Overview
Work History
Education
Skills
Certification
Timeline
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Matheresa Jacob

Nacogdoches,TX

Overview

22
22
years of professional experience
1
1
Certification

Work History

Utilization Review Nurse

McBee
07.2024 - Current
  • Experience with Microsoft and Excel.
  • Knowledgeable with prior authorization process.
  • Proficient with conducting admission, concurrent, and discharge reviews using Interqual guidelines.
  • Performed admission reviews based for medical necessity based upon [Type] specification.
  • Conducted thorough evaluations of medical necessity for procedures, leading to optimal resource utilization.
  • Demonstrated commitment to ethical practice by upholding patient confidentiality and advocating for individual rights in all interactions with stakeholders.
  • Maintained professional competence by staying current on industry trends, best practices, and regulatory requirements specific to utilization review nursing.
  • Ensured compliance with regulations and accreditation standards by maintaining accurate documentation of all utilization review activities.
  • Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.

Inpatient Lead Case Manager

Nacogdoches Medical Center
04.2018 - Current
  • Integrates care coordination utilization management, and discharge planning.
  • Lead and coordinate activities of a diverse group of people, demonstrates critical thinking and problem-solving skills.
  • Proficient with Microsoft, Excel, Cerner EMR system.
  • Knowledgeable with prior authorization process.
  • Proficient with conducting admission, concurrent, and discharge reviews using Interqual guidelines.
  • Proficient with prior authorizations process.
  • Coordinates with multidisciplinary team reviews of clinical care provision and financial management of patients under review.
  • Coordinates the timeliness and completion of transition assessments.
  • Demonstrates knowledge of regulations and contractual limitations related to the management of outpatient observations.
  • Facilitates the Patient Care Conferences with Interdisciplinary teams.
  • Discusses medical management with physician related to over/under utilization of resources.
  • Identifies and intervenes as appropriate when variances occur in patient care.
  • Led multidisciplinary teams to develop and implement comprehensive patient care plans.
  • Coordinated case management processes, ensuring timely access to resources and services.
  • Mentored new case managers, fostering professional development and improving team performance.
  • Analyzed patient data to identify trends and drive improvements in service delivery.
  • Facilitated communication between healthcare providers and patients, enhancing care continuity.
  • Streamlined workflows to optimize efficiency within case management operations.
  • Developed training materials for staff on best practices in case management strategies.
  • Conducted regular assessments of patient progress, adjusting plans as needed for optimal outcomes.
  • Facilitated regular meetings with patients, ensuring progress towards goals was on track and addressing any barriers encountered.
  • Maintained strong relationships with patients, resulting in a high rate of successful case outcomes.
  • Managed crisis situations effectively, providing immediate assistance and coordinating follow-up support as needed.
  • Reviewed cases regularly to identify trends or common issues that could inform improvements in service delivery approaches.
  • Coordinated services for patients across multiple agencies, ensuring seamless provision of necessary supports.
  • Ensured compliance with relevant regulations and ethical standards, maintaining a strong reputation for the organization in the field.
  • Participated in ongoing professional development opportunities, contributing to a culture of learning within the organization.
  • Conducted thorough assessments to determine the most appropriate resources and services for each client.
  • Evaluated program effectiveness using data-driven analysis techniques, resulting in continuous improvement efforts.
  • Reduced case resolution time by streamlining processes and improving communication between departments.
  • Provided leadership, guidance and support to staff members.
  • Referred clients to appropriate team members, community agencies and organizations to meet treatment needs.
  • Monitored program performance and outcomes for successful delivery of services.
  • Streamlined workflow processes for increased efficiency in daily tasks, leading to more timely case resolutions.
  • Implemented quality control measures to ensure consistency in case management practices throughout the team.
  • Coordinated services with other agencies, community-based organizations, and healthcare professionals to provide useful benefits to clients.

