MARGARET C. RHODES, RN, MSN
Clemson,SC
Summary
Adaptable health care leader accustomed to the integration of new health care delivery systems and restructuring of work in an increasingly complex regulatory environment. Focused on efficient, evidence based and quality driven care in order to provide an exceptional patient and customer care.
Overview
21
21
years of professional experience
Work History
Case Management - Manager
Greenkey Resources/Dignity Health/Travel
Bakersfield, CA
07.2022 - Current
- Streamline, standardize and implement case management processes and techniques to maximize revenue cycle.
- Decrease average length of stay to align with the national average through various measures in a predominately indigent population.
- Work directly with the Chief Medical Officer and Physician Advisor on difficult discharges.
- Coordinate and supervise a multidisciplinary approach to daily staffing using case managers, social workers and care coordination assistants to complete discharge planning, initial assessments and InterQual in a timely manner.
- Collaborate with multidisciplinary teams, e.g., nursing, PT/OT/ST, to reduce case management barriers and facilitate patient discharges.
- Coordinate directly with government/commercial payors and vendors in the community to facilitate timely authorization of home health care, skilled nursing facilities, acute rehabs, long term acute care facilities and durable medical equipment.
- Monitor/validate order status changes and delivery of MOON/documentation Condition Code 44.
- Guide and supervise travel case managers and social workers in addition to permanent staff in accordance with regulatory agency statues and organizational policy and procedures.
- Generate daily r
Nurse Care Manager
Aya Healthcare/IU Health Methodist/Travel
Indianapolis, IN
01.2022 - 07.2022
- Managed care from admission to discharge for a level one trauma center for all levels of care.
- Evaluated healthcare needs, goals for treatment and available resources of each patient and facilitated care in the community.
- Collaborated, referred and communicated across all programs to ensure appropriate coordination of services.
- Educated patients, families and caregivers on diagnosis and prognosis, treatment options, disease process and management.
Nurse Care Manager Supervisor
UNM Hospital/Travel
Albuquerque, NM
07.2021 - 01.2022
- Determined, coordinated and supervised daily staffing assignments and levels.
- Provided direction, orientation, training, coaching and mentoring to staff.
- Assessed quality of services delivered.
- Ensured staff compliance with departmental and organization policies, procedures and protocols.
- Performed staff responsibilities as needed to fulfill required service levels.
- Resolution of complex issues and complaints.
- Represented Case Management on the morning bed management call.
- Established a new practice to include bed availability at all local Skilled Nursing Facilities, Inpatient Rehabs and Long Term Acute Care Hospitals.
- Assisted in the development of standardized documentation templates for initial assessments, discharge to facilities, Home Health and DME.
- Oversaw an increase in initial assessments within one week from 40% ot 90%.
Transplant Nurse Care Manager
Aya Healthcare/IU Health University/Travel
Indianapolis, IN
01.2021 - 07.2021
- Planned and coordinated care for patients from pre-admission through post-discharge by working collaboratively with the multidisciplinary team.
- Ensured patients were assigned the appropriate level of care, received the appropriate services and transitioned to the appropriate post-discharge level of care.
- Worked with third party payors to ensure coverage.
- Knowledge of Federal guidelines outlining coverage of inpatient and outpatient hospital services.
- Knowledge of Medicare/Medicaid insurance and regulatory guidelines.
- Working knowledge of third party denial and appeal process.
COVID Nurse Care Manager
Aya Healthcare/Las Palmas Medical Center/Travel
El Paso, Texas
11.2020 - 01.2021
- Responsible for ongoing concurrent assessments of patient care needs.
- Identified patients with significant deviations in their plan of care and work collaboratively with physicians, staff, support services, patient and family toward resolution,
- Maintained collaborative relationships with utilization management and payor organizations.
- Knowledge of InterQual, MEDITECH and Midas.
Utilization Management Care Manager
Titan Medical Group/UPMC/Travel
Pittsburgh, Pennsylvania
06.2020 - 12.2020
- Performed clinical reviews for cases requiring authorizations using established InterQual criteria.
- Communicated with Medical Directors and Attending Physicians regarding evaluation of medical appropriateness.
- Maintained collaborative relationships with utilization management and payor organizations.
- Ensured timely and proper documentation to meet payor deadlines.
- Collaborated with other departments to ensure necessary information is obtained to support authorization, level of care/medical appropriateness.
