Michelle Sue Gaines
Registered Nurse
Boynton Beach,FL
Summary
Michelle Gaines is a Registered Nurse in the state of Florida with an extensive experience of 15+ years in Case management which includes 12+year of experience in handling Maternity cases. Responsible for prioritizing patients' needs within a managed care environment. Successful nurse manager and Hospital Supervisor. Proficient in Medical terminology, Plan Benefits, Eligibility, Verification and Enrollment. Proficient Microsoft office and other Computer Skills.
Overview
36
36
years of professional experience
Work History
RN Telehealth
MDLIVE
Miramar, FL
04.2020 - 10.2021
- Provided direct patient care, stabilized patients and determined next course of action.
- Managed care from admission to discharge.
- Participated in nursing simulation activities, evidence-based practice project implementation and competency development to further nursing education.
- Taught patients how to improve lifestyle choices, dramatically reducing chance of symptom reoccurrence.
OB Triage Nurse
Aventura Medical Center
Aventura, FL
10.2016 - 05.2020
- Conduct health coaching and education to provide member self-care and self-management skills and tools during pregnancy and post-partum period.
- Collaborate with Center's clinical staff to coordinate care and determine most appropriate access to care (High risk OB/GYN).
- Provide support and emergency coverage for daily facility site and/or telephonic concurrent reviews and discharge planning and coordination of assigned hospitals as needed.
- Provide teaching on hypertension in pregnancy and instructed on proper use of at home blood pressure monitor and scale.
- Serves as a primary liaison between the doctor and patient.
- Upon arrival in the Emergency Room the OB Triage RN is responsible for communicating with patients, assessing and evaluating their needs and advising the patients of the recommended actions/course of treatment as directed by the Physician.
- Conducts the initial case management assessment including but not limited to pertinent medical history, current diagnosis and identifies goals for the treatment plan.
- Assessing and evaluating their needs and advising the patients of the recommended actions/course of treatment as directed by the Physician.
- Oversee utilization of population and disease management tools to improve health and wellness of our pregnant patients.
- Track and trends centers Meaningful Use and HEDIS performance metrics/ operations reports and communicates to centers outcomes data.
- Conduct member health education for members identified as at risk or high risk conditions during pregnancy telephonically.
- Handling inpatient visits for high risk members on behalf of health center for discharge education and center follow up care scheduling.
- Assist in quality improvement and development activities of clinical services processes, initiatives and programs.
- Manage ongoing tasks such as outbound calls to conduct health assessments from pre-conception through postpartum.
- Coordinate care and educate members on maternity/GYN procedures, and assist with self-management.
- Work with identified high risk members, with the member's family and health care providers to support adherence to the medical treatment plan.
- Participate in Center health education and disease management activities and initiates and identifies barriers to the plan of care and intervenes, as appropriate.
- Familiar with Interqual- is a set of criteria used to determine if a patient’s hospital length of stay is appropriate.
- NCQA - continues to promote population health management through the accreditation, Certification and recognition programs, the addition of a case management accreditation.
Nurse Case Manager II
Sunshine Health Plan
Sunrise, FL
06.2016 - 06.2018
- Conducts the initial case management assessment including but not limited to pertinent medical and obstetrical history, current diagnosis and identifies goals for the treatment plan.
- Initiates and identifies barriers to the plan of care and intervenes, as appropriate and promotes wellness and provides education regarding preventative care measures.
- Included prenatal assessments, abdominal measurements, fetal heart monitoring and pelvic exams, as well as trimester diagnostic testing Provides focused education and emotional support regarding risk factors.
- Worked with agencies and service providers to facilitate case coordination and information sharing.
- Responsible for health coaching and education to provide member self-care and self-management skills and tools during pregnancy and post-partum period.
- Maintained effective and efficient record keeping procedures including completing the required case file documents timely.
- Conduct inpatient visits for high/at risk members on behalf of health center for discharge education and center follow up care scheduling.
- Provided comprehensive health assessments such as physical, mental and psychosocial for multiple gynecologic and maternity patients.
