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
.
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
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