Monica Fox
Lititz,PA
Summary
Registered Nurse with a background in direct care, triage, surgical support, and case management for complex patient populations. Brings strong written and verbal communication, attention to detail, EMR and Microsoft Office proficiency, and hands-on experience guiding members through authorization, appeals, and chronic disease care.
Overview
1
1
Certification
23
23
years of professional experience
Work History
Registered Nurse Case Manager
Highmark Wholecare
Pittsburgh, PA
10.2022 - Current
- Facilitated case management for Medicaid members, emphasizing care transitions and chronic disease management, while managing prior authorization and denial appeals.
- Delivered comprehensive case management services to diverse patient population, conducting needs assessments and developing individualized care plans.
- Coordinated discharge planning with providers, connected members to community resources, and participated in interdisciplinary meetings with care team, hospital staff, and medical director for complex cases.
- Participated in interdisciplinary meetings to review complex cases and share input on appropriate next steps.
- Communicated clearly with patients, families, and healthcare providers to support care coordination.
- Acted as liaison between patients, families, and insurance companies regarding service authorization.
- Maintained patient confidentiality in compliance with HIPAA guidelines and privacy measures.
Registered Nurse
Wellspan Health
Lebanon, PA
08.2019 - 09.2022
- Executed pre-operative orders, prepared patients for surgery, assessed for complications post-operation, and administered prescribed medications to ensure patient safety and readiness.
- Utilized critical thinking skills to assess changes in patient conditions, recognize complications and intervene appropriately.
- Managed multiple tasks to deliver timely, high-quality patient care in fast-paced environments, enhancing overall patient satisfaction.
- Collaborated with interdisciplinary team members, utilizing strong communication skills to facilitate optimal patient outcomes.
- Educated patients on post-surgical care and instructions.
Registered Nurse
Eden Park Pediatrics
Lancaster, PA
03.2004 - 09.2019
- Provided direct patient care, including assessment and evaluation of health status, development of individualized plans of care and implementation of nursing interventions.
- Administered medications and performed minor procedures such as suture removal, ear lavage, and urinary catheterization.
- Utilized critical thinking skills to assess changes in patient conditions, recognize complications and intervene appropriately.
- Educated patients on diagnosis, medications, nutrition, and pain management to empower self-care and improve health outcomes.
- Oversaw and guided medical assistants to enhance team effectiveness and patient support.
- Conducted telephone triage using pediatric protocols to ensure timely and appropriate care.
Education
Diploma of Nursing - Nursing
Geisinger School of Nursing
Danville, PASkills
- Chronic disease management
- Medicaid compliance
- HIPAA compliance
- EMR proficiency
- AI documentation
- Ability to manage case load of 50 or more cases
- Manage multiple tasks and prioritize
- Proficient in Excel and Microsoft office
- Attention to detail
- Strong verbal and written communication skills
Certification
- CCM certified
- RN License
Timeline
Registered Nurse Case Manager
Highmark Wholecare
10.2022 - Current
Registered Nurse
Wellspan Health
08.2019 - 09.2022
Registered Nurse
Eden Park Pediatrics
03.2004 - 09.2019
Diploma of Nursing - Nursing
Geisinger School of Nursing