Kimmarie Mignano

Primary duties and responsibilities

• Conduct assessments: Perform initial and reassessment visits, which can be in-person at a patient's home or virtual (telehealth).
• Evaluate needs: Use the Uniform Assessment System (UAS) to evaluate a patient's medical, functional, and social needs, as well as their psychosocial and environmental safety status.
• Determine eligibility: Use clinical expertise to determine if a patient is eligible for home and community-based services based on the assessment findings.
• Collaborate on care plans: Work with healthcare teams to develop individualized, person-centered service plans that address the patient's needs.
• Document and report: Accurately and efficiently document all findings in the required software, such as electronic medical records (EMRs).
• Communicate: Serve as a liaison between the patient, their family/caregivers, and the care management team, and provide feedback to home care agencies.
• Follow regulations: Adhere to all relevant state and federal regulations, policies, and procedures.

• Reviewed prior authorization requests for medical services and procedures.
• Collaborated with healthcare providers to obtain required documentation.
• Evaluated insurance guidelines to determine eligibility for services.
• Maintained accurate records of authorization requests and outcomes.
• Communicated decisions to patients and providers promptly and clearly.
• Resolved discrepancies in authorizations by coordinating with internal teams.
• Updated system databases with relevant patient information and status changes.
• Followed all Medicare, Medicaid, HIPAA and private insurance regulations and requirements.
• Verified patient's insurance eligibility prior to appointment date for payment purposes.
• Applied knowledge of Medicare, Medicaid and third-party payer requirements utilizing on-line eligibility systems to verify patient coverage and policy limitations.
• Responded promptly to inquiries from providers, members, and other departments within the organization.
• Maintained accurate records on all prior authorizations requested, received, and denied.
• Notified ordering providers of denied authorizations.
• Maintained files for referral and insurance information, entering referrals into system.

• Conducted comprehensive assessments and created individualized care plans
• Coordinated care transitions and discharge planning, improving continuity of care.
• Educated patients and families on care plans and community resources to support recovery.
• Led crisis intervention efforts, providing emotional support to patients and families.
• Contributed to quality improvement projects to enhance patient care efficiency.

• Managed complex cases with a focus on optimizing patient care transitions and discharge processes.
• Identified safety concerns through risk assessments and implemented preventive measures.
• Collaborated with interdisciplinary teams to ensure seamless patient care coordination.
• Acted as patient advocate, facilitating communication between patients, families, and healthcare providers.

• Delivered emergency care to patients in Level 2 Trauma/Stroke Center
• Performed rapid assessments, triage, and critical interventions in high-pressure settings.
• Managed high-acuity patients, including trauma, cardiac, and stroke cases, ensuring prompt and effective care.
• Served as Charge Nurse during shifts, overseeing patient flow, coordinating care assignments, and providing guidance to nursing staff.
• Led emergency response efforts, including code blue and rapid response teams, ensuring organized and timely interventions.
• Provided mentorship and training to new ER staff, enhancing team performance and adherence to protocols.
• Maintained accurate documentation in EMR systems, ensuring compliance with healthcare regulations and quality standards.
• Level 2 Trauma/Stroke Center

• Provided comprehensive care for geriatric patients, focusing on chronic and acute conditions
• Developed personalized care plans, addressing both physical and cognitive health needs.
• Supervised nursing staff, ensuring adherence to care standards and safety protocols.
• Facilitated patient education on medication management, disease prevention, and safety.