Moraig Gawlitza
BUCKEYE,AZ
Summary
Accomplished Registered Nurse Case Manager with 18+ years of experience dedicated to quality care of diverse patients. Skillfully blend hands-on skills with advanced background in acute inpatient care, short term care facility settings. Work effectively with all levels of healthcare providers, physicians and administrators to address patient needs. Dedicated and compassionate Registered Nurse (RN) with progressive career history in direct patient care, triage and care coordination in fast-paced environment. Proven to remain calm under pressure and skillfully handle difficult patients and high-stress situations. Consistently developing strong relationships with patients and families through empathetic communication, respectful attitude and excellent customer service. Accomplished Registered Nurse Case Manager with 15+ years of experience dedicated to quality care of diverse patients. Skillfully blend hands-on skills with advanced background in hospital and insurance office settings. Work effectively with all levels of healthcare providers, physicians and administrators to address patient needs. Accomplished Registered Nurse Case Manager with 15+ years of experience dedicated to quality care of diverse patients. Skillfully blend hands-on skills with advanced background in hospital and insurance office settings. Work effectively with all levels of healthcare providers, physicians and administrators to address patient needs.
Overview
18
18
years of professional experience
1
1
Certification
Work History
RN Case Manager
Aetna
11.2015 - 05.2020
- Effectively communicated with physicians regarding patient needs, performance, medications and changes.
- Completed initial assessments of patients and family to determine and address individual home care needs. ·
- Coordinated with interdisciplinary professionals to develop plans of care, administer tests and monitor patient status.
- Advocated for patients by communicating care preferences to practitioners, verifying interventions met treatment goals and identifying insurance coverage limitations.
- Evaluated healthcare needs, goals for treatment and available resources of each patient and connected to optimal providers and care.
- Responded promptly and professionally to patient questions and concerns.
- Created individualized care plans based on nursing diagnosis and incorporated appropriate nursing methods to achieve positive outcomes.
- Participated in patient and family planning process, as well as provided instructions and addressed question and concerns.
- Liaised with physicians regarding patient needs, performance and changes.
- Coordinated rehabilitative and preventive nursing processes and procedures.
Transition Case Manager
Scottsdale Healthcare Thompson Peak Hospital
10.2005 - 05.2014
- Took active role in patient and family planning process, detailing instructions and responding appropriately and effectively to questions and concerns.
- Built partnerships with related organizations to develop support and gain greater attention for important issues.
- Educated young people about strategies for driving discussions and promoting social changes.
- Became strong advocate for patient reform.
- Effectively communicated with physicians regarding patient needs, performance, medications and changes.
- Completed initial assessments of patients and family to determine and address individual home care needs. ·
- Coordinated with interdisciplinary professionals to develop plans of care, administer tests and monitor patient status.
- Evaluated healthcare needs, goals for treatment and available resources of each patient and connected to optimal providers and care.
- Responded promptly and professionally to patient questions and concerns.
- Participated in patient and family planning process, as well as provided instructions and addressed question and concerns.
- Conducted regular re-evaluations to address changes in needs and conditions, introducing revisions to care plans.
- Worked with suppliers and vendors on provision of medical equipment, items and services.
- Coordinated rehabilitative and preventive nursing processes and procedures.
- Coordinated and managed volunteer activities for community service projects.
- Led group discussions and activities to meet different community needs.
- Approached issues proactively to best meet current and future community needs.
- Facilitated community outreach to expand participation and support.
Clinical Care Coordinator
Evercare/United Healthcare
10.2002 - 10.2005
- Coordinated, monitored, assigned and documented patient and clinical care activities.
- Provide ongoing case management to patients to implement appropriate treatment plan, adhere to quality models and maximize utilization of services needed to achieve optimal outcomes.
- Verified insurance and communicated coverage to staff and patients.
- Filed and tracked insurance claims and communicated claims status to patients.
- Prepared insurance claims for submission to clearinghouses or insurance companies.
- Obtained prior authorization and precertification for outpatient procedures.
- Checked documentation for accuracy and validity on updated systems.
- Mentored new clinical staff members for proper onboarding and orientation processes.
- Built strong relationships with patients and families for optimized care satisfaction.
- Organized systems for tracking patient records to improve ease of retrieval.
- Coordinated, monitored, assigned, and documented patient and clinical care activities.
Education
Nursing Diploma - Nursing
St Vincent's Medical Center School of Nursing
Bridgeport, CT06.1977
Skills
- Mental and Physical Assessments
- Patient Discharging
- Patient and Family Advocacy
- Complex Problem-Solving
- Determine Medical Necessity
- Team Coordination
- HIPAA Education
- Care Plan Development
- Intakes and Discharges
- Patient Care Planning
- Patient Admission
- Medical Consultation
- Care Management
- Long-Term Care
- Setting Up Referrals
- Hospice Philosophy Understanding
- Patient Intervention
- Patient Assessments
- Patient Counseling
- Patient Care
- Staff Training
- Patient Health Information Access
- Case Conferences
- Case Management Activities
Accomplishments
Awarded Case Manager of the Year , runner up in 2013.
- Patient Advocacy - Explained treatment procedures, medication risks, special diets and physician instructions to patients.
- Documentation - Ensured charting accuracy through precise documentation.
Certification
- InterQual certified Instructor , McKesson - 2011,2012
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Quote
Trust in the Lord with all your heart, and do not lean on your own understanding. In all your ways acknowledge Him, and He will direct your paths.
Proverbs 3:5=6; The Bible
Timeline
RN Case Manager
Aetna
11.2015 - 05.2020
Transition Case Manager
Scottsdale Healthcare Thompson Peak Hospital
10.2005 - 05.2014
Clinical Care Coordinator
Evercare/United Healthcare
10.2002 - 10.2005
Nursing Diploma - Nursing
St Vincent's Medical Center School of Nursing