Moraig Gawlitza
Litchfield Park,AZ
Summary
Telephonic Nurse Case Manager with proven track record in productivity and efficiency. Expertise in patient advocacy, care coordination, and health education, leading to improved patient outcomes. Strong communication and problem-solving skills utilized to manage cases and support patients and families effectively. Experienced in documentation management and daily living support for disabled clients, demonstrating excellent organizational abilities.
Overview
20
20
years of professional experience
1
1
Certification
Work History
Telephonic Nurse Case Manager
Aetna, a CVS Health
San Antonio, Texas
11.2015 - 05.2021
- Identified opportunities for cost savings through utilization management strategies.
- Developed relationships with community resources to ensure appropriate referrals are made.
- Maintained detailed case notes in the electronic health record system.
- Assisted with coordination of transitions of care across settings including discharge planning activities.
- Coordinated services between primary care physician, specialists, ancillary providers and community resources.
- Performed follow up calls to assess patient satisfaction with care received.
- Assessed patient eligibility for insurance coverage and benefits.
- Monitored patient progress, identified barriers, and intervened as needed.
- Participated in interdisciplinary team meetings related to individual cases.
- Provided telephonic health coaching and education to patients.
- Interpreted laboratory results and imaging studies for assigned patients.
- Facilitated timely authorizations for requested services.
- Served as a liaison between patients and families and healthcare providers.
- Developed care plans in collaboration with physicians and other healthcare providers.
- Educated patients on various disease processes, treatments, medications, lifestyle modifications.
- Reviewed referrals from primary care physicians or other sources for appropriateness of service levels based upon clinical criteria.
- Conducted comprehensive assessments of patient's medical history and needs.
- Consulted with pharmacists regarding drug interactions or side effects when necessary.
- Provided telephone triage services by responding to callers' inquiries regarding their health concerns.
- Counseled patients on self-management techniques such as medication adherence and symptom management.
Transitional RN Case Manager
Scottsdale Healthcare Hospital TPK
Scottsdale, Arizona
10.2005 - 05.2014
- Developed discharge plans for patients transitioning from acute care settings to home or alternate facilities.
- Conducted weekly interdisciplinary team meetings to review case management activities for assigned caseloads.
- Reviewed clinical data including lab results, radiology reports and vital signs to assess appropriateness of treatments.
- Facilitated transitions between levels of care through effective coordination of resources within a managed care environment.
- Assessed patient's physical, mental, and psychosocial health status to develop individualized care plans.
- Communicated regularly with family members regarding patient care needs and progress toward goals.
- Participated in quality improvement initiatives related to case management processes.
- Analyzed financial information related to insurance coverage eligibility prior to initiating services.
- Monitored and evaluated effectiveness of treatment plans and interventions.
- Maintained accurate documentation of patient progress in the electronic health record.
- Collaborated with physicians, nurses, and other healthcare professionals to ensure optimal patient outcomes.
- Ensured compliance with regulatory standards concerning utilization review, ethical decision making and legal aspects of case management practice.
- Attended continuing education seminars relevant to case management practices.
- Coordinated medical services between primary care providers, specialists, hospitals and outpatient clinics.
- Provided emotional support and counseling to patients dealing with chronic illness or end-of-life issues.
- Identified high-risk cases requiring intensive monitoring or specialized interventions.
- Provided direct nursing care such as wound dressing changes, IV therapy, medication administration and patient education.
- Facilitated referrals to community resources for additional support services.
- Actively participated in multidisciplinary rounds discussing complex cases with members of the healthcare team.
- Educated patients on disease prevention strategies, wellness promotion techniques and lifestyle modifications.
- Coordinated with healthcare team to establish, enact and evaluate patient care plans.
- Delivered information regarding care and medications to patients and caregivers in comprehendible terminology.
- Monitored diet, physical activity, behaviors and other patient factors to assess conditions and adjust treatment plans.
- Helped patients and families feel comfortable during challenging and stressful situations, promoting recovery and reducing compliance issues.
- Observed strict safety measures, including checking medication dosages before administration to patients.
- Prepared medical equipment and tools to aid physician during examination and treatment of patients.
- Advocated for patient needs with interdisciplinary team and implemented outlined treatment plans.
- Referred patients to specialized health resources or community agencies to furnish additional assistance.
- Achieved departmental goals and objectives by instituting new processes and standards for in-patient care.
- Interpreted and evaluated diagnostic tests to identify and assess patient's condition.
RN Care Coordinator
United Healthcare Evercare
Phoenix, Arizona
10.2002 - 10.2005
- Coordinated communication between physicians, nursing staff, patients, and families to facilitate the delivery of healthcare services.
- Collaborated with community partners such as social service agencies and home health providers to coordinate resources for patients in need of additional support services.
- Ensured compliance with applicable laws, regulations, accreditation standards, policies and procedures related to clinical care management activities.
- Performed chart audits on a periodic basis in order to evaluate accuracy of documentation completed by clinicians.
Intake RN
VNS of Connecticut
Bridgeport, Connecticut
06.2001 - 06.2003
- Educated patients on self-management strategies such as lifestyle modifications and stress reduction techniques.
- Monitored vital signs of all patients during their stay in the facility.
- Documented patient care information including history, vitals, treatments, and results in electronic health records system.
- Maintained a safe environment for all patients by following policies and procedures related to infection control.
- Obtained informed consent from patients prior to any medical procedure or test.
- Managed multiple tasks simultaneously while providing quality nursing care in a timely manner.
- Coordinated referrals to other healthcare providers or specialists as needed.
- Developed individualized care plans based on each patient's unique needs.
- Recorded care information accurately and completely in electronic data system.
Education
Diploma - Nursing Diploma
St Vincent's Medical Center School of Nursing
Bridgeport, CT06-1977
Skills
- Multidisciplinary approach
- Chronic disease management
- Medication management
- Quality improvement
- Cultural history
- Clinical assessment
- Case evaluation
- Home care management
- Utilization review
- Healthcare regulations
- Community resources
- HIPAA compliance
- Palliative care
- Routine examinations
- Student precepting
- Wound care
- Microsoft office
- Teamwork and collaboration
- Healthcare informatics
- Creative problem solving
- Interpersonal skills
- Patient advocacy
- Health education
- Preventive health
- Interpersonal communication
- Training staff
- Documentation
- Orthopedic care
- Medication reconciliation
- Acute care expertise
- Patient assessment
- Decision-making
- Multitasking
- Adaptability and flexibility
- Patient care assessment
- Analytical thinking
- Clear patient communication
- Patient and family advocacy
- Pain management
- Patient care oversight
- Procedure assistance
Affiliations
- Enjoys time with my family and dogs
- Loves to travel especially to anything Disney!
- Daily Bible Study
Accomplishments
Case Manager of the Year runner up 2013
Certification
- RN license in Arizona
Languages
English
Professional
Timeline
Telephonic Nurse Case Manager
Aetna, a CVS Health
11.2015 - 05.2021
Transitional RN Case Manager
Scottsdale Healthcare Hospital TPK
10.2005 - 05.2014
RN Care Coordinator
United Healthcare Evercare
10.2002 - 10.2005
Intake RN
VNS of Connecticut
06.2001 - 06.2003
Diploma - Nursing Diploma
St Vincent's Medical Center School of Nursing
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