LAUREN L WILSON
Interlachen
Summary
Experienced clinical documentation professional skilled in maintaining accurate medical records and supporting healthcare teams. Dedicated to enhancing patient care through precise documentation and effective collaboration. Recognized for adaptability and reliability, consistently ensuring compliance and quality in all tasks.
Overview
9
9
years of professional experience
Work History
Nurse Clinical Manager
Centerwell Home Health
12.2023 - Current
- Ensured employees were informed about policy and procedure changes affecting their roles.
- Coordinated interdisciplinary team meetings to discuss complex cases or review potential areas of concern within clinic environment.
- Directed multi-disciplinary team of home health care professionals serving over 20 clients.
- Collaborated with multidisciplinary teams to optimize patient outcomes through evidence-based practice.
- Developed patient-specific plans of care covering medication administration, assessed risks and personnel requirements.
- Provided ongoing support and mentorship for junior staff members as they navigated their roles within healthcare system.
- Ensured compliance with local, state, and federal regulations governing healthcare facilities.
- Managed patient complaints and concerns in timely and professional manner.
- Maintained accurate records and charted consistently in EHR system.
- Advised patients on at-home care and preventive lifestyle choices.
- Supported accreditation efforts by ensuring compliance with regulatory guidelines during clinical review activities.
- Collaborated with billing department to resolve discrepancies in claims processing, resulting in accurate reimbursement for services rendered.
- Demonstrated strong attention to detail by identifying discrepancies in medical records and collaborating with healthcare providers to rectify errors, ultimately enhancing the accuracy of patient information.
- Streamlined workflow processes by identifying gaps in clinical documentation and providing timely feedback to providers.
Registered Nurse
Centerwell Home Health
11.2022 - 12.2023
- Alleviated patient fears of treatments using kind, empathetic communication.
- Worked closely with physicians, surgeons and nursing staff as part of unit team.
- Dressed, cleaned and redressed wounds for optimum healing.
- Recorded changes in patient conditions and laboratory test results.
- Administered oral, IV and intramuscular medications as part of patient treatments.
- Implemented treatment plans for acute and chronic conditions.
- Educated patients and caregivers on proper at-home care and treatment regimens.
- Conducted accurate chart updates in computer system.
- Trained and mentored student nurses, interns and new graduates in proper procedures and care techniques.
- Educated patients on preventive care and lifestyle choices to improve overall health.
- Documented all patient care activities in electronic health records accurately and timely.
- Obtained physician's written prescription and approval for treatment changes.
- Taught patients how to use assistive devices like walkers or canes correctly.
- Provided wound care, including dressing changes and monitoring for infection.
- Maintained strict patient confidentiality in alignment with HIPAA directives.
- Assessed patient needs and developed care plans accordingly.
Registered Nurse
HCA Florida Putnam Hospital
04.2021 - 11.2022
- Conducted accurate chart updates in computer system.
- Worked closely with physicians and nursing staff as part of unit team.
- Alleviated patient fears of treatments using kind, empathetic communication.
- Monitored patients' conditions and progress by regularly evaluating vital signs, symptoms, and response to treatment.
- Utilized infection control measures such as hand hygiene, proper disposal of contaminated materials, and isolation precautions.
- Resolved or reduced patient symptoms with intramuscular, intravenous, and oral medicines.
Scheduler
Centerwell Home Health
10.2016 - 08.2018
- Executed work safely and according to schedule with detailed plans and resource schedules.
- Updated team on schedule status in regular meetings and made proactive updates to account for new developments.
- Documented base schedule for future turnaround schedule, continuously refined strategies and shared baseline details across sites.
- Monitored resource allocation and adjusted schedules as needed.
- Assisted in preparing schedule reports for management review.
- Prioritized tasks based on urgency, complexity, and resource availability.
- Communicated schedule changes to relevant stakeholders promptly.
- Analyzed project data to improve scheduling processes and procedures.
Education
Associate in Science (A.S.) - undefined
Rasmussen University
Ocala, FL03.2021
High School - undefined
Palatka High School
Palatka, FL06.2016
Skills
- Medical documentation
- Clinical assessment
- Patient care management
- Patient advocacy
- Mentoring and coaching
- Patient safety
- Nursing staff supervision
- Ethical decision-making
- Documentation compliance
- Process improvements
- Proficient in software
- Skilled in software
- Clinical documentation management
- Training and mentoring
- Report creation
- Clinical documentation oversight
Timeline
Nurse Clinical Manager
Centerwell Home Health
12.2023 - Current
Registered Nurse
Centerwell Home Health
11.2022 - 12.2023
Registered Nurse
HCA Florida Putnam Hospital
04.2021 - 11.2022
Scheduler
Centerwell Home Health
10.2016 - 08.2018
Associate in Science (A.S.) - undefined
Rasmussen University
High School - undefined
Palatka High School
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