Inpatient Case Manager

Nacogdoches Medical Center
04.2017 - 04.2018
  • Conducted thorough assessments of patient needs, identifying barriers to healthcare access and solutions.
  • Developed and implemented comprehensive case management plans to address client needs and goals.
  • Maintained accurate documentation of all case management activities, ensuring compliance with regulatory standards.
  • Improved patient outcomes by developing comprehensive care plans and coordinating with multidisciplinary teams.
  • Facilitated family meetings to discuss patient care plans.
  • Participated in interdisciplinary care conferences to discuss patient care plans and referrals.
  • Utilized evidence-based best practices to guide clinical decision-making and optimize patient outcomes.
  • Coordinated patient discharge planning and follow-up care.
  • Enhanced patient satisfaction with thorough assessments, timely interventions, and clear communication of care plans.
  • Coordinated comprehensive discharge planning for patients, ensuring seamless transitions to post-acute care settings.
  • Educated patients and families on available resources and support services, empowering them to make informed decisions about their care.
  • Developed supportive professional relationships with patients to enhance quality of life and achieve self-sufficiency.
  • Reduced hospital readmissions by identifying high-risk patients and implementing targeted interventions.
  • Collaborated with healthcare providers to drive continuity of care.
  • Managed caseload to satisfy multiple patients with diverse needs.
  • Served as a liaison between patients, families, medical staff, and external agencies to facilitate effective communication throughout the continuum of care.

House Supervisor

Nacogdoches Medical Center
07.2014 - 04.2017
  • Serves as administrative authority for the smooth function of all units on assigned shift. Notifies administration on call and appropriate unit manager for urgent needs and keeps them informed of the needs and problems of non- urgent matters.
  • Assures that adequate staffing is in place for all units.
  • Provides clinical expertise in the management of medical and psychiatric emergencies.
  • Obtains supplies from Central Supply and Surgery Department after hours.
  • Restocks the Crash Cart immediately after use.
  • Works with the staffing schedule and nurse managers to assure that vacancies are filled in advance.
  • Complies with hospital’s policies and procedures.
  • Provides positive environment with co-workers, patients and their families.
  • Provides assistance with discharge planning during case management off hours.
  • Supervised nursing staff to ensure compliance with hospital policies and quality patient care standards.
  • Developed and implemented staffing schedules, optimizing resource allocation and operational efficiency.
  • Coordinated emergency response efforts, ensuring timely interventions for critical patients.
  • Served as a liaison between hospital administration and nursing staff, advocating for improvements that positively impacted patient care delivery.
  • Streamlined communication between departments for better patient care and timely treatment.
  • Promoted a safe working environment for nursing staff by enforcing strict adherence to safety guidelines.
  • Implemented evidence-based practices in nursing procedures, leading to improved patient outcomes.
  • Improved patient satisfaction by implementing efficient nursing schedules and staff assignments.
  • Ensured compliance with healthcare regulations through thorough documentation and adherence to protocols.
  • Championed interdisciplinary teamwork across various units within the hospital, resulting in a more cohesive and collaborative care approach.

Case Manager/Field Nurse

Texas Home Health
11.2015 - 12.2016
  • Evaluates and implements individualized plan of care according to patient needs.
  • Communicates with other health care providers to ensure appropriate treatment plans are provided.
  • Provides education for clients and their families regarding disease processes.
  • Maintains privacy and dignity to clients during treatments and visits.
  • Uses electronic charting using OASIS documentation.