- Monitored and evaluated for areas of process improvement.
Registered Nurse
Trusted Health/Lynchburg General Hospital/Travel
Lynchburg, Virginia
06.2020 - 10.2020
- Managed orthopedic patient care to include patient assessments, treatments, and medication administration.
- Established IV access.
- Evaluated diagnostic tests.
- Maintained patient safety.
- Provided patient and family education.
- Facilitated teamwork.
Chief Community Care/Case Management
Ralph H. Johnson VA Medical Center
Charleston, South Carolina
08.2017 - 03.2020
- Assessed the health and management needs of Veterans.
- Interacted with external vendors within the community and assist with timely and appropriate care coordination.
- Removed barriers and identified resources to provide optimal health outcomes.
- Educated Veterans with specific health conditions on internal VA programs to help manage the disease process.
- Assisted the Veteran/family with navigating the health care process and health related decision process to optimize outcome.
- Provided advanced clinical and administrative recommendations relative to the VA Office of Community Care.
- Integral knowledge of the VA Mission Act, Patient-Centered Community Care (PC3), TriWest/Optum and Veterans Choice Program (VCP).
- Facilitated all GEC consults through the Office of Community Care, e.g., GEC Home/HH Aide, GEC Hospice/Palliative Care, GEC Bowel/Bladder, GEC Adult Day Care, GEC Skilled Nursing, GEC Respite.
- Ensured new Community Care/Case Management standards and processes are implemented and adhered to.
- Conducted clinical reviews to ensure appropriate and timely care coordination.
- Ensure all Veterans receive timely and appropriate care as it relates to med/surg, oncology, pulmonary, cardiology and diagnostic radiology.
- Worked with Executive Leadership, and Service Chiefs to identify areas in need of improvement within Community Care.
- Developed and implemented process improvement plans with follow-up for continued improvement.
- Developed internal audit process to review Community Care consults daily to ensure timely and appropriate consult processing.
- Worked daily with Office of Community Care (OCC) and Claims Adjudication and Reimbursement (CAR), to review complex cases to determine clinical eligibility and program determination under various Non-VA programs.
- Responsible for the acquisition, planning, coordination, oversight and quality assurance functions related to care in the community.
- Participated in the development of educational programs related to staff development and quality measures.
- Managed relationships with community vendors.
- Demonstrated effective verbal and written communication, organizational skills and the ability to prioritize work in a stressful and rapidly changing environment.
- VISN representation as it relates to all aspects of Community Care/Mission Champion.
- Collaborated in the development of the fiscal year budget to ensure financial objectives were met.
- Gathered and reported data relative to appropriate patient community admissions, discharges and transfers.
- Responsible for performance improvement, customer satisfaction, patient safety, employee relations, standards of care and practice, and accreditation and regulatory compliance.
- Ensured Joint Commission and Office of Inspector General (OIG) standards were met and actively participate in surveys.
- Proficient at a variety of software systems and supporting processes to include CPRS, JLV Vista Imaging, FBCS and Excel.
Patient Care Coordinator/Case Management
Roper St. Francis Healthcare
Charleston, SC
01.2016 - 08.2017
- Provided direction, supervision and education for all clinical staff to achieve quality patient services through optimal clinical operations.
- Assisted in educating staff nurses on completeness and timeliness of documentation to meet standards, interpreted standards for staff and resolved ethical issues relevant to scope of practice.
- Clinical case coordination to ensure that patient care was conducted in an effective, efficient and safe manner.
- Ensured compliance with policies and procedures, competency evaluations to include proficiency in the computer/handheld devices and thorough documentation of clinical services by all field staff.
- Performed comprehensive assessment evaluations.
- Collaborated with physicians, patients, families and other members of the patient care team to develop a patient specific care and treatment plans.
- Initiated appropriate referrals for other medical services.
- Provided compassion and support to patients and family members.
Nurse Manager
Palmetto Health
Columbia, South Carolina
11.2010 - 06.2015
- Planned, organized and managed activities to optimize patient flow and ensure appropriate patient placement for a 1,138 licensed beds system to include a Level 1 Trauma/Emergency Services/Chest Pain ER.
- Instrumental in the research, redesign and implementation of an internal nursing float pool, and reduction of external agency.
- Worked with service line representatives and managers to develop recruitment and retention plans for nursing needs.
- Provided clinical expertise regarding qualifications of nursing individuals.
