Melinda Halbloom
Melbourne,IA
Summary
Accomplished Registered Nurse Case Manager with 30 + years of experience dedicated to quality care of diverse patients. Skillfully blend hands-on skills with advanced background in acute LTC settings. Work effectively with all levels of healthcare providers, physicians and administrators to address patient needs. Seasoned nursing professional offering proven clinical knowledge, natural interpersonal strengths and technical abilities. Knowledgeable about EMR charting, medication administration and interdisciplinary collaboration focused on optimizing patient care and support. Quality-focused and efficiency-driven leader.
Overview
20
20
years of professional experience
Work History
RN Case Manager
Centene Iowa Total Care
03.2019 - 12.2020
- Advocated for patients by communicating care preferences to practitioners, verifying interventions met treatment goals and identifying insurance coverage limitations.
- Effectively communicated with physicians regarding patient needs, performance, medications and changes.
- Evaluated healthcare needs, goals for treatment, and available resources of each patient and connected to optimal providers and care.
- Responded promptly and professionally to patient questions and concerns.
- Created individualized care plans based on nursing diagnosis and incorporated appropriate nursing methods to achieve positive outcomes.
RN Reviewer
AmeriHealth Caritas Family Of Companies
02.2016 - 11.2018
- Evaluated patient histories, complaints, and current symptoms.
- Communicated with healthcare team members to plan, implement and enhance treatment strategies.
- Documented treatments delivered, medications and IVs administered, discharge instructions, and follow-up care.
- Using Inter Qual program evaluated patient records for necessity of care and payment
- Prepared paperwork for physician review on all denials
RN
Healthways
04.2012 - 12.2015
- Educated patients, families and caregivers on diagnosis and prognosis, treatment options, disease process, and management and lifestyle options.
- Telephone work and used strategies for health coaching to assist patients in a better life Calling out to more than 50 patients per day with over 90% return call from patient
RN Reviewer
Aetna
07.2014 - 09.2014
- Communicated with healthcare team members to plan, implement and enhance treatment strategies.
- Documented treatments delivered, medications and IVs administered, discharge instructions, and follow-up care.
- Evaluated electronic medical records for continued Skilled Nursing Stays using Medicare Medicaid guidelines
RN
ChildServe Childcare Center
03.2007 - 03.2012
- Administered medications via oral, IV, and intramuscular injections and monitored responses.
- Administered medications and treatment to patients and monitored responses while working with healthcare teams to adjust care plans.
- Educated patients, families and caregivers on diagnosis and prognosis, treatment options, disease process, and management and lifestyle options.
- Managed care from admission to discharge.
- Updated patient charts with data such as medications to keep records current and support accurate treatments.
- Evaluated healthcare needs, goals for treatment, and available resources of each patient and connected to optimal providers and care.
RN Staff Nurse
Mercy General Hospital
01.2001 - 05.2004
- Performed various nursing interventions such as wound dressing, vital sign monitoring, and specimen collection.
- Monitored patients' conditions and reported changes in physical presentation, appearance, and behavior to discuss treatment with physicians.
- Administered medications via oral, IV, and intramuscular injections and monitored responses.
- Assessed physical, psychological, physiologic, and cognitive status of patients.
- Implemented medication and IV administration, catheter insertion, and airway management.
- Gathered patient health data through interviews and observation, documenting data in electronic records.
Education
Bachelor of Science - Nursing
Chamberlain College of Nursing
St Louis, MO03.2012
Associate of Science - RN
Iowa Valley Community College - Marshalltown Community College
Marshalltown, IA12.1984
Associate of Applied Science - LPN
Iowa Valley Community College - Marshalltown Community College
Marshalltown, IA12.1980
Skills
- Emotional Awareness
- Medicare Regulation
- Medical Screening
- Patient and Family Advocacy
- Shared Governance
- Chronic Disease Management
- Body Mechanics Knowledge
- Disease Management Programs
- Disease Processes
- Managing Deadlines
- Disease Specialization
- Case Conferences
- EMR Systems
- HIPAA Education
- Strong Clinical Judgment
- Determine Medical Necessity
- Team Coordination
- Setting Up Referrals
- ICD-9 Forms
- Care Management
- Chronic disease management
Timeline
RN Case Manager
Centene Iowa Total Care
03.2019 - 12.2020
RN Reviewer
AmeriHealth Caritas Family Of Companies
02.2016 - 11.2018
RN Reviewer
Aetna
07.2014 - 09.2014
RN
Healthways
04.2012 - 12.2015
RN
ChildServe Childcare Center
03.2007 - 03.2012
RN Staff Nurse
Mercy General Hospital
01.2001 - 05.2004
Bachelor of Science - Nursing
Chamberlain College of Nursing
Associate of Science - RN
Iowa Valley Community College - Marshalltown Community College
Associate of Applied Science - LPN
Iowa Valley Community College - Marshalltown Community College
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