Nicole Crozier
Carlsbad,CA
Summary
With 20 years of extensive experience in Case Management, I am a dedicated Registered Nurse adept at managing high caseloads while upholding exceptional care standards. I thrive in high-pressure environments and possess the ability to recommend optimal resources and courses of action to meet patient needs, aiming to restore each individual to their highest quality of life. My background includes successful collaboration with Medical Groups and IPA's to ensure efficient patient care within a large Health Plan. Proficient in medical terminology, evidence-based guidelines, and familiar with Milliman Care Guidelines, I possess a strong technical skill set encompassing various information systems and software applications such as Microsoft Word, Excel, Outlook, and Teams. Leveraging exceptional interpersonal and communication skills, I am dedicated to thriving within team environments and delivering top-tier healthcare services.
Overview
16
16
years of professional experience
1
1
Certificate
Work History
RN Case Manager
Blue Shield of CA
San Diego, CA
02.2019 - Current
- Researched and designed treatment/care plans to promote quality of care, cost-effective health care services based on individuals' medical needs with a caseload of over 250 members
- Collaborated with the interdisciplinary healthcare team to help reduce hospital readmissions and ensure members receive timely preventive care and screening tests
- Completed Transitions of Care follow-up to maintain continuity of care
- Demonstrated clinical judgment and independent analysis to identify and navigate barriers that may prevent Members from achieving their healthcare goals
- Interpreted and evaluated diagnostic tests to identify and assess patient's condition.
- Participated in quality improvement initiatives related to case management processes.
- Educated patients and families about health maintenance, disease prevention and treatments.
- Utilized computerized Resource and Patient Management System (RPMS) and Electronic Health Record (EHR) system.
HOME HEALTH RN CASE MANAGER
Scripps
San Diego, CA
10.2008 - 01.2019
- Facilitated seamless delivery of nursing care to individuals and families in their homes and communities
- Assessed and developed individualized plans of care using interdisciplinary methods in compliance with CMS Oasis guidelines.
- Evaluated and addressed discharge planning requirements in the transition of care process prior to patient discharge.
- Supervised and delegated responsibilities to Licensed Vocational Nurses (LVNs) and Home Health Aids (HHAs) as instructed.
- Conducted regular re-evaluations to address changes in needs and conditions, and introduced revisions to care plans such as referrals
- Collaborated with physicians to develop treatment plans that met the needs of each patient.
- Developed discharge plans for patients transitioning from home health services to other settings.
- Maintained accurate documentation of assessments, treatments, medications, and progress notes in accordance with agency policies.
- Ensured compliance with applicable regulatory standards related to home health services.
- Monitored changes in patient's condition and behavior to evaluate effectiveness of interventions.
- Recognized and responded accordingly to changes in condition, ensuring further evaluation or intervention when necessary.
- Provided guidance and imparted clinical knowledge to newly hired home health nurses to enhance their skills.
Education
Bachelor of Science -
University of Arizona Global Campus
12.2022
Associate of Science - Nursing
Bristol Community College
06.2003
Skills
- Case Management
- Utilization Management
- Clinical Documentation
- Telephonic Assessments
- InterQual/Milliman Criteria Knowledge
- Medicare and CMS Guidelines
- Motivational Interviewing
- Care Coordination
- Autonomous problem solving
- Transitions of Care
- Chronic Disease Management
- Proficient in Microsoft Office (excel,outlook,word,power point, MS Teams)
- Interdisciplinary Collaboration
- Quality Improvement
- Time Management
- Organizational Skills
- Experience with Epic, Salesforce, Auth Accel, Facets
- Health Plan and IPA knowledge
- Discharge Planning
Additional Information
- Registered Nurse in the State of California License (current/active) Scripps Nurse of the year 2012
Certification
RN license in California
Basic Life Support (BLS) Certification.
Certified Case Manager (CCM)
Six Sigma Health Greenbelt (LSS)
Timeline
RN Case Manager
Blue Shield of CA
02.2019 - Current
HOME HEALTH RN CASE MANAGER
Scripps
10.2008 - 01.2019
Bachelor of Science -
University of Arizona Global Campus
Associate of Science - Nursing
Bristol Community College
Affiliations
- Healing Touch Level One
*Pending Holistic Nurse Baccalaureate Board Certified (HNB-BC) by American Holistic Nurse Association (AHNA)
References
References available upon request.
Volunteerism
- Volunteer at Topkare Hospice
- Volunteer San Diego Humane Society
References
References available upon request.
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