Summary
Overview
Work History
Education
Skills
Timeline
Generic

Kimberly Bailey

Milford,PA

Summary

Reliable individual bringing 25 years of experience in healthcare environments. Maintains positive relationships with case managers and providers. Remains polished and calm under extreme stress.

Overview

18
18
years of professional experience

Work History

Utilization Management Nurse

Hamaspik Choice
08.2022 - Current
  • Expedited claim resolution by effectively communicating clinical rationale for treatment recommendations to insurance reviewers.
  • Enhanced patient care by conducting comprehensive assessments and implementing appropriate interventions.
  • Strengthened relationships with community resources by networking, attending meetings, and establishing collaborative partnerships.
  • Coordinated seamless transitions of care across multiple settings including acute care hospitals, rehabilitation facilities, and home care services.

Patient Access RN Manager

HOSPICE of ORANGE & SULLIVAN COUNTY
05.2021 - Current
  • Assess patient’s home care needs including physical, emotional, and spiritual
  • Improved patient care by teaching patients and family members how to handle different needs
  • Helped families make appropriate decisions regarding care and end-of-life planning
  • Determined hospice eligibility of referred patients by conducting initial nursing evaluations
  • Reviewed authorized coordinated and supervised vendors to meet the patient’s needs
  • Coordinated community resources and programs to aid patients and family
  • Enhanced patient satisfaction through effective communication, empathy, and timely response to their needs.
  • Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing conditions.


RN CARE MANAGER

BON SECOUR HOSPITAL/MEDICAL GROUP
05.2018 - 05.2021

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  • Enhanced patient satisfaction through effective communication, empathy, and timely response to their needs.
  • Collaborated with interdisciplinary teams for comprehensive patient care plans, resulting in better health outcomes.
  • Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing conditions.
  • Educated patients, families and caregivers on diagnosis and prognosis, treatment options, disease process, and management and lifestyle options.
  • Improved patient outcomes by providing high-quality nursing care and implementing evidence-based practices.

CARE MANAGER /MDS

HOMESTEAD REHABILITATION and REHABILITATION CENTER
06.2012 - 05.2018
  • Conduct quality and clinical study data collection reviews
  • This includes a chart review, complete detailed electronic data worksheets
  • Ensured optimal levels of care to facilitate a speedy recovery
  • Performed regular follow-up on the patient after discharge
  • Determined appropriate plan according to patient requirements
  • Aided design with help of educational materials
  • Implemented discharge plans for individual patients at the time of admission
  • Followed infection protocols and implemented up to date EBP policies
  • Reduced readmission rates by >60% on our subacute unit
  • Participate in collaborative training specific to clinical study objectives.

CARE MANAGER

BELLE REVE SENIOR LIVING CENTER
05.2009 - 11.2013
  • Coordinated smooth admissions, discharges and transfers by handling paperwork and delegating assignments
  • Same day accurately completed and submitted UAS assessment documentation
  • Maintained facility compliance with detailed documentation covering care plans, actions and incidents
  • Identified and addressed care deficiencies, proactively improving care for all patients at long term care facility
  • Maximized unit efficiency, keeping supplies and records well-organized for expected needs
  • Delivered evidence-based, cost-effective care to every patient based on extensive experience in elder care
  • Contributed to team efficiency, optimal patient flow and accuracy in treatments by maintaining accurate and detailed reports and records.

NURSE/lpn

Premier Health/Dr. Joseph Casella
04.2006 - 05.2009
  • Triage patients, obtain vitals, medication reconciliation, collaborated with community resources and insurance companies for individual patient needs
  • Obtained prior authorization and managed medical appeals
  • Chart review and audits
  • Inventory and stock
  • Precepting and mentor for office personnel.

Education

BSN -

CHAMBERLAIN COLLEGE of NURSING
06.2022

ASN -

EXCELSIOR COLLEGE
10.2019

Skills

  • Clinical assessment
  • Care Coordination
  • Quality Improvement
  • Healthcare regulations
  • Utilization review
  • Interdisciplinary Collaboration
  • Discharge planning coordination
  • Insurance Verification
  • Medicare knowledge
  • Medicaid knowledge
  • Palliative Care
  • Utilization Management
  • Teamwork and Collaboration
  • Attention to Detail
  • Critical Thinking
  • Effective Communication

Timeline

Utilization Management Nurse

Hamaspik Choice
08.2022 - Current

Patient Access RN Manager

HOSPICE of ORANGE & SULLIVAN COUNTY
05.2021 - Current

RN CARE MANAGER

BON SECOUR HOSPITAL/MEDICAL GROUP
05.2018 - 05.2021

CARE MANAGER /MDS

HOMESTEAD REHABILITATION and REHABILITATION CENTER
06.2012 - 05.2018

CARE MANAGER

BELLE REVE SENIOR LIVING CENTER
05.2009 - 11.2013

NURSE/lpn

Premier Health/Dr. Joseph Casella
04.2006 - 05.2009

BSN -

CHAMBERLAIN COLLEGE of NURSING

ASN -

EXCELSIOR COLLEGE
Kimberly Bailey