Kerri Sechman
Northumberland,PA
Summary
Knowledgeable NCM II with robust background in coordinating patient care and facilitating communication between healthcare providers. Proven track record in managing complex cases and ensuring optimal patient outcomes. Demonstrated ability in providing patient education and coordinating multidisciplinary teams. Adept at leveraging technology to enhance healthcare delivery and improve patient outcomes.
Overview
14
14
years of professional experience
Work History
Nurse Case Mgr II
Anthem
01.2021 - Current
- Collaborates with healthcare providers/consumer driving personalized health management & improve health outcomes for optimal consumers
- Performs care management activities within the scope of licensure for members with complex & chronic care needs
- Primary duties may include, but are not limited to: Ensures medically appropriate, high-quality, cost-effective care through assessing the medical necessity of inpatient admissions, outpatient services, out of network services, & appropriateness of treatment setting & level of care
- Partners with physician clinical reviewers/medical directors to interpret appropriateness of care, intervention planning, and general clinical guidance
- Collaborates with providers to assess consumer needs for early identification of & proactive planning for discharge
- Conducts clinical assessment to develop goals that address individual needs in order to develop a care plan, implements & coordinates a care plan
- Monitors & evaluates effectiveness of the care management plan & modifies as necessary
- Assists with development of utilization/care management policies & procedures
- Participates in or leads intradepartmental teams, projects, & initiatives
- Combination of Nurse Case Manager II for Carelon, acute care clinical experience in hospital setting with clinical experience as ER Nurse Care Mgr, Direct patient care in Critical Care, Intermediate Care & Med/Surg care
- Current, unrestricted RN licensure in all 50 U.S. States.
- Knowledge of medical management process and ability to interpret & apply member contracts, member benefits & managed care products
- Educated patients and caregivers on healthcare protocols and processes.
- Served as a liaison between patients and various support services such as financial assistance programs, community resources, and mental health counseling to ensure holistic care was provided.
- Applied critical thinking skills during case reviews to identify potential risks or challenges before they escalated into larger issues.
Registered Nurse, COVID HOTLINE/CALL CENTER
EVANGELICAL COMMUNITY HOSPITAL
01.2021 - 05.2021
- Managed 75 calls per day Inbound/Outgoing calls via cloud phone for concierge COVID related issues
- Provided patients with COVID test results via phone, documenting results in patients Outpatient EMR
- Educated patients on isolation & home disinfection if a positive test was confirmed
- Provided telephone support for patients traveling from state to state
- Utilized critical thinking skills to prioritize nursing interventions based on patients' acuity levels and individual needs.
- Conducted thorough patient assessments to identify changes in condition, promptly notifying physicians and initiating appropriate interventions when necessary.
Clinical Systems Specialist
EVANGELICAL COMMUNITY HOSPITAL
01.2018 - 01.2021
- Supporting hospital staff with Allscripts functionality & training
- Conducting hospital wide upgrade & transition to new electronic health record (EPIC)
- Leading inpatient workgroups to collect information such as reports, forms & 3rd party applications & Discern system disparities
- Align documentation requirements/systems builds per recommended by EOT as well as any necessary information research needed for successful transition to new EHR
- Served as liaison between IT department and clinical staff, translating technical terminology into accessible language to facilitate understanding and collaboration.
- Coordinated with vendors on system enhancements or customizations tailored to meet specific organizational needs while maintaining budgetary constraints.
Emergency Room Case Manager II
Evangelical Community Hospital
01.2011 - 01.2018
- Lead Emergency Department Case Manager-Hospital to Home Program, increasing prevention of hospital readmissions
- UR management for new admissions using InterQual/Mckesson & MCG/Milliman's Acute Adult Criteria, Acute Pediatric Criteria to supporting clinical decisions with informed care that leading patients to the best possible outcomes
- Collaborates with healthcare providers ensuring patients get the right level of care, appropriate care activities for the right amount of time; such as Executive Health Resources
- Prevention of underused/overuse of medical resources using evidence-based care guidelines
- Successful completion in a timely manner for placements in SNF, ARH, drug/alcohol rehab placements, 201/302 or dual diagnosis inpatient psychiatric placements and arrange HHS, DME, PT OT as Outpatients obtaining all insurance authorizations for both inpatient/outpatient placement, services and transportations before same day shift ending
- Work closely with the Community Health Resources such as but not limited to Area on Aging, Rabbit Transit, Home health care to assist consumers with appropriate level of care to remain in the home successfully
- Assisted patients with medication education & trouble shooting cost increasing medication compliance
- Provide Crisis Intervention for/with: Children & Youth (CY47), Adult Protective Services, Susquehanna Women in Transition and successful shelter placements for the homeless
- Maintained accurate documentation on all cases, ensuring compliance with regulations and confidentiality requirements.
