MIRIAM KELLEY
Omaha,NE
Summary
Compassionate Case Manager accustomed to treating diverse patient needs while managing dynamic conditions. Collaborative professional possessing excellent clinical knowledge and judgment combined with strong documentation and problem-solving abilities. Well-versed in managing emergent cases with poise.
Overview
5
5
years of professional experience
Work History
Medicare & Medicaid Case Manager, RN
Molina Healthcare
01.2025 - Current
- Manage an assigned caseload of approximately 700 Medicare and Medicaid members with complex healthcare needs.
- Reviewed inpatient records during hospitalizations to assess clinical conditions, identify care needs, and coordinate services.
- Examined discharge summaries, ED encounters, and utilization patterns to identify care gaps and facilitate targeted outreach.
- Complete health risk assessments and create, monitor, and revise individualized care plans.
- Coordinated transitions of care and medication reconciliation post-hospital and ED visits, addressing follow-up barriers and supporting ED diversion efforts.
- Work with providers and health-plan teams on coverage, eligibility, and prior authorization questions; document interventions accurately.
Cardiac Registered Nurse
Nebraska Medicine
Omaha, NE
11.2022 - 06.2025
- Care for medically complex cardiac patients, including LVAD recipients, heart/lung transplant patients, artificial hearts, and post-cardiac surgery patients.
- Interpreted telemetry, ECGs, hemodynamic data, and clinical status changes; communicated concerning findings to ensure timely interventions.
- Managed specialized cardiac infusions and external pacing, coordinating with interdisciplinary teams to optimize treatment and discharge planning.
- Reviewed orders, treatment plans, medications, and clinical documentation in Epic to ensure delivery of safe, evidence-based care.
Float Pool Registered Nurse
North Kansas City Hospital / Aya Healthcare
Kansas City, MO
02.2024 - 05.2024
- Conducted patient assessments and delivered treatments across various inpatient units to address diverse acuity and care needs.
- Coordinated handoffs and ensured continuity of care while accurately documenting in Cerner.
- Delivered bedside nursing care in acute care hospital and travel assignments
- Completed patient assessments and updated electronic health records
- Administered medications and monitored responses per hospital protocols
Behavioral Health Registered Nurse
Boys Town National Research Hospital
Omaha, NE
12.2021 - 12.2022
- Assessed behavioral health needs and monitored psychiatric medications to inform individualized care plans.
- Collaborated with interdisciplinary teams to facilitate therapeutic group sessions that supported patient recovery.
- Performed behavioral assessments for pediatric patients at Boys Town National Research Hospital.
- Administered psychotropic medications and monitored responses during inpatient care.
- Implemented crisis intervention and de-escalation techniques during acute behavioral episodes.
Education
Bachelor of Science - Nursing (BSN)
Nebraska Methodist College of Nursing and Allied Health
05-2021
Bachelor of Arts - Sociology
University of California, Santa Barbara
05-2010
Skills
- Medicare & Medicaid
- Case management
- Care coordination
- Health risk assessments
- Transitions of care
- Medication reconciliation
- Clinical record review
- Emergency department diversion
- Authorization workflows
- Chronic Care Management
- Epic & Cerner
- Epic, Cerner
- Registered Nurse — Multistate Compact License
- Microsoft Office
- Spanish: Native proficiency
- Patient Education
Personal Information
Title: UTILIZATION MANAGEMENT NURSE CONSULTANT
Timeline
Medicare & Medicaid Case Manager, RN
Molina Healthcare
01.2025 - Current
Float Pool Registered Nurse
North Kansas City Hospital / Aya Healthcare
02.2024 - 05.2024
Cardiac Registered Nurse
Nebraska Medicine
11.2022 - 06.2025
Behavioral Health Registered Nurse
Boys Town National Research Hospital
12.2021 - 12.2022
Bachelor of Science - Nursing (BSN)
Nebraska Methodist College of Nursing and Allied Health
Bachelor of Arts - Sociology
University of California, Santa Barbara