Lorri LeGacy RN-CCM

• Managed complex cases involving multiple comorbidities, requiring close monitoring and coordination of various healthcare services.
• Collaborated with interdisciplinary teams for comprehensive patient care plans, resulting in better health outcomes.
• Enhanced patient satisfaction through effective communication, empathy, and timely response to their needs.
• Educated patients, families and caregivers on diagnosis and prognosis, treatment options, disease process, and management and lifestyle options.
• Developed strong relationships with patients'' families, providing emotional support while addressing concerns or questions about care plans.
• Educated patients on disease management and self-care techniques, promoting lifestyle changes for improved health.
• Reduced hospital readmission rates through effective case management and patient education on self-care techniques.
• Coordinated care conferences with interdisciplinary team members, ensuring all perspectives were considered in the development of comprehensive treatment plans.
• Advocated for patients' rights and preferences, working diligently to align care with individual values and goals.
• Enhanced patient satisfaction with empathetic communication and timely updates on care progress.
• Reduced hospital readmission rates with proactive follow-up care and patient education on self-management techniques.
• Advocated for patients with insurance companies, securing coverage for necessary treatments and medications.
• Developed strong relationships with patients and their families, providing support and education on health management.
• Improved patient outcomes by developing and implementing comprehensive care plans tailored to individual health needs.
• Assessed patient needs, ensuring timely access to necessary services and resources.
• Led case review meetings to discuss complex cases, fostering collaborative problem-solving approaches.
• Utilized electronic health record systems for accurate documentation and streamlined workflow processes.
• Provided emotional support to patients coping with chronic illness or end-of-life decisions, fostering resilience during difficult times.
• Educated patients and families on available community resources, facilitating access to necessary support services.

○ Perform daily telephone triage for pediatric and adult patients

○ Triage and assess the needs of walk in patients

○ Monitor patients with chronic illnesses in collaboration with Planned Care Team

○ Strictly adhered to best practice goals in the context of level 3 Patient-Centered Medical Home (PCMH)

○ Provide direct evaluation and supervision for the assigned medical assistants

○ Closely cooperate with disenfranchised patients while offering assistance in the daily navigation of health

care system

○ Provide outreach and education for patients with complex medical requirements

◦ Coordinate care with various hospital sites, medical practices, VNA services, and community care

organizations

Specialized focus on working with individuals with substance use disorders

○ Made significant contributions to the development of a Vivitrol protocol reflecting best practices

○ Conducted telephone triage in two primary care clinic sites with multiple providers per shift.

○ Triaged walk-in patients with urgent care needs and requirements

○ Monitored patients with chronic illnesses such as diabetes, HTN, CHF, and COPD.

○ Managed all childhood vaccinations based on Centers for Diseases Control (CDC) and MA DPH guidelines

○ Handled the documentation of all aspects of nursing care with proficiency in EPIC Electronic Medical Records system.

○Performed accurate documentation of patient assessments, interventions, and outcomes in compliance with regulatory standards. ○ Offered care to a varied surgical patient population with specialization in Orthopedics, Endocrine, Obstetrics and gynecology (OB/GYN), Gastrointestinal (GI) and Genitourinary (GU), and Vascular ○ Delivered medical care to patients with various illnesses, including cardiac, respiratory, skin and wound, infectious diseases, addiction and detox, and diabetes.