Nichole Bolden
Cypress,TX
Summary
Accomplished Registered Nurse Case Manager with 17+ years of experience dedicated to quality care of diverse patients. Skillfully blend hands-on skills with advanced background in clinical and administrative settings. Work effectively with all levels of healthcare providers, physicians and administrators to address patient needs. Proven history of success in optimizing patient care as well-qualified and highly experienced Case Manager. Minimize hospital stays through detailed focus on internal systems and individual patient needs. Focused on boosting utilization and department operational efficiency.
Overview
22
22
years of professional experience
Work History
Ipatient Care Review Clinician
Molina Healthcare
Irving, TX
06.2021 - Current
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Performed admission reviews for medical necessity based upon mcg specification.
- Submitted cases for criteria failures and helped facilitate resolutions and approvals.
- Ensured that reviews where done in a timely manner to meet TAT state guidelines.
Registered Nurse
A Hug Away Healthcare
Katy, TX
11.2020 - 06.2021
- Conferred with physicians to discuss diagnoses and devise well-coordinated treatment approaches.
- Advocated for patients by communicating care preferences to practitioners, verifying interventions met treatment goals and identifying insurance coverage limitations.
- Advised patients and caregivers of proper wound management, discharge plan objectives, safe medication use and disease management.
- Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing conditions.
- Delivered medications via oral, IV and intramuscular injections, monitoring responses to address new concerns.
- Provided direct patient care, stabilized patients and determined next course of action.
REGISTERED NURSE CASE MANAGER
Humana Senior Bridge
Houston, Texas
05.2015 - 11.2020
- Making outbound calls to assess members current health status.
- Identifying gaps or barriers in treatment plans.
- Providing patient education to assist with self management.
- Interacting with Medical Directors on challenging cases.
- Coordinating care for members.
- Making referrals to outside sources,Coordinating services as needed (home health, DME, etc).
- Educating members on disease processes encouraging members to make healthy lifestyle changes.
- Documenting and fact finding.
- Making post-discharge calls to ensure that discharged member receive the necessary services and resources.
- Educated patients and loved ones about different treatment options and outside care approaches, reducing burden on hospital resources.
- Consulted with clinicians to devise and manage effective ongoing care plans for at-risk patients.
- Responded promptly and professionally to patient questions and concerns.
Home Health RN Case Manager
Heart Home Health
Houston, TX
11.2006 - 05.2015
- Advised and coached patients progressing from hospitals, rehab facilities and other medical organizations to at-home treatment settings.
- Provided complete care to home health patients, including physical assessments, medication and chronic disease management.
- Worked with multidisciplinary team to carry out successful treatment plans for diverse acute and chronic conditions.
- Responded to patient requests with appropriate clinical and personal assistance.
- Determined and addresses individual home care needs by completing detailed assessments and reviewing documentation.
- Collaborated with vendors to procure medical equipment, supplies and services.
- Introduced changes to patient care plans based on regular evaluations and patient changes.
ASSISTANT DIRECTOR OF NURSING
AP Home Health Care
Katy, TX
08.2011 - 05.2015
- Provide nursing care in accordance with the client's plan of care to include comprehensive health and psychosocial evaluation, monitoring of the client's condition, health promotion and prevention, coordination of services, teaching and training activities and direct nursing care.
- Consult with the attending physician concerning alterations of patients care plans, checks with the appropriate supervisor and makes.
- Established new policies and updated existing policies to improve standard of care for patients.
- Established and monitored infection control programs to provide safe, sanitary environment to prevent transmission of disease and infection.
- Collaborated with staff, management and external groups to coordinate patient care.
RN Case Manager
United Behavioral Health
Houston, TX
10.2005 - 08.2006
- Consulted with clinicians to devise and manage effective ongoing care plans for at-risk patients.
- Evaluated healthcare needs, goals for treatment and available resources of each patient and connected to optimal providers and care.
- Authored initial assessments of patients and family to develop plans for individual home care needs.
- Coordinated rehabilitative and preventive nursing processes and procedures.
- Directed appropriate preventive and rehabilitative nursing processes and protocols.
- Conducted regular re-evaluations to address changes in needs and conditions, introducing revisions to care plans as needed.
- Reduced care costs without sacrificing quality through effective service coordination and multidisciplinary collaboration.
- Liaised with physicians regarding patient needs, performance and changes.
Psychiatric Charge Nurse
West Oaks Hospital
Houston, TX
05.2005 - 08.2006
- Performed patient assessments to monitor expected response to medications, altering treatment plans as needed.
- Monitored vital signs, nutritional intake and signs and symptoms of complications to report deviations to supervisor.
- Oversaw care of suicidal patients and acted swiftly to reduce risk of harm to themselves or others.
- Responded to numerous volatile situations and violent outbreaks to restore safety and security of patients and staff.
- Provided direct quality care to patients by monitoring, recording and evaluating psychiatric conditions.
- Monitored all primary care needs for patients to coordinate access to appropriate providers, including immunizations, vision, hearing and dental care.
- Administered medication and treatments to patients to observe and record responses.
- Coordinated with medical and paramedical professionals to provide appropriate input and effectively formulate and implement treatment plans for patients.
Medical Surgical Charge Nurse
Harris Health Ben Taub Hospital
Houston, TX
05.2003 - 05.2004
- Quickly responded to situations impacting safety and security to unit, actualizing crisis prevention interventions to control and de-escalate situations.
- Oversaw delivery of care for all patients on 32-bed medical-surgical unit, providing direct care to up to 8 patients, delegating nursing assignments and supervising team comprised of nurses, LPNs, technicians and unit clerks.
- Implemented care plans for patient treatment after assessing physician medical regimens.
- Reported findings to quality departments after conducting routine restraint audits and worked with team to devise corrective actions for deficiencies.
- Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing conditions.
Education
Bachelor of Science - Nursing
Western GovernorsUniversity
12.2017
Associate of Science - Nursing
Houston CommunityCollege
Houston, TX05.2003
Bachelor of Science - Psychology
University of Houston
Houston, TX05.2000
Skills
Patient management Patient assessments Case Management
Staff Management
Staff education and training
Chronic disease management Direct patient care
Accomplishments
- Research - Completed groupstudy focused on patientcomfort, costs and test results,which resulted in increasedpatient satisfaction.
Affiliations
American Nurses Association
(ANA) Member 2020 to
Current Member ID 04239304
Texas Nursing Association
(TNA) Member 2020 to
Current ID number 04239304
Timeline
Ipatient Care Review Clinician
Molina Healthcare
06.2021 - Current
Registered Nurse
A Hug Away Healthcare
11.2020 - 06.2021
REGISTERED NURSE CASE MANAGER
Humana Senior Bridge
05.2015 - 11.2020
ASSISTANT DIRECTOR OF NURSING
AP Home Health Care
08.2011 - 05.2015
Home Health RN Case Manager
Heart Home Health
11.2006 - 05.2015
RN Case Manager
United Behavioral Health
10.2005 - 08.2006
Psychiatric Charge Nurse
West Oaks Hospital
05.2005 - 08.2006
Medical Surgical Charge Nurse
Harris Health Ben Taub Hospital
05.2003 - 05.2004
Bachelor of Science - Nursing
Western GovernorsUniversity
Associate of Science - Nursing
Houston CommunityCollege
Bachelor of Science - Psychology
University of Houston