Kirsten Hess
CVS Health
York,PA
1
Certification
6
years of professional experience
Pennsylvania state licensed Registered Nurse (RN) Case Manager with experience coordinating complex patient care, evaluating clinical needs, and collaborating with multidisciplinary teams to support quality, cost-effective outcomes. Strong clinical judgment and expertise in reviewing medical records, interpreting patient conditions and treatment plans, and applying clinical criteria. Experienced in navigating workflows, documentation requirements, and processes while advocating for patients and maintaining compliance with organizational standards. Seeking to leverage clinical expertise, case management experience, and strong analytical and communication skills in an Appeals Nurse Consultant role.
Work History
Registered Nurse Case Manager
1 Year 7 Months- Coordinated care plans with interdisciplinary teams to ensure optimal patient outcomes.
- Management of high member caseloads (over 650 members consistently)
- Assessed patient needs and developed personalized treatment strategies for complex cases.
- Facilitated communication between patients, families, and healthcare providers to enhance understanding.
- Monitored patient progress, adjusting care plans based on clinical assessments and feedback.
- Implemented quality improvement initiatives that streamlined case management processes and enhanced service delivery.
- Evaluated patient progress and adjusted care plans accordingly, ensuring continuity of care across all healthcare settings.
- Collaborated with physicians and other healthcare providers to ensure appropriate resource utilization for complex cases.
- Evaluated healthcare needs, goals for treatment, and available resources of each patient and connected to optimal providers and care.
- Streamlined care coordination processes to reduce hospital readmissions and emergency department visits.
- Enhanced interdisciplinary team communication through regular case conferences, promoting effective collaboration for optimal patient care.
Senior Staff Registered Nurse
2 Years 9 Months- Communicates daily with patients, clinicians, authorities, and other interdisciplinary team members regarding case plan
- Coordinates interventional individualized care planning, including consults, imaging, treatments, and other patient-specific assessments and testing
- Refers patients to medical services including visiting nursing services, PT/OT, oxygen therapy, wound care services, and home infusions
- Collaborated with social workers, physicians, and ancillary staff to provide appropriate teaching, care planning, and resource navigation
- Skilled in the management of acute and chronic medical conditions in a pediatric setting
- Utilized clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services and benefits for patients
- Demonstrates keen attention to detail and accuracy in evaluating diverse sources of information for precision and quality assurance to form treatment plans and support optimal patients' outcomes
- Champions excellence in medical management by assessing medically complex pediatric patients including Medicaid recipients to triage acuity of re admissions, identify individual needs, developing a patient specific care plan to address objectives/goals identified during office assessment, interventions planning and implementing the care plan to meet identified needs for chronic care management
- Conducts telephonic follow up with all pediatric patients to ensure continuity of care across the continuum.
Registered Nurse
1 Year 11 MonthsEducation
Bachelor's Degree in Nursing
Associate's Degree in Nursing
Skills
Complex case management
Time management
Problem solving
Detail oriented
Adaptability
Patient advocacy
Discharge planning
Resource navigation/Care Coordination
Clinical Judgment & Decision-Making
Interdisciplinary collaboration
Written and Verbal communication
Clinical documentation review and charting
Microsoft office (Word
Excel
PowerPoint
Outlook
Teams)
Electronic Medical Record (EMR) (MedCompass
Epic)
Remote experience
Condition Monitoring
Certification
Licensed Registered Nurse - Pennsylvania (currently pursuing compact licensure)
Currently pursuing CCM certification
Timeline
Registered Nurse Case Manager
CVS Health
01.2025 - CurrentRead More
Senior Staff Registered Nurse
UPMC Children's Specialty Services
03.2022 - 12.2024Read More
Registered Nurse
Penn State Health Rehabilitation Hospital
03.2020 - 02.2022Read More
Pennsylvania College of Health Sciences
Associate's Degree in Nursing
Read More
Capella University
Bachelor's Degree in Nursing
Read More