Latisha Mays
Winchester,KY
Summary
Certified Case Manager with over 16 years of experience in Nursing. Excellent reputation for resolving problems, improving patient outcomes, and driving overall operational improvements while ensuring the best patient experience possible. Fosters communication and collaboration among team members.
Overview
17
17
years of professional experience
1
1
Certification
Work History
Ambulatory Case Manager
Baptist Health Medical Group
02.2022 - Current
- Achieved positive client outcomes by developing and implementing comprehensive case management plans.
- Enhanced communication between clients and providers through consistent follow-ups and progress updates.
- Coordinated essential services for clients, resulting in improved overall well-being and selfsufficiency.
- Collaborated with multidisciplinary teams to address client needs and formulate tailored support strategies.
Inpatient Case Manager
Baptist Health Lexington
07.2019 - 02.2022
- Educated patients and loved ones about different treatment options and outside care approaches, reducing burden on hospital resources.
- Managed support services and fostered communication among social workers, physical and occupational therapists, hospital staff and patients.
- Took active role in patient and family planning process, detailing instructions and responding appropriately and effectively to questions and concerns.
- Consulted with clinicians to devise and manage effective ongoing care plans for at-risk patients.
- Updated patient charts using Epic with data such as initial discharge evaluation and discharge plan to keep records current and support treatment progress.
- Identified care needs of individual patients and coordinated responses based on physician advice, insurance limitations and procedural costs.
- Conducted regular re-evaluations to address changes in needs and conditions, introducing revisions to care plans as needed.
Community Care Case Manager
St. Claire Regional Medical Center
08.2016 - 05.2019
- Currently serving as the 1st Community Care Case Manager for St. Claire Regional Medical Center in their partnership with the Goodhelp Accountable Care Organization.
- Help manage chronic diseases such as diabetes, CHF, COPD , and diabetes in populations considered high risk for adverse events.
- Collaborate with home health agencies, primary care providers, and community outreach agencies to ensure patients have necessary education, resources , and support to manage chronic diseases at home
- Assist in developing guidelines and workflow to manage a large population.
- Perform post acute care, ER follow up, and post procedural telephone calls.
- Medication review, create transition of care plans.
Denials Coordinator
St. Claire Regional Medical Center
03.2013 - 08.2016
- Reviewed insurance company payment denials for patient medical services, determined the basis for payment denial through a comprehensive review of patient's medical record for both concurrent and retrospective care. Determined the appropriateness for appeal.
- Served as the liaison for the Patient Finance Office and multiple internal hospital departments as well as private companies which assist the hospital with the appeal process.
- Provided staff with education, support, and feedback for changing Medicare rules and denial processes
- Recognize trends and prepare reports for the VP of Quality
Utilization Review Case Manager
St. Claire Regional Medical Center
10.2011 - 03.2013
- Performed medical necessity review for acute care stays using InterQual criteria.
- Collaborated with care team to ensure correct bed status
- Assisted with setup of post discharge services such as home health and home infusions
- Kept up-to-date with ongoing regulatory changes that impact patient care
Medical Surgical Staff Nurse
St. Claire Regional Medical Center
06.2007 - 10.2011
- Communicated with healthcare team members to plan, implement and enhance treatment strategies.
- Implemented care plans for patient treatment after assessing physician medical regimens.
- Educated patients, families and caregivers on diagnosis and prognosis, treatment options, disease process and management and lifestyle options.
- Participated in education activities, including evidence-based practice project implementation, nursing competency development and nursing simulation activities.
- Observed and reported patient condition, progress and medication side effects to accurately document updates.
- Administered different therapies and medications in line with physician orders and treatment plan.
Education
Bachelor of Science - Nursing
Chamberlain College of Nursing
St. Louis, MO2011
Associate of Applied Science - Nursing
Morehead State University
Morehead, KY2007
Skills
- Chronic disease management
- Interdisciplinary collaboration
- Certifications
- Process optimization
- Needs assessment
- Treatment planning
- Patient assessments
- Micorsoft Excel, Word, and PPT
- Experienced with platforms such as Tableau, Zirmed, and Availity
- Population Health
Accomplishments
- Helped devise criteria for Mobile Medicine referrals
- Selected to participate in the 2016 Centers for Medicare and Medicaid Services Provider Outreach and Education Advisory Group
- Member of the Kentucky Goodhelp ACO Quality Committee
- Discovered and reconciled 43 accounts totaling $360,587 for which payments were incorrectly recouped by the insurer
- Through the initial start up of the Goodhelp ACO at St. Claire, recognized areas for improvement which included (but not limited to) medication reconciliation, discharge teaching packets, and LACE tool scoring. This awareness and information brought to stakeholders attention led to process changes, improvement and better patient outcomes.
- Helped design current documentation template for St. Claire's GHACO
Certification
Accredited Case Manager via American Case Management Association
BLS Certified
Advanced Care Planning
References
Elizabeth Napier, RN Utilization Review - St. Claire Regional Medical Center 606-776-9216
Jessica Callahan, RN Case Manager - St. Claire Regional Medical Center 606-776-0737
Stephanie Porter, APRN - Veterans Administration Medical Center 606-356-0688
Timeline
Ambulatory Case Manager
Baptist Health Medical Group
02.2022 - Current
Inpatient Case Manager
Baptist Health Lexington
07.2019 - 02.2022
Community Care Case Manager
St. Claire Regional Medical Center
08.2016 - 05.2019
Denials Coordinator
St. Claire Regional Medical Center
03.2013 - 08.2016
Utilization Review Case Manager
St. Claire Regional Medical Center
10.2011 - 03.2013
Medical Surgical Staff Nurse
St. Claire Regional Medical Center
06.2007 - 10.2011
Bachelor of Science - Nursing
Chamberlain College of Nursing
Associate of Applied Science - Nursing
Morehead State University