Margaret Kingsley
Summary
Experienced healthcare professional seeking a Case Management role in a hospital environment, leveraging strong clinical knowledge, interdisciplinary collaboration, and care coordination skills to support quality outcomes, effective resource utilization, and improved patient experiences across the continuum of care.
Overview
11
11
years of professional experience
Work History
Clinical Supervisor
Horizon Blue Cross Blue Shield of NJ
Hopewell, NJ
06.2023 - Current
- Collaborated with multidisciplinary teams to coordinate care for members with complex needs, ensuring comprehensive support was provided across all domains of life functioning.
- Liaised with other healthcare professionals to develop comprehensive patient care plans and provide highest quality of care.
- Designed and introduced leadership development, coaching and team management model to promote professional development.
- Enhanced team collaboration through small team huddles, 1:1 touchpoints, and training sessions.
- Responded to crisis situations with calm and professional approach to optimize support.
- Monitored, analyzed, and corrected staff performance and to raise standards of practice.
- Lead and directed team of 17 clinical personnel and support staff.
- Implemented performance improvement initiatives focused on enhancing client experience and service quality.
- Utilized various outcome measures in order to evaluate the effectiveness of interventions to help meet performance guarantees.
- Monitored adherence to ethical guidelines among clinical staff members, supporting their ongoing professional growth while maintaining high quality care standards.
- Increased client satisfaction by fostering a supportive and in-person relationship with my accounts.
- Fostered collaborative environment, encouraging interdisciplinary teamwork to enhance patient outcomes.
- Responded to member or client complaints and concerns, restoring trust and maintaining clinic reputation for quality care.
- Recruited, hired and trained staff, providing direct supervision, ongoing staff development and continuing education to employees.
Case Manager
Horizon Blue Cross Blue Shield
03.2021 - 05.2023
- Assess member's clinical needs against established guidelines and/or standards to ensure that the services provided are medically appropriate to member's needs and aligned with the benefit structure.
- Evaluate the necessity, appropriateness and efficiency of medical services and procedures provided for both acute and chronic health care needs.
- Develop, coordinate and assist in implementation of individualized plan of care for members and identification of barriers towards Self-Management and optimal wellness.
- Coordinate with members, family, physicians, hospitals and other external customers with respect to the appropriateness of care from diagnosis to outcome.
- Coordinate the delivery of high quality, cost-effective care supported by clinical practice guidelines established by the plan addressing the entire continuum of care including transitional care.
- Monitor member's medical care activities, regardless of the site of service, and outcomes for appropriateness and effectiveness.
- Advocate for the member/family among various sites to coordinate resource utilization and evaluation of services provided.
- Encourage member participation and compliance in the case/disease management program efforts.
- Document accurately and comprehensively based on the standards of practice and current organization policies.
- Interact and communicate with multidisciplinary teams either telephonically and/or in person striving for continuity and efficiency as the member is managed along the continuum of care.
- Evaluate care by problem solving, analyzing variances and participating in the quality improvement program to enhance member outcomes.
- Serve as mentor/trainer to new RN's and other staff as needed.
- Present clinical cases during audits conducted by external review organizations.
- Facilitator for PNM Case Rounds for my Team.
- Participant in the work-flow committee.
Peri-Anesthesia Nurse
Atlantic Eye Surgery Center
04.2015 - 03.2021
- Provided patient education.
- Assisted doctors with surgeries and non-invasive procedures.
- Accurately documented all elements of nursing assessment, treatments, medications, discharge instructions, and follow up care.
- Started and maintained vascular infusions.
- Manage care for post-operative patients through discharge.
- Provide patient care under strict time constraints.
Clinical Supervisor
Hackensack Meridian at Home
01.2018 - 02.2021
- Assist clinical staff in maintaining delivery of quality care while maintaining agency compliance and policies.
- Handle all patient calls between Friday and Monday, assessing, treating and developing an appropriate plan of care to meet individual patient's needs.
- Document all changes in patient's condition and update care plans to achieve positive outcomes.
- Organize and review all incoming pending referrals for Monmouth County on the weekends.
- Onboarding instruction for newly hired Home Health Aides as needed.
Staff Nurse
Hackensack Meridian Health at Home
05.2016 - 01.2018
- Doing admissions, symptom management, teaching medication and disease management, developing a plan of care to meet the needs of Home Health/Hospice patients and their families.
- Evaluations and care for post hospitalized and ill patients who reside in assisted livings, and at home, manage weekend staff covering Ocean and Monmouth counties, pronouncements.
- Giving emotional support to patients and their families.
- Keeping open communication with Hospice/Home Care Teams regarding all findings and patient's needs.
- Give dignity to the terminally ill patients at end of life.
Nursing Supervisor
HealthSouth Rehabilitation Hospital
07.2015 - 04.2016
- Clinical oversight for 80 nursing employees.
- Facilitated patient care rounds to ensure patient Plan of Care was followed.
- Development and implementation of patient care programs, policies and procedures.
- Assess and identify reasons for patient readmissions.
- Coordinating clinical activities.
- Measurement, assessment, and improvement of nursing staff.
- Ensure optimal nursing care is provided, staffing is maintained, and costs contained.
- Interviewing and hiring of nursing staff.
Education
RN to MSN program -
Chamberlain School of Nursing
Licensed Practical Nurse - undefined
Bristol, VA Practical Nursing School
Bristol, VAAssociate of Science - undefined
Mercer County College
Skills
- Quality assurance
- Staff management
- Case management
- Interdisciplinary collaboration
- Reporting requirements
- Performance metrics
- Process implementation
- Employee performance evaluations
- Employee recruitment and hiring
- Compliance with regulatory guidelines
- Clinical quality improvement
Languages
Greek
Community Service
CASA of Monmouth County, RAINE Foundation, Covenant House, Arc of Monmouth, Lion's Club, Lunch Break, Family Promise
Timeline
Clinical Supervisor
Horizon Blue Cross Blue Shield of NJ
06.2023 - Current
Case Manager
Horizon Blue Cross Blue Shield
03.2021 - 05.2023
Clinical Supervisor
Hackensack Meridian at Home
01.2018 - 02.2021
Staff Nurse
Hackensack Meridian Health at Home
05.2016 - 01.2018
Nursing Supervisor
HealthSouth Rehabilitation Hospital
07.2015 - 04.2016
Peri-Anesthesia Nurse
Atlantic Eye Surgery Center
04.2015 - 03.2021
Licensed Practical Nurse - undefined
Bristol, VA Practical Nursing School
Associate of Science - undefined
Mercer County College
RN to MSN program -
Chamberlain School of Nursing