- Assist in quality improvement and development activities of clinical services processes, initiatives and programs.
- Collaborate with contracted customers, health plan representatives and clinical staff to coordinate and address service and care issues.
Staff Nurse
West Boca Medical Center
Boca Raton, FL
02.2014 - 04.2016
- The care of L&D patients integrates the biophysical, socio-cultural, psychological and spiritual aspects of the individual and family.
- The care of L&D patients covers a wide spectrum, ranging from antepartum to postpartum and recovery room patients.
- Responsibility of overseeing the operation of the unit and was expected to serve as a consultant to nursing care coordinator of Patient Services.
- Supervisor of all staff on duty.
Case Manager Supervisor
Prestige Healthcare
New York, NY
10.2014 - 12.2015
- Conducts the initial case management assessment including but not limited to pertinent medical and obstetrical history, current diagnosis and identifies goals for the treatment plan.
- Supervised 2 offices - Staff of 25 Case Managers.
- All office based Telephonic Case Managers.
- Monitored calls to patients, chart review, coordinating care, used decision support software for pre- authorizations and prior authorizations.
- Initiates and identifies barriers to the plan of care and intervenes, as appropriate.
Nurse Case Manager/Clinical Supervisor
ALERE LLC Remote
, GA
01.2008 - 10.2014
- Conducts the initial case management assessment including but not limited to pertinent medical and obstetrical history, current diagnosis and identifies goals for the treatment plan.
- Initiates and identifies barriers to the plan of care and intervenes, as appropriate.
- Promotes wellness and provides education regarding preventive care measure.
- Provides focused education and emotional support regarding risk factors.
- Supports and actively participates in all leadership activities and training opportunities.
- Identifies at-risk employees and collaborates with clinical manager on strategies to retain, reduce turnover and improve employee satisfaction.
School Nurse
Kol Tikvah Preschool
08.2002 - 01.2008
- Clinical care, immunizations, lice checks, care coordination, forms kept up to date.
Staff Nurse
The New York-Presbyterian Hospital
New York City, NY
01.1991 - 01.2002
- Unit.
- The care of L&D patients integrates the biophysical, socio-cultural, psychological and spiritual aspects of the individual and family.
- The care of L&D patients covers a wide spectrum, ranging from antepartum to postpartum and recovery room patients.
- Operating room skills experiences include circulating and scrub nurse.
- Charge nurse- Responsibility of overseeing the operation of the unit and was expected to serve as a consultant to nursing care coordinator of Patient Services.
- Supervisor of all staff on duty.
- Representative of administration and its goals.
Staff Nurse
Neonatal Intensive Care Unit
01.1986 - 01.1991
- Provided care for critically ill newborns including operating highly technological monitoring equipment and recognize physiological changes in newborn’s condition.
- Possessed in depth knowledge of the physiology of the body systems and social skills needed to help parents cope with stress.
Education
B.S - Nursing
State University of New York – Downstate Medical Center
B.S - Nursing
Wilkes University
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State University of New York
Skills
- Chronic Disease Management
- Triaging
- Acute Care Expertise
Timeline
RN Telehealth
MDLIVE
04.2020 - 10.2021
OB Triage Nurse
Aventura Medical Center
10.2016 - 05.2020
Nurse Case Manager II
Sunshine Health Plan
06.2016 - 06.2018
Case Manager Supervisor
Prestige Healthcare
10.2014 - 12.2015
Staff Nurse
West Boca Medical Center
02.2014 - 04.2016
Nurse Case Manager/Clinical Supervisor
ALERE LLC Remote
01.2008 - 10.2014
School Nurse
Kol Tikvah Preschool
08.2002 - 01.2008
Staff Nurse
The New York-Presbyterian Hospital
01.1991 - 01.2002
Staff Nurse
Neonatal Intensive Care Unit
01.1986 - 01.1991
B.S - Nursing
State University of New York – Downstate Medical Center
B.S - Nursing
Wilkes University
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State University of New York