Laura Lehman MSN, RN, CDCES, CCM

-Geriatric Clinic Care Coordinator 4/2021 - 2/2023

-Certified Diabetic Educator (CDCES) 11/2017 - 4/2021

- Remote RN Telehealth Coordinator 9/2014 - 11/2017

- RN Care Manager, Primary Care St Louis, MO 6/2013 9/2014

-Remote Community Care Coordinator 2/2023 - 1/2024

• Developed individualized discharge plans for patients based on their medical and psychosocial needs.
• Conducted assessments to assess patient's level of functioning and identify appropriate resources upon discharge.
• Collaborated with other healthcare professionals to ensure successful transition from hospital to home setting.
• Assisted in the coordination of services needed after hospitalization such as home health care, durable medical equipment, transportation.
• Maintained timely communication with physicians regarding patient's progress during the course of treatment prior to discharge.
• Monitored and documented patient's condition following discharge and reported changes in status to attending physician.
• Participated in multidisciplinary team meetings when determining appropriate levels of care prior to discharge.
• Coordinated community resources such as housing, food banks, financial assistance programs. for discharged patients who need additional support after leaving the hospital.

-Care Manager—Utilization Review 4/2010 - 6/2013

-Lead RN Disease Management 9/2007 - 4/2010

• Assessed patient's health needs and identified potential risk areas through review of records and interviews with providers.
• Collaborated with physicians, nurses, case managers, discharge planners, social workers and other healthcare professionals to develop a comprehensive plan of care within specified guidelines.
• Participated in interdisciplinary team meetings to discuss complex cases or those requiring an alternative treatment plan or continued stay evaluation.
• Identified opportunities for cost savings by recommending alternative treatments or modalities when appropriate.
• Maintained accurate documentation related to all activities performed in compliance with departmental policies.