Kristen Douglas
Flat Rock,IN
Summary
Knowledgeable Case Manager with solid history of managing complex caseloads and providing comprehensive support to diverse client populations. Proven ability to assess client needs and develop tailored action plans that drive positive outcomes. Demonstrated strong communication and problem-solving skills in high-pressure environments.
Overview
13
13
years of professional experience
Work History
Case Manager/Utilization Review Nurse
Major Health Partners
01.2017 - 02.2024
- Coordinated care plans for diverse patient populations to enhance health outcomes.
- Assessed patient needs through comprehensive evaluations and developed tailored interventions.
- Facilitated communication among healthcare teams to ensure continuity of care and support services.
- Achieved positive client outcomes by developing and implementing comprehensive case management plans.
- Applied utilization review criteria (InterQual) to approve or deny care.
- Evaluate patient records to determine if services meet clinical and regulatory criteria for medical necessity.
- Accurately document review outcomes and justifications in internal systems.
- Provide clinical justification or clarification to support appeal processes.
Bedside RN
Major Health Partners
08.2014 - 01.2017
- Monitor and assess patients’ health status (vital signs, symptoms, pain levels).
- Administer medications and treatments as prescribed.
- Accurately chart patient information in electronic health records.
- Coordinate with physicians, therapists, and other healthcare staff.
- Provide culturally competent and respectful care.
Social Work Case Manager
Major Health Partners
08.2011 - 03.2013
- Developed individualized service plans to address client needs and facilitate access to resources.
- Coordinated multidisciplinary team meetings to ensure comprehensive case management and support.
- Advocated for clients within community services, enhancing resource utilization and engagement.
- Monitored client progress through regular assessments, adjusting interventions as necessary for optimal outcomes.
- Coordinated discharge plans for patients with complex medical/mental health needs.
Education
Bachelor of Science - Nursing
Marian University
Indianapolis, IN08-2014
Master of Social Work - Social Work
University of Kentucky
Lexington, KY08-2011
Bachelor of Social Work - Social Work
University of Indianapolis
Indianapolis, IN05-2010
Skills
- Problem-solving
- Case management
- Time management
- Case documentation
- Positive attitude
- Conflict resolution
- Email and telephone etiquette
Timeline
Case Manager/Utilization Review Nurse
Major Health Partners
01.2017 - 02.2024
Bedside RN
Major Health Partners
08.2014 - 01.2017
Social Work Case Manager
Major Health Partners
08.2011 - 03.2013
Bachelor of Science - Nursing
Marian University
Master of Social Work - Social Work
University of Kentucky
Bachelor of Social Work - Social Work
University of Indianapolis
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