Margaret Ellis Lawton
Pembroke Pines,Florida
Summary
Experienced Clinical Case Manager with over 25 years as a Registered Nurse in diverse healthcare settings. Expertise in clinical care, community health, and leadership roles, fostering team collaboration and staff motivation. Strong time management and organizational skills, with proficiency in medical equipment and healthcare software.
Overview
1
1
Certification
35
35
years of professional experience
Work History
Clinical Care Nurse/Disease Management/Market Care Navigator RN
Humana-Conviva Care Center
Miami Dade, Florida
01.2025 - Current
- Facilitated clinical transition support to ensure care continuity post-discharge, coordinating follow-up and preventing avoidable readmissions for inpatient, observation, and emergency department patients. Medicare Advantage Stars, HEDIS and quality performance across value-based population. Delivered culturally appropriate chronic disease education to empower patients in self-management of diabetes, hypertension, congestive heart failure, and chronic obstructive pulmonary disease. Following patients for 30 days post discharge to ensure patient does not get readmitted back to hospital. Especially handling uncontrolled condition symptoms and medication management/education. Completed the multi-complexity assessment to inform updates to the patient's care plan. Ensure the patient's provider is updated on care plan progress. Participated in high risk rounds with multidisciplinary team to collaboratively address patient care and achieve shared goals. Aim to identify and address potential risks repeated utilization; improve patient safety and enhance overall quality of care.
Care Manager/Population Healthcare Nurse/ North Shore Clinic
Humana-Elite Healthcare
Pembroke Pines, Florida
03.2023 - 12.2024
- Coordinated complex cases, focusing on discharge planning and post-discharge follow-up. Identify potential barriers to care, advocate for patients and prevent readmission and ensure follow-up post-hospitalization visit. Collaborate with other team members and provide community resources to address social determinants of health.
- Conducted member assessments for Humana-Elite Healthcare care coordination needs.
- Developed individualized care plans with patients, families, and providers.
- Coordinated referrals to community resources and specialist services.
Population Healthcare Manager/Disease Case Manager, RN
Community Care Health Plan (Memorial and Broward Health; formally MIH)
Sunrise, Florida
01.2015 - 01.2023
- Evaluated and educated high-risk clients with chronic conditions such as diabetes, hypertension, and congestive heart failure to mitigate complications. Developed educational plans covering disease process, lifestyle modifications, self-care behaviors, and access to community resources. Conducted educational group classes for community members to enhance awareness and management of chronic conditions.
- Directed healthcare operations for Community Care Health Plan across Memorial and Broward Health
- Coordinated care management workflows for member services and provider networks
- Reviewed utilization requests and authorized medically necessary services
Clinical/Case Resource Manager/Disease Manager
Memorial Health Care System/Memorial Integrated Healthcare
Miramar, Florida
12.2008 - 12.2013
- Evaluated needs of patients with diabetes, hypertension, congestive heart failure, and other co-morbid chronic illnesses; coordinated care between patients and providers. Identified patient needs and formulated an intervention and educational plan that included knowledge of disease processes, self-care behaviors, and lifestyle counseling. Strive toward helping the patient achieve goals; self-management and improve clinical outcomes.
- Managed staffing plans across Memorial Health Care System service lines.
- Coordinated daily schedules for Memorial Integrated Healthcare clinical teams.
- Reviewed leave requests and coverage gaps for patient care units.
Registered Nurse- Medical/Surgical/Orthopedic Nurse Specialist
Memorial Health Care System/Memorial Hospital West
Pembroke Pines, Florida
03.2002 - 12.2008
- Able to prioritize care for multiple patients' needs, accountable for providing assessment, implementation, and evaluation of adolescent, adult and geriatric patients. Provide direct patient care, participate as a member of the research team, mentorship of novice nurses, coordinate interdisciplinary patient care, prepare staff for Joint Commission and education update, assess as Clinical resource nurse and maintain and review documentation electrically.
