Mary Dukes
Millen,Georgia
Summary
Experienced and highly motivated Nurse Care Manager achieves expected outcomes, demonstrates leadership and serves as resource in management of clinically complex patients. Displays excellent interpersonal and team-building skills and collaborates effectively with physicians, nurses and members of healthcare team. Proficient and functional working knowledge of computer databases, electronic medical record systems and information technology.
Overview
30
30
years of professional experience
Work History
Care Manager
Centene
04.2024 - Current
- Develop, assess and adjust, as necessary, the care plan and promote desired outcome
- Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short- and long-term goals, treatment and provider options
- Coordinate services between Primary Care Physician (PCP), specialists, medical providers, and non-medical staff as necessary to meet the complete medical socio-economic needs of clients
- Develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs
- Provide patient and provider education
- Facilitate member access to community-based services
- Monitor referrals made to community-based organizations, medical care and other services to support the members’ overall care management plan
- Actively participate in integrated team care management rounds
- Identify related risk management quality concerns and report these scenarios to the appropriate resources
- Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems.
- Self-motivated, with a strong sense of personal responsibility.
- Worked effectively in fast-paced environments.
- Organized and detail-oriented with a strong work ethic.
- Paid attention to detail while completing assignments.
- Learned and adapted quickly to new technology and software applications.
- Used critical thinking to break down problems, evaluate solutions and make decisions.
Nurse Care Navigator
Healthmap Solutions
04.2023 - 04.2024
- Case management telephonically for members with chronic kidney disease
- Educated and empowered member on slowing progression of kidney disease
- Collaborate and refer members to internal specialty team (Registered Dietitian, Behavioral Health, Pharmacy and Social Workers) and external resources for identified gaps in care
- Promote self-management through empowering member and families through education
- Drive patient and families in their own care and to support self-management
- Serve as liaison between the patient, the patient’s support network, treating physician, and other ancillary providers as a member of the interdisciplinary care team to coordinate care, resolve nursing problems and assist patients in meeting individual goals
- Notify providers of identified patient needs based on policy
- Accountable for individual metrics and key performance indicators as identified by the organization.
Case Manager
United Healthcare
06.2017 - 04.2023
- Complex care management telephonically
- Prioritize large volume case management load
- Make concerted effort to reach member post hospitalization to ensure that member receive the necessary services and resources to decrease readmission
- Identify gaps or barriers in treatment plan
- Provide patient education to assist with self-management and identified lower level of appropriate care for non-emergent symptoms
- Coordinate care and services for members
- Encourage members to participate in developing their care plan
- Collaborate with members’ care team for continuity of care
- Made internal and external referrals sources
- Adapt to regular process changes as new program(s) evolves.
Case Manager
WellCare Health Plans
10.2014 - 06.2017
- Coordinates, monitors and ensures that appropriate and timely primary, acute and long-term care services are provided to members across the continuum of care
- Works directly with the member in the field, i.e., inpatient bedside, member's home, provider's office, hospitals, etc
- While collaborating with management to assess, plan, implement, coordinate, monitor and evaluate services and outcomes to maximize the health of the member
- Develops and monitors members plan of care, to include progress toward meeting established goals and self-management activities
- Interacts continuously with member, family, physician(s), and other providers utilizing clinical knowledge and expertise to determine medical history and current status
- Assess the options for care including use of benefits and community resources to update the care plan
- Maintains accurate records of case management activities in the Enterprise Medical Management Automation (EMMA) System using clinical guidelines
- Coordinates community resources, with emphasis on medical, behavioral, and social services
- Applies case management standards, maintains HIPAA standards and confidentiality of protected health information and reports critical incidents and information regarding quality of care issues
- Ensures compliance with all state and federal regulations as well as Corporate guidelines in day-to-day activities
- Adapts to changes in policies, procedures, new techniques and additional responsibilities
- Perform other duties as assigned.
Nurse Manager
East Georgia Healthcare Center
12.2005 - 09.2014
- Leads and direct staff in complying with nursing service standards of practice and policies
- Maintains nursing guidelines by writing and updating policies and procedures
- Provides leadership to ensure compliance of State and Federal Regulations
- Work with Medical Director and Departmental Heads to evaluate systems and processes to ensure effective medical service
- Maintains quality assurance through chart reviews measuring health outcomes against national standard of care
- Provides effective and efficient budget management in all financial matters in the medical department to ensure cost containment and the best utilization of resources
- Responsible for hiring, training and conducting counseling and coaching for 8 sites to ensure continuity of care and meet the needs of the community served
- Conducts monthly staff meetings and prepares and documents staff and quality improvement efforts
- Maintains a cooperative relationship among health care teams (internal and external) by communicating information; requests; building rapport.
