Nursing Supervision – Managed staffing, scheduling, and resource person for all hospital areas to assist with all nursing needs and facilitated working relationships with outside agencies to put the client in the right place at the right time to promote optimum care
Performed “Patient-Centered Care”
Coordinated the review, revision, and creation of Operational Policies in the hospital.
Nurse Auditor
David-James LLC
Baltimore, Maryland
03.2022 - 05.2023
For Medicare and Medicaid
Auditing Medicare programs based on the Code of Federal Regulations in managing patient populations under these regulations
Obtained White House Level of clearance for auditing
Medicare auditing for Part C & D programs
Dual Needs plans for Medicaid and Medicare populations
Aetna CVS Health
Albany, Ohio
06.2017 - 03.2022
Subject Matter Expert
SME UMNC National Team
09.2019 - 03.2022
In subacute care from Sept 1st, 2019, to present
Provide professional and compassionate education to coworkers on other teams related to post-sub-acute care cases
Resource point person on weekends for the SME team
SRL UMNC Great Lakes Team
06.2017 - 09.2019
Developed working relationships with Acute Rehab, LTACH, and Skilled Nursing Facilities to facilitate hospital discharges to decrease length of stays IP while meeting turnaround times per NCQA, Commercial AOC’s, Medicare, and Aetna’s Wiki requirements
Completed Yellow Belt ABX training
Proficient in Med Compass, ATV, IDX, Q-Next platforms
Proficient in managing large caseloads of 60-80 cases in triaging/prioritizing patient acuity to meet turnaround times
Received multiple quality reviews at 100% accuracy
Meet and exceed productivity metrics
Send out Pending Reports, weekend staffing, and weekend workflow to the team
Keep the team educated on changes to the weekend workflow
Completed preceptor training courses
Formal leader on Weekend workflow process and staffing, informal leader on weekday workflows
Founder and Chair of St Ann
TotalMed Wisconsin
01.2017 - 06.2017
Contracted with Aetna on the Dual's Team for UM
QNXT proficient
NCQA standards, Medicare Standards, and Medicaid Standards proficient
Managing cases from inpatient acute care admission through subacute levels of care to discharge to home., ’s Case Management’s Community
Case, Review Registered Nurse
Mount Carmel St Ann’s Hospital
Westerville, Ohio
09.2014 - 01.2017
Obtain insurance approvals for hospital stays
Proficient in CMS guidelines
InterQual and MCG Proficient
Analyze discharge barriers to decrease lengths of stays
Wrote policies and procedures for the department’s needs on utilization review
Secretary of the Quality Champions Committee and developed a subcommittee to gather data for performance improvement projects.
Emergency Room Registered Nurse & Fill-in Night Shift Nursing Supervisor
Hocking Valley Community Hospital
Logan, Ohio
04.2006 - 08.2014
Trauma Certified – TNCC
Nursing Supervision – Managed staffing, scheduling, and resource person for all hospital areas to assist with all nursing needs and facilitated working relationships with outside agencies to put the client in the right place at the right time to promote optimum care
Developed “Hero of the Week” to improve team unity
Performed “Patient-Centered Care”
Coordinated the review, revision, and creation of Operational Policies in the Emergency Room
Intensive Care Unit Registered Nurse, •Charge Nurse and Preceptor Nurse
University Hospital
East Columbus, Ohio
06.2000 - 04.2006
Performed “Patient-Centered Care”
Developed Visitation Policy based on Evidence-Based Practice
Night Shift Supervisor Registered Nurse
Crestview Manor Nursing Home Lancaster
, Ohio
04.1997 - 02.2000
Managed a 200-bed skilled nursing facility
Worked my way up from Nursing Assistant to LPN to RN
Education
Psychiatric Mental Health Nurse Practitioner -
Purdue Global University
11.2023 - Current
Dual Master of Science - Nursing and Healthcare Administration