Personal Nurse/Case Manager/Clinician
Humana, Inc.
Miramar, Florida
10.2002 - 12.2002
- Developed telephonic plans of care to assist clients with their health plans, provided clinical education, assisted members with healthcare needs and health plan options, navigated members to resources for their healthcare needs prior to surgery, and facilitated pre- and post-hospital teaching and discharge planning.
- Coordinated care plans for Humana members across complex medical needs.
- Reviewed clinical records to guide medical necessity decisions and case management.
- Collaborated with physicians, social workers, and care teams on member care.
Staff Registered Nurse/Relief Charge Nurse-Rehab/Medical Unit
Kindred Healthcare of Hollywood
Hollywood, Florida
04.1997 - 03.2002
- Prioritized and provided comprehensive care to multiple clients. Assess, plan, implement and evaluate care for adults/geriatric population. Coordinate and formulate plan of care with interdisciplinary team members to care of clients. Assisted in preparing for JCAHO survey, provided education and supervised staff members, assessed rehab daily operations, charged nurse for forty bed unit, consulted on wound care and coordinated interdisciplinary patient care.
Hospice Nurse/Case Manager/Chart Reviewer
Vitas Hospice Healthcare
Miami, Florida
08.1993 - 12.1996
- Case Management
- Coordinating interdisciplinary patient care
- Coordinated interdisciplinary patient care to ensure comprehensive support for patients and families
- Assisted patients with pain management techniques during care visits
- Performed utilization reviews to ensure appropriate patient care services
- Maintained documentation for hospice care to uphold compliance and facilitate continuity of care
Registered Nurse/Medical/Surgical Unit
North Shore Medical Center
Miami, Florida
07.1991 - 08.1993
- Provided nursing support to patients in high-demand areas.
- Coordinating interdisciplinary patient care
- Coordinated interdisciplinary patient care to ensure comprehensive treatment plans
- Maintained accurate documentation and nursing notes to support patient care and compliance
- Educated staff on best practices to enhance clinical skills and patient outcomes
- Guided new nursing staff through clinical procedures and protocols.
Education
Master of Science - Nursing, Education
University of Phoenix
Plantation, FloridaBachelor of Science - Nursing
University of Phoenix
Plantation, FloridaAssociate of Science - Nursing
Miami-Dade Community College
Miami, FloridaCertification
Basic Cardiac Life Support provider
Affiliations
- Florida Nurses Association
- American Nurses Association
- Sigma Theta Tau International
Personal Information
Title: RN, MSN/Ed
Timeline
Clinical Care Nurse/Disease Management/Market Care Navigator RN
Humana-Conviva Care Center
01.2025 - Current
Care Manager/Population Healthcare Nurse/ North Shore Clinic
Humana-Elite Healthcare
03.2023 - 12.2024
Population Healthcare Manager/Disease Case Manager, RN
Community Care Health Plan (Memorial and Broward Health; formally MIH)
01.2015 - 01.2023
Clinical/Case Resource Manager/Disease Manager
Memorial Health Care System/Memorial Integrated Healthcare
12.2008 - 12.2013
Personal Nurse/Case Manager/Clinician
Humana, Inc.
10.2002 - 12.2002
Registered Nurse- Medical/Surgical/Orthopedic Nurse Specialist
Memorial Health Care System/Memorial Hospital West
03.2002 - 12.2008
Staff Registered Nurse/Relief Charge Nurse-Rehab/Medical Unit
Kindred Healthcare of Hollywood
04.1997 - 03.2002
Hospice Nurse/Case Manager/Chart Reviewer
Vitas Hospice Healthcare
08.1993 - 12.1996
Registered Nurse/Medical/Surgical Unit
North Shore Medical Center
07.1991 - 08.1993
Master of Science - Nursing, Education
University of Phoenix
Bachelor of Science - Nursing
University of Phoenix
Associate of Science - Nursing
Miami-Dade Community College