Medical/Surgical Staff Nurse, and Relief Charge Nurse

Nacogdoches Medical Center
01.2008 - 07.2014
  • Performed all tasks with a patient-centered focus while seeking opportunities for improvement of processes and treatments.
  • Implemented new floor assignments based on evaluation of staffing requirements.
  • Assisted patients with healing and recovery after surgery.
  • Provided necessary health education training for patients.
  • Acted as patient advocate and implemented patient care through a team nursing process covering 7 patients per shift.
  • Provided behavioral/emotional support and supervision for those with dementia and Alzheimer’s.
  • Assisted patients with multiple chronic diagnoses including COPD and asthma.
  • Proficient with core measures with specific diagnosis.
  • Achieved departmental goals and objectives by instituting new processes and standards for in-patient care.
  • Evaluated patient care needs, prioritized treatment and maintained patient flow.
  • Accurately documented all elements of nursing assessment, treatments, medications, discharge instructions and follow-up care.
  • Responsible for Hemovac Autotransfusion System administration.
  • Worked as part of team to ensure proper care of body mechanics and safety of patient.
  • Partnered with team of Registered Nurses to ensure over all well-being of all patients.
  • Often commended for maintaining the safety, respect and dignity of patients.
  • Interviewed patients to obtain medical information and measure their vital signs, weight and height.
  • Maintained patient charts and confidential files.
  • Implemented care plans for patient treatment after assessing physician medical regimens.
  • Promoted patient and family comfort during challenging recoveries to enhance healing and eliminate non-compliance problems.
  • Communicated with healthcare team members to plan, implement and enhance treatment strategies.
  • Administered medications and treatment to patients and monitored responses.
  • Documented treatments delivered, medications and IVs administered, discharge instructions, and follow-up care.
  • Identified areas for improvement in nursing workflows through regular observation and feedback from staff members, implementing changes as needed to enhance efficiency.
  • Facilitated therapeutic communication, conflict resolution and crisis intervention by redirecting negative behaviors and helping patients regain or improve coping abilities.
  • Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing conditions.
  • Supported hospital accreditation efforts by ensuring adherence to established standards and best practices within the nursing department.
  • Assessed team members' workloads and pitched in to help in areas where need was most evident.
  • Provided skilled, timely and level-headed emergency response to critically-ill patients.
  • Conducted ongoing monitoring and evaluations of behaviors and conditions, and updated clinical supervisors with current information.
  • Educated patients and families on illnesses, medications and treatment plans.
  • Consistently evaluated clinical performance of nursing staff through regular observation and constructive feedback sessions, providing opportunities for growth and development.
  • Trained new nurses on protocols, procedures, and emergency response measures.
  • Managed complex cases of critically ill patients, ensuring optimal treatment plans were executed effectively.
  • Demonstrated strong clinical judgment in prioritizing interventions based on patient acuity levels and available resources.
  • Educated patients, families and caregivers on diagnosis and prognosis, treatment options, disease process, and management and lifestyle options.
  • Maintained up-to-date knowledge of emerging trends in nursing practice by attending relevant conferences, workshops, and webinars to better support the professional development of fellow nurses.
  • Devised individualized care plans tailored to each patient''s unique situation, optimizing clinical outcomes.
  • Monitored patient reactions after administering medications and IV therapies.
  • Monitored hemodynamic variances to identify signs of life-threatening complications.
  • Implemented infection control measures to reduce hospital-acquired infections, contributing to improved patient safety metrics.
  • Reduced medication errors through thorough review of medication orders and close monitoring of administration procedures.
  • Ensured compliance with regulatory standards, conducting regular audits of nursing documentation and practices.
  • Enhanced patient satisfaction through effective communication, empathy, and timely response to their needs.
  • Promoted a safe environment through strict adherence to infection control protocols, reducing the risk of hospital-acquired infections.
  • Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
  • Improved patient outcomes by collaborating with interdisciplinary healthcare teams to develop individualized care plans.
  • Facilitated safe discharges for patients by collaborating with case managers, social workers, and other healthcare professionals in developing comprehensive discharge plans.
  • Developed trusting relationships with patients and families, acting as an advocate for their needs within the healthcare system.

Inpatient Case Manager

Lufkin Memorial Hospital
06.2006 - 12.2007
  • Developed individualized plans of care for discharge according to patient's need for a smooth transition from hospital to home or another facility in accordance with policies.
  • Assessed patient's home situation and arranged patient's needs accordingly for home such as medical equipment, Home Health Agency, Home Hospice, etc.
  • Knowledgeable with Interqual criteria for meeting Inpatient or Observation Status.
  • Provided accurate clinical reviews for insurance companies.
  • Responsible for coordinating transfers with other acute facilities for higher level of care and arranging for transport.
  • Worked harmoniously with hospital staff to ensure patient's safety.