- Responsible for the direct oversight of all internal patient movement, direct admits, consults and transfers from outside facilities.
- Managed department human resources by determining qualifications, competence, credentialing, and performance expectations; implementing and monitoring staffing plans; providing orientation, in-service training, and continuing education of all persons in the department.
- Continuously assessed and improved the department's performance by designing operational processes, monitoring performance through data, analyzing the data, and implementing sustainable performance improvement.
- Chaired Quality Assurance Committee while collaborating with physicians and other health care providers to establish and maintain quality patient care.
- Development of policies, procedures, protocols, and systems of measures for achieving the best possible system performance relative to patient throughput.
- In depth knowledge regarding hospital obligation relative to the Emergency Medical Treatment and Labor Act (EMTALA).
- Evaluated individual performance of team members, which included Performance Evaluations and Performance Improvement Plans.
Administrator on Duty/Nursing Supervisor
Palmetto Health
Columbia, South Carolina
12.2005 - 11.2010
- Exercised considerable judgment in applying professional knowledge related to solving nursing and administrative issues in conjunction with or in the absence of leadership.
- Provided immediate follow-up, documentation and communication to appropriate leadership.
- Developed and implemented daily staffing plan based on patient acuity, patient census and available staff.
- Identified and communicated staff needs for continuing education to the Department of Education.
- Maintained nursing guidelines by writing and updating policies and procedures.
- Facilitated and managed all hospital emergency codes in collaboration with physicians, unit staff and safety/security.
- Facilitated appropriate and meaningful conversation with patient friends/family members that were not privileged to confidential patient information and successfully de-escalated potentially volatile situations.
- Liaison between nursing departments, physicians, ancillary departments, hospital administration and the community.
- Supervised and mentored clinical staff.
- Collaborated with other departments to ensure best practices.
- Assisted staff to efficiently utilize staffing resources to meet patient care requirements and other professional responsibilities.
Nursing Supervisor/Float Pool Nurse/ED RN
Lexington Medical Center
West Columbia, SC
01.2003 - 05.2005
- Served as administrative authority to facilitate the smooth function of all units.
- Collaborated with physicians and multidisciplinary team members, providing physical and psychological support for both patients and families.
- Performed rounds at least twice per shift to monitor conditions and care.
- Assisted with the development and implementation of nursing policies and procedures.
- Made sound, ethical and independent clinical decisions consistent with hospital protocols.
- Assigned and directed float pool and agency staff in accordance with patient acuity and hospital protocol.
Education
Master of Science - Nursing/Leadership
Benedictine University
2015
Bachelor of Science - Nursing
Gannon University
1995
Skills
- Proficient in InterQual, Cerner, Allscripts, Meditech, NaviHealth, Midas, Microsoft Word and Excel
- Care coordination/Case Management/Utilization Review
- Public speaking/Presentation skills
- Problem/Conflict resolution
- Critical thinking
- Time management
Additional Information
- Nurse Licensure Compact
- Pennsylvania State Nursing License
Timeline
Case Management - Manager
Greenkey Resources/Dignity Health/Travel
07.2022 - Current
Nurse Care Manager
Aya Healthcare/IU Health Methodist/Travel
01.2022 - 07.2022
Nurse Care Manager Supervisor
UNM Hospital/Travel
07.2021 - 01.2022
Transplant Nurse Care Manager
Aya Healthcare/IU Health University/Travel
01.2021 - 07.2021
COVID Nurse Care Manager
Aya Healthcare/Las Palmas Medical Center/Travel
11.2020 - 01.2021
Utilization Management Care Manager
Titan Medical Group/UPMC/Travel
06.2020 - 12.2020
Registered Nurse
Trusted Health/Lynchburg General Hospital/Travel
06.2020 - 10.2020
Chief Community Care/Case Management
Ralph H. Johnson VA Medical Center
08.2017 - 03.2020
Patient Care Coordinator/Case Management
Roper St. Francis Healthcare
01.2016 - 08.2017
Nurse Manager
Palmetto Health
11.2010 - 06.2015
Administrator on Duty/Nursing Supervisor
Palmetto Health
12.2005 - 11.2010
Nursing Supervisor/Float Pool Nurse/ED RN
Lexington Medical Center
01.2003 - 05.2005
Master of Science - Nursing/Leadership
Benedictine University
Bachelor of Science - Nursing
Gannon University
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