Natalie Holmes

• Outreach to referred patients who may have or is at risk of developing kidney disease to offer company care coordination services offered thru their insurer.
• Document outreach call details in charts of potential member
• If member accepts offer, appointment for initial CMA (care management assessment) with NCM(nurse care manager) is scheduled.
• Input member additional detailed medical information obtained during call.
• Increased outreach attempts from 25 calls to 65-110 outreach calls daily

Admitting accepted patients to the 32-bed rehab unit by converting to inpatient status from outside facilities, or in house transfers.

Team collaboration to ensure that the patients stay was satisfactory and their needs were met.

• Communicated with patients, ensuring that medical information was kept private.
• Answer inbound calls and addressing concerns of family members.
• Performed outreach calls to in-network home health agencies and outpatient rehabs at recommendation of therapists and physicians with patient preferences for post discharge continued care.
• Make referrals through Navi- Health for outpatient therapy, skilled nursing facilities, ALFs, DME
• Order recommended DME and ensure delivery prior to patient discharge to home or bedside
• Faxing
• Filing
• Kept inventory of unit supplies. Ordered and stocked unit supplies
• Toured unit with families of potential patients
• Discharge patients/Kept record
• Follow up on discharged patients and document information in UDS for reimbursement purposes
• Schedule follow up appointments for discharging patients prior to discharge to ensure its printed on discharge instructions
• Distributed patient surveys prior to discharge and assisted patients when needed
• Kept work area safe, clean and tidy

• Assisted patients in development of eating, dressing and grooming skills.
• Utilized approved restorative approaches and adhered to treatment plans in execution of patient care, making recommendations to nursing
• Communicated effectively with patients to identify needs and establish comfortability level throughout therapeutic exercises.
• Administered variety of therapeutic treatments to patients such as range of motion, progressive mobility exercises and speech therapy.
• Operated equipment appropriately and according to user instructions, reporting damaged or malfunctioning equipment.
• Maintained accurate and thorough documentation of therapy session outcomes to track patients' progress towards treatment goals.
• Facilitated personal hygiene management, feeding and ambulation.
• Maintained patient stability by checking vital signs and performing monthly, daily, weekly weights and recording intake and outtake information for 10-60 residents.
• Reduced risks of patient infection and cross-contamination by cleaning and sterilizing equipment.
• Transported patients between rooms and appointments or testing locations.
• Cared for clients with diagnoses such as respiratory failure, diabetes, Parkinson's disease and muscular dystrophy.
• Provided care to patients throughout lifespan with consideration of aging processes, human development stages and culture.
• Carried out day-day-day duties accurately and efficiently.