Dedicated healthcare professional with over 30 years of extensive experience in diverse settings, including acute care hospitals, home healthcare case management, medical centers, and population health remote care management. Proven ability to manage multiple projects while consistently driving patient goals and exceeding expectations. Expertise in conducting thorough assessments, developing tailored care plans, and fostering effective communication among interdisciplinary care teams. Proactive advocate for patients and families, adept at navigating complex healthcare systems to ensure seamless coordination and access to optimal care.
Overview
32
32
years of professional experience
1
1
Certification
Work History
RN Care Advisor
Innovative Healthcare Collaborative of Indiana (IHCI)
12.2021 - Current
Perform comprehensive telephonic assessments of patient’s medical, pharmaceutical and psycho-social needs and identify gap and barriers in improving each patient’s health.
Collaborated with interdisciplinary teams to develop comprehensive care plans for diverse patient populations.
Individualize patient care plans based on identified needs, work with patients on removing barriers to improve patients’ health outcomes.
Educate patients on diagnosis, treatment plan, medications, future appointments with providers, and self-care management based on individual patient learning style.
Manage 30-45 patients within transition care, condition care and MVP care program.
Coordinate care for patients across commercial, Medicare and Medicaid insurance populations.
Serve as patient contact, advocate and resource for patients, family members and providers and develop relationships through trust, respect and communication.
Experience in use of Epic electronic medical record and Care Flow healthcare platform.
Proficient in Microsoft Office.
Effectively communicates with all care teams.
Collaborate as a member of the Heart Failure Condition Care development team.
Serve as a preceptor, onboarding and mentoring nursing staff.
Created Asthma and COPD education materials for email care programs.
Revised and maintained patient education resources for Diabetes, Coronary Artery Disease, Hypertension and Pulmonary email care programs.
Improved patient outcomes by implementing evidence-based nursing interventions and individualized care plans.
Provided support in navigating healthcare systems, improving patient access to resources.
Developed educational materials to inform patients about services and programs available.
Established rapport quickly with new clients through genuine empathy while maintaining professional boundaries.
Coordinated with healthcare professionals to ensure seamless delivery of services.
Worked with patients to ascertain issues and make referrals to appropriate specialists.
RN Care Advisor
Evolent HealthCare- Deaconess OneCare
07.2018 - 12.2021
Conduct assessments and individualize care plans to meet the diverse needs of patients.
Advocate for needed services and collaborate with interdisciplinary care teams.
Experienced in use of Epic, Greenway and Meditech electronic health records.
Experienced in use of Identifi care platform.
Proficient in Microsoft Office.
Effectively communicates with all care team members.
Participated in the design and support of the Congestive Heart Failure initiative.
Participates in routine diversity and inclusion education and initiatives.
Participate in routine care conference to improve patient outcomes.
Completes 2 success stories each quarter.
Participate and complete annual compliance training and continuing education initiatives.
Participates in the Actioneer Committee and EACC.
Clinical RN Heartland Cardiology
Memorial Hospital and Healthcare Center
Jasper, IN
01.2016 - 07.2018
Performed Anti-coagulation Therapy Management of point of care, phone or Alere self-testing patients using Standing Stone Coagulation clinic electronic charting.
Performed walk-in patient assessment and manage approximately 60-75 incoming calls, emails and faxes per day.
Provided patient education on procedures, medications, disease process and management.
Notified and educated patients of test results and referrals.
Clinical chart preparation, obtained the chief complaint or reason for the visit, obtained vital signs, performing an ECG, reviewed current medications and allergies, updated patient history and review of systems, collect lab and procedure results.
Authorized prescription refills under direct supervision of the physician.
Effectively communicated with patient, patient caregiver, physicians and support staff.
Participated in staff meetings, in-service and clinical process improvement.
Experienced in use of Greenway, Meditech and E-transcribe electronic medical record charting.
Clinical Manager RN
Adaptive Nursing and Healthcare Services
Jasper, IN
09.2016 - 12.2016
Completed comprehensive client assessment to ensure appropriateness for home care services.
Created and updated patient care plans coordinating with MD, clinician and client.
Provided training, supervision and education of home health aid.
Provided affective care coordination specific to patient needs.
Completed accurate communication and documentation in a timely manner.
Participated in staff meetings, in-service and clinical process improvement.
Home Health RN Case Manager
Memorial Hospital and Healthcare Center
Jasper, IN
07.1998 - 03.2016
Manage approximately 30 patients and complete comprehensive patient assessments of individuals by evaluating physical, mental and environmental health status.
Developed individual appropriate care plans and provided nursing interventions based on assessment.
Coordinated home health services provided by ancillary personnel such as home health aids, therapies and medical social services.
Ordered appropriate durable medical equipment to meet needs of patient and made recommendations to patient/patient caregiver and physician.
Administered meds/IVs and performed prescribed treatments such as colostomy, ileostomy, tracheostomy care, diabetic care and wound care.
Initiated and managed negative pressure wound care dressing/care.
Completed lab draws/specimens as ordered.
Completed sterile central line care and instruct patient/patient caregiver on IV management.
Instructed patient and patient caregivers on diagnosis, meds, home safety, pain management, wound care/ wound vac and IV management.
Monitored patient progress and adjusted treatment plans based on clinical assessments and feedback.
Experienced in Medicare/Medicaid Oasis assessment guidelines.
Experienced in Allscripts electronic charting.
Completed Home Health Aid supervisory visits as per orders.
Effectively communicated with patients, patient caregivers, physicians, and support staff.
Nursing Practice Council Home Healthcare representative.
Mentored new RNs entering the field of home health case management fostering a supportive learning environment for professional growth.
Home Care Nurse
St. Joseph's Hospital
Huntingburg, IN
09.1997 - 07.1998
Performed physical, mental and environmental assessment.
Developed individualized patient care plans and implemented nursing interventions based on assessment.
Coordinated home health services with home health aids, therapies and medical social services.
Completed home health aid supervisory visits.
Instructed patient and patient caregivers on diagnosis, medications, home safety, pain management, wound care and IV management.
Registered Nurse
St. Joseph's Hospital
Huntingburg, IN
05.1994 - 07.1998
Conducted comprehensive assessments of patients' health status to inform treatment decisions.
Administered medications and treatments in accordance with patient care plans.
Collaborated with multidisciplinary teams to optimize patient outcomes and care coordination.
Conducted thorough patient assessments to identify changes in condition, promptly notifying physicians and initiating appropriate interventions when necessary.
Prevented the spread of infections by consistently adhering to strict infection control protocols and educating patients on proper hygiene practices.
Documented treatments delivered, medications and IVs administered, discharge instructions, and follow-up care.
Educated family members and caregivers on patient care instructions.
Managed patients recovering from medical or surgical procedures.
Wound Care RN, Foot Care RN, Triage RN, and Patient Care Team RN at CCM HealthWound Care RN, Foot Care RN, Triage RN, and Patient Care Team RN at CCM Health