Michelle Newland
Summary
Nurturing and committed individual with 17 years of experience working in a commercial health plan setting is seeking advancement to CM mentor. Possesses a strong passion for working directly with people to identify concerns, goals, and support
Overview
34
34
years of professional experience
1
1
Certification
Work History
Integrated Care Manager
BCBS Of Arizona
02.2014 - Current
- Seeks member engagement in the CM process to promote health awareness, identify barriers, provide resources and identify their personal health care goals
- Pro-actively works with the members to identify concerns, and barriers that can lead to gaps in care or the inability to meet their health care needs.
- Collaborates with the member to develop an individual care plan and appropriate interventions that will address concerns and optimize management of the health condition.
- Provides education and support to members and families on disease management, preventive health, access to care, and treatment options that promotes improvement with self-management of their health condition, reduces risk of an admission or readmission, and promotes overall wellness.
- Participates in the onboarding, training, and mentorship of new employees when there is a need.
- Actively participated in the roll out of the Rapid Response Team, and remains active on the team to prevent members with a life altering conditions to prevent delays in obtaining urgent diagnostics or recommended treatments,
- Actively participates in interdisciplinary care round to review cases, share insights, discuss challenges, and develop solutions that promotes members quality of life, and return to the most optimal level of wellness.
Complex Case Manager
Excellus BCBS Of WNY
12.2006 - 01.2014
- Conducted comprehensive clinical assessments for members of the health plan to identify areas of concerns, gaps in care, and barriers that may limit member's access to health care.
- Facilitated timely access to healthcare services for members by determine available resources, and navigating insurance coverage, and advocating on the member's behalf.
- Mentored new case managers through training sessions, and job shadowing opportunities,
- Identified as a subject matter expert SME in the roll out of a new care planning system Vital, acting as resource for staff to answer questions, problem=solve, and to assist staff with becomeomg proficient with its use.
- Participated in activities such as chart audits and updating work flows in preparation for accreditation with regulatory agencies NCQA and URAC.
ICU Staff RN II/Relief Charge RN
Unity Health System
06.1990 - 06.2006
- Provided exceptional care to critically ill patients requiring life-sustaining interventions such as ventilator management, complex wound care, balloon pumps, Intracranial pressure monitoring, CVP monitoring and more.
- Educated patients, families and caregivers on diagnosis and prognosis, treatment options, disease process, and management and lifestyle options.
- Maintained accurate and timely documentation of patient assessments, interventions, responses, and outcomes to ensure seamless transition of care during shift changes.
- Participated in regular rounds with interdisciplinary team members to discuss ongoing plans of care tailored specifically towards patients'' evolving needs.
- Collaborated with physicians to assess, plan, implement, and evaluate individualized patient interventions.
- Developed individualized care plans tailored to diverse patient populations with varied medical conditions.
- Managed staffing assignments for each shift based on patient acuity levels, ensuring adequate coverage for all areas of the ICU
- Mentored and trained new nurses, ensuring they were well-prepared to provide high-quality care in critical situations.
- Contributed to successful department JCAHO accreditation by consistently operating to highest standards of care.
- Audited charts and reviewed clinical documents to verify accurate documentation and quality
- Skilled at working independently and collaboratively in a team environment.
- Utilized strong clinical judgment in prioritizing patient needs during high-stress situations, ensuring optimal outcomes.
Education
Associate of Applied Science - Nursing
Monroe Community College
Rochester, NYSkills
- Strong Critical Thinking Skills
- Effective problem solving skills
- Excellent verbal and written skills
- Experience with training and mentoring
- Compassionate, Empathetic and People oriented
- Proficient with Microsoft/Excel/PowerPoint/One note
- Extensive acute care background
- Motivational interviewing
Certification
- CCM Certification
- ACLS, BLS, PALS certification
Timeline
Integrated Care Manager
BCBS Of Arizona
02.2014 - Current
Complex Case Manager
Excellus BCBS Of WNY
12.2006 - 01.2014
ICU Staff RN II/Relief Charge RN
Unity Health System
06.1990 - 06.2006
Associate of Applied Science - Nursing
Monroe Community College
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