Michelle Graves
Tularosa,NM
Summary
Self-motivated, compassionate, and dependable Registered Nurse experienced in case management. Dedicated to helping clients identify needs and coordinate care within multi-disciplinary teams. Committed to maintaining open communication with staff members and leaders to increase collaboration and eliminate operational gaps.
Overview
19
19
years of professional experience
Work History
Case Manager Remote
Premier- Contigo Health Division
Charlotte, NC
02.2023 - Current
- Remote case management duties to include reviewing, approving and inputting plans of care for surgical procedures.
- Determine organizational policies regarding program eligibility, requirements and benefits.
- Assisting members in completing pre surgical clearance, reviewing clinicals and documenting in EHR.
- Providing ongoing patient education from initial intake to pre-op, post-op and follow up care.
- Responsible for reviewing clinical notes, labs and diagnostic testing and collaborating with interdisciplinary team.
- Consult with staff on resolution of complex service issues.
- Review treatment plans against individual goals and healthcare standards.
- Transition clients to different providers based on geographical location and medical needs.
- Coordinate care with various insurance carriers.
Home Health Nurse
Mountain Shadows Home Health Inc.
Alamogordo, NM
07.2005 - Current
- Develop individualized care plans, covering goals based on nursing diagnosis and incorporating therapeutic, preventive and rehabilitative nursing actions.
- Responsible for overall case management to ensure patient has access to care, medication and specialty programs as needed.
- Collaborate with clinical staff to advocate for individual patient needs and insurance coverage.
- Knowledgeable with prior authorizations, referral management, and denial processes.
- Complete tele-visits and home visits as needed to maintain patient safety and health.
- Identify potential problems, patient care trends, and report to interdisciplinary team as needed.
- Collaboration with community resources to meet patient/family needs.
- Troubleshoot and resolve complex customer service issues to enhance patient and family experience.
- Demonstrate flexibility during changes to patient care practice.
- Schedule evaluations and procedures for patients.
- Utilize nursing skills for wound care, vital signs, and medication assistance.
- Provide home health aides with training, guidance, and support, as well as supervision to achieve objectives.
- Assist patients with activities of daily living and functional mobility to increase comfort and quality of life.
Director of Nursing
Presbyterian Medical Services
, NM
11.2016 - 11.2021
- Oversaw the daily operations of the nursing department including staffing, scheduling, budgeting, and resource allocation.
- Provided ongoing employee education, training and compliance while fostering an environment supportive of both employees and patients for three family practice clinics.
- Responsible for implementing standards of practice to ensure compliance and patient safety.
- Provided preventative care to the needy and vulnerable in the community.
- Provided ongoing care coordination for pediatric, adult and geriatric patients from diverse backgrounds.
- Effectively communicated with multi-disciplinary team to meet patient needs and goals.
- Ability to lead clinical teams in maintaining CLIA Certification for Point of Care testing and maintaining quality control measures for definitive and screening waived tests.
- Responsible for pharmacy drug room ordering, expirations and adhering to policy and procedure according to the New Mexico Board of Pharmacy.
- Administers vaccines, injections and oral medications as ordered by providers.
- Assist with minor procedures as requested by providers.
- Conducted quality improvement audits to include chart reviews, and patient quality indicators to meet state and federal guidelines.
- Experienced in working with NM Medicaid and Medicare, private insurance, and TriCare regarding referrals, prior authorizations, and denials.
- Triaged patients for primary care visits, provided point of care testing and documented in EHR.
Resource RN-Outpatient Surgery Registered Nurse
Gerald Champion Regional Medical Center
Alamogordo, NM
11.1996 - 2005
- 2000-2005- Clinical Resource/Lead RN-Pre-op and step down recovery in outpatient unit.
- Obtained pre-admission evaluations, testing, and labs for surgical procedures.
- Collected lab specimens, ordering and interpreting diagnostic tests and lab results.
- Gathered current medical information and reviewed histories to gather details for surgeons.
- Collaborated with surgeons and anesthesia team regarding abnormal testing and plan of care.
- Conveyed information to patients about arrival times and preoperative procedures.
- Trained nursing staff on patient care, safety and skills, while supporting growth and professional development.
- Evaluated and documented on patients recovering from surgeries and post anesthesia.
- Employed nursing best practices and clinical judgment to continuously evaluate patients' progress and employed intervention to achieve desired outcomes.
- 1996-2000- RN on Med/Surg Unit
- 2022-Case Management & Education
Education
Master of Science - Nursing Education
Eastern New Mexico University
Portales, NM05.2015
Bachelor of Science - Nursing
New Mexico State University
Las Cruces, NM12.2004
Associate of Science - Nursing
New Mexico State University At Alamogordo
Alamogordo, NM05.1995
Skills
- Experience in remote case management
- Ability to implement or change individualized care plans utilizing the nursing process
- Knowledgeable with pre-op testing, planning and education
- Experience with prior authorization, referral management and denial processes
- Critical thinking and analytical skills
- Knowledgeable with Medicaid, Medicare, and private insurance practices
- Experience with diverse populations
- Knowledgeable with Medically Fragile Program
- Chart reviews/audits
- Healthcare operations
- Utilization review
- Diabetes management
- ICD 10 Coding and billing
- Lab Director/CLIA Waived knowledge
- Documentation in electronic health records
- Accreditation coordination
- Recruiting and hiring
- Multidisciplinary team collaboration
- Performance metrics
- Quality assurance
- Employee retention strategies
- Schedule management
- Patient safety
- Staff supervision
Timeline
Case Manager Remote
Premier- Contigo Health Division
02.2023 - Current
Director of Nursing
Presbyterian Medical Services
11.2016 - 11.2021
Home Health Nurse
Mountain Shadows Home Health Inc.
07.2005 - Current
Resource RN-Outpatient Surgery Registered Nurse
Gerald Champion Regional Medical Center
11.1996 - 2005
Master of Science - Nursing Education
Eastern New Mexico University
Bachelor of Science - Nursing
New Mexico State University
Associate of Science - Nursing
New Mexico State University At Alamogordo
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