
Healthcare Lean Six Sigma Yellow Belt - undefined
SSGI
Project Management Course - undefined
UMass Isenberg School of Management
Diploma Nursing - Nursing
Baystate Medical Center School of Nursing
Certified Case Manager -
Commission for Case Manager Certification
Bachelor of Science - Nursing
Elms College
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