- Conducted thorough assessments of clients'' situations, identifying issues, goals, and necessary interventions.
Nursing Supervisor
Nottingham Village Retirement Center & Rehab
01.2012 - 01.2013
- Overseen the SNF staff 2 LPN's, 3 CNA's while they provided quality patient care for the best possible and desired outcome
- Managing nursing staff for adherence to policies & procedures for effective patient care
- Direct interactions with patients & their families in clinical settings
- Dedicated patient advocate
- Work alongside staff nurses in treating patients
- Direct communication with physicians, nursing staff, & patient's families during emergencies
- Assess, plan, implement & evaluate new admissions, complete the proper documentation on events as necessary
- Ensure appropriate staffing for the acuity of the residents
- Promoted interdisciplinary collaboration by fostering strong relationships with physicians, therapists, and other healthcare professionals.
Education
Associate of Applied Science - Nursing
Pennsylvania College of Technology
Williamsport, PADiploma - Nursing
Danville Area Practical Nursing Program
Washingtonville, PAHigh School Diploma -
Shikellamy High School
Sunbury, PASkills
- Care Coordination
- Effective Case Stabilization Strategies
- Comprehensive Patient Evaluations
- Patient/Family Education
- Inpatient advocacy
- Effective Transition Planning
- Microsoft Outlook Proficiency
- Effective Time Allocation
- Pharma General Rounds
- Mercer Audit Participation
Accomplishments
- Collaborated with team of six NCM's in the development of Quality of Member Interaction Initiative. Improvement of Quality of Member Interaction Initiative by obtaining Pharma team feedback and presenting to the Quality of Member Interaction Initiative workgroup through collecting and presenting Pharma team feedback for quality improvement in regards to Trigger suggested scripting, CM introduction Scripting, PST updates, workflow updates.
- Requested by TL/Mgr as Unofficial support for Pharma Nurse Case Managers team when evening Team Lead absent, approximately 8 co workers.
- Maintaining 30 CEU
- RN licenses in all 50 U.S. states
- Completed CURES training-White belt
Personal Information
Title: AD RN, NCM II
Timeline
Nurse Case Mgr II
Anthem
01.2021 - Current
Registered Nurse, COVID HOTLINE/CALL CENTER
EVANGELICAL COMMUNITY HOSPITAL
01.2021 - 05.2021
Clinical Systems Specialist
EVANGELICAL COMMUNITY HOSPITAL
01.2018 - 01.2021
Nursing Supervisor
Nottingham Village Retirement Center & Rehab
01.2012 - 01.2013
Emergency Room Case Manager II
Evangelical Community Hospital
01.2011 - 01.2018
Associate of Applied Science - Nursing
Pennsylvania College of Technology
Diploma - Nursing
Danville Area Practical Nursing Program
High School Diploma -
Shikellamy High School
Similar Profiles
Anthony PaskettAnthony Paskett
Provider Service Team Leader at AnthemProvider Service Team Leader at Anthem
Deborah BrownDeborah Brown
Security Crowd Control at AnthemSecurity Crowd Control at Anthem
Jennifer LahJennifer Lah
Provider Relationship Account Manager-Medicaid, Commercial, Medicare at AnthemProvider Relationship Account Manager-Medicaid, Commercial, Medicare at Anthem
MARIANNE MMARIANNE M
Pharmacy Associate at AnthemPharmacy Associate at Anthem
Wendy YarskyWendy Yarsky
CDI Specialist at Geisinger Medical CenterCDI Specialist at Geisinger Medical Center