Medical/Surgical Staff Nurse, and Relief Charge Nurse

Nacogdoches Medical Center
06.2003 - 06.2006
  • Started intravenous fluids, administered medications, and documented patient charts by recording food and fluid output and intake.
  • Developed trusting relationships with patients and families, acting as an advocate for their needs within the healthcare system.
  • Recorded details regarding therapies to keep patient charts updated.
  • Facilitated therapeutic communication, conflict resolution and crisis intervention by redirecting negative behaviors and helping patients regain or improve coping abilities.
  • Observed and documented patient factors such as diets, physical activity levels, and behaviors to understand conditions and effectively modify treatment plans.
  • Offered exceptional care and support to individuals recovering from acute incidents and dealing with chronic conditions.
  • Provided health education to patients and families regarding discharge instructions and plans of care.
  • Administered medications and treatment to patients and monitored responses.
  • Monitored hemodynamic variances to identify signs of life-threatening complications.
  • Served as an advocate for patients'' rights and preferences, working closely with families to ensure their voices were heard during care planning discussions.
  • Implemented care plans for patient treatment after assessing physician medical regimens.
  • Monitored patient vital signs to perform thorough condition assessments.
  • Promoted a safe environment through strict adherence to infection control protocols, reducing the risk of hospital-acquired infections.
  • Quickly responded to situations impacting safety and security to unit, actualizing crisis prevention interventions to control and de-escalate situations.
  • Maintained up-to-date knowledge of emerging trends in nursing practice by attending relevant conferences, workshops, and webinars to better support the professional development of fellow nurses.
  • Improved patient satisfaction scores with attentive listening, empathy, and timely response to concerns.
  • Managed patients' pain by implementing pharmacological and non-pharmacological pain management interventions.
  • Ensured compliance with regulatory standards, conducting regular audits of nursing documentation and practices.
  • Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
  • Served as a preceptor for nursing students and new hires, sharing knowledge and expertise while fostering an environment conducive to learning.
  • Streamlined communication between interdisciplinary teams, optimizing patient treatment plans and outcomes.

Education

Bachelor - Science in Nursing

The University of Texas At Arlington
Arlington, TX
2023

Associate Degree - Nursing

Angelina College
05.2003

Skills

  • Recognized as an excellent care provider Outstanding in multitasking while providing quality care Proficient with computerized charting
  • Excellent verbal and communication skills Great organizational and time management skills Known as hardworking and trustworthy individual Disciplined, energetic individual who quickly establishes rapport with patients, physicians, and colleagues
  • Positive attitude
  • Problem-solving
  • Time management
  • Multitasking and organization
  • Critical thinking
  • Clear communication
  • Relationship building
  • Care coordination
  • Staff management
  • Case management
  • Utilization review
  • Reliability

Certification

  • Registered Nurse in the State of Texas (2003-05 - present) License number 697299
  • Licensed Vocational Nurse in the State of Texas (2002-10 - 2003) License number 186468
  • Basic Life Support Certified

Timeline

Utilization Review Nurse

McBee
07.2024 - Current

Inpatient Lead Case Manager

Nacogdoches Medical Center
04.2018 - Current

Inpatient Case Manager

Nacogdoches Medical Center
04.2017 - 04.2018

Case Manager/Field Nurse

Texas Home Health
11.2015 - 12.2016

House Supervisor

Nacogdoches Medical Center
07.2014 - 04.2017

Medical/Surgical Staff Nurse, and Relief Charge Nurse

Nacogdoches Medical Center
01.2008 - 07.2014

Inpatient Case Manager

Lufkin Memorial Hospital
06.2006 - 12.2007

Medical/Surgical Staff Nurse, and Relief Charge Nurse

Nacogdoches Medical Center
06.2003 - 06.2006

Bachelor - Science in Nursing

The University of Texas At Arlington

Associate Degree - Nursing

Angelina College

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Matheresa Jacob