Mental Health Nurse
Emanuel PDC
05.2004 - 12.2005
- Processed male detainees upon arrival to facility to include detailed medical history
- Daily sick call
- Medication administration
- Assisted provider with performing physicals on new detainees and chronic care
- Carried out medical orders in compliance with policy
- Counseled detainee with mental health diagnosis weekly concerning medication compliance
- Served on safety committee to decrease risks of injury to employees and detainees.
Lead Nurse
Emanuel YDC
03.2000 - 03.2004
- Responsible for arranging medical care for juvenile females age 12 - 18 years of age
- Provided direction and oversight to Registered Nurses and Licensed Practical Nurses
- Lead monthly staff meetings and prepared and documented staff and quality improvement efforts
- Participated in monthly environmental, health and safety inspections of the detention center
- Submitted written reports including areas of concern
- Ensured that appropriate measures were taken to maintain compliance with required standards
- Conducted intake interview upon admission to determine level of care
- Conducted sick call and made referrals to outside providers as directed by Medical Director
- Received and carried out orders for medications, test, and follow-up care
- Prepared and gave oral and intramuscular medications.
Staff RN
Pineland MH/MR/SA
12.1997 - 03.2000
- Cared for consumers with acute and chronic mental health illnesses
- Promoted medication compliance for chronic mental health consumers
- Administered monthly intramuscular medications to schizophrenia consumers
- Provided monthly educational sessions for patients and their families concerning mental illnesses
- Ordered medications through patient assistance programs for uninsured consumers
- Responsible for monitoring Antabuse administration for substance abuse consumers
- Responsible for receiving, carrying out and documenting physician orders.
Staff RN
Jenkins County Hospital
12.1994 - 12.1997
- Worked with patients from birth until age 99
- Initiated patient care plan upon admission
- Carried out medical and nursing treatment in a timely and accurate manner
- Assisted physicians in the care of patients including daily rounds, assisted with simple invasive and non-invasive procedures, provided status reports
- Followed procedure for medication administration and controlled substance inventory
- Maintained safety and infection control
- Supervised care given by Licensed Practical Nurses and Nurse Assistants
- Worked in emergency department cared for trauma, acute illnesses and chronic illnesses.
Education
Bachelor of Science Nursing -
South University
Savannah, Georgia01.2014
Associate Nursing Degree -
Armstrong Atlantic State University
Savannah, Georgia01.1995
Skills
- Care Planning
- Case assessments
- Clinical Documentation
- Service Coordination
- Medication reviews
- Patient Education
- Workflow Coordination
- Policy Adherence
- Quality Improvement
- Resource Utilization
- Discharge Planning
- Community-based Educational Programs
- Critical Thinking
- HIPAA Guidelines
- Decision-Making
- Patient education and counseling
- Medicare Compliance
- Problem Identification
- Clinical Quality Program Standards
- Utilization Management
Licensurecertification
- Compact Georgia Licensure Registered Nurse
- Certified Case Manager
References
- Dr. Traceyan Mendez, 618 Arrowhead Way, Clearfield Pennsylvania 16830, 478-494-9865
- Regina G. Cody, FNP, PO Box 1128, Millen Georgia 30442, 478-494-1388
- Robert Yarbrough, 201 Niver Road, Statesboro Georgia 30458, 912-687-2684
- Josephine Thomas-Beach, 59 Heritage Way, Savannah Georgia 31419, 912-224-6581
Timeline
Care Manager
Centene
04.2024 - Current
Nurse Care Navigator
Healthmap Solutions
04.2023 - 04.2024
Case Manager
United Healthcare
06.2017 - 04.2023
Case Manager
WellCare Health Plans
10.2014 - 06.2017
Nurse Manager
East Georgia Healthcare Center
12.2005 - 09.2014
Mental Health Nurse
Emanuel PDC
05.2004 - 12.2005
Lead Nurse
Emanuel YDC
03.2000 - 03.2004
Staff RN
Pineland MH/MR/SA
12.1997 - 03.2000
Staff RN
Jenkins County Hospital
12.1994 - 12.1997
Bachelor of Science Nursing -
South University
Associate Nursing Degree -
Armstrong Atlantic State University