Nicole Thomas
Santa Clara,CA
Summary
A Registered Nurse with keen experience as an advocate for patients. Experienced in clinical, public health, and travel nurse case management. Strong people skills. Provides nursing expertise and problem-solving solutions to diverse populations in various communities.
Overview
21
21
years of professional experience
Work History
Utilization Review Nurse
Santa Rosa Memorial Hospital
05.2023 - 08.2023
- Level II Trauma Center
- Utilized EPIC EHR, MCG, Teams/Microsoft Outlook, Tiger-Connect, R-1 Physician Advisory Services
- Managed caseload; 25-45 cases daily
- Evaluated medical guidelines, benefit coverage to determine appropriateness of services
- Submitted cases for criteria failures to physician advisor, to facilitate resolutions/approvals
- Prepared submitted reviews for authorizations from multiple insurance carriers for various levels of care
- Performed admission reviews based on medical necessity
- Weekly Utilization Management, Case Management meetings
RN Case Manager-Utilization Review Nurse
Mercy Hospital Downtown - Bakersfield
02.2023 - 05.2023
- Completed initial assessments of patients and family to determine and address individual home care needs
- Coordinated with interdisciplinary professionals to develop plans of care, monitor patient status
- Discharge planning, i.e., placement determination, home health, DME, transfers, insurance verification.
- Utilized Cerner EHR
- Utilized Interqual for admission, continue stay reviews
- Participated in interdisciplinary team decision, length of stay meetings.
- Managed 20-30 cases daily.
RN Case Manager-Utilization Review Nurse
Community Hospital Of San Bernardino
08.2022 - 10.2022
- Coordinated with interdisciplinary professionals to develop plans of care
- Evaluated healthcare needs, goals available and resources of each patient and connected to optimal providers, care
- Completed initial assessments of patients and family to determine and address individual home care needs
- Utilized EHR Cerner with Interqual
- Identified care needs of individual patients and coordinated responses based on physician advice, insurance limitations and procedural costs
- Consulted with clinicians for appropriate discharge planning/plan of care, including placement, DME, social service needs
- Managed 18-30 patients; varied daily
Utilization Review Specialist-Case Management
NCW Staffing- Kaiser Permanente
05.2022 - 07.2022
- Repatriated Kaiser patients from Non-Kaiser facilities
- Caseloads consisted of claims and referrals ranging from 6-15 cases daily
- EHR Reno, Health Connect
- Reviews completed in Reno system
- Collaborated with Kaiser, non-Kaiser providers, regarding appropriate placement for patients needs
- Participated in multiple team-decision meetings to create appropriate discharge planning needs for each patient/member
RN Case Management-Utilization Review Nurse
St. Bernadine Medical Center
01.2022 - 04.2022
- Coordinated reviews, assessments, discharge planning per EMR Cerner with Interqual
- Completed initial assessments of patients/family to determine discharge plan, address individual home care needs
- Coordinated with interdisciplinary professionals at MDR to determine plan of care for discharge planning needs
- Delegated duties to care coordinator assistants to assist with discharge planning needs, insurance services
- Managed caseloads of 18-30 cases
- Participated in complex length of stay meetings with interdisciplinary input on progression of care, solutions
RN Vaccinator- LA County
Favorite Healthcare Staffing
05.2021 - 07.2021
- Documented patient care accurately and concisely in My-Turn system
- Administered vaccinations via intramuscular injection
- Completed screening questions with patients following CDC guidelines
- PPE attire worn; face mask, eye protection, medical gloves, gown and PAPR
- Completed thorough assessments to understand current patient conditions and medical history
- Provided education for post-vaccination care, follow up
- Monitored patient post-vaccination for any adverse reactions, needs
RN Vaccinator- Orange County
ProLink Healthcare
04.2021 - 06.2021
- Provided thorough screenings to adults, children populations to assess for medical concerns, contraindications to vaccine
- Provided Pfizer-BioNTech, Moderna, Janssen vaccinations to adult, children (Pfizer only; 12-15 years of age) populations
- Monitored patients reactions post vaccination for 15-30 minutes, depending on individual's personal needs
- Provided medical consultation from experts (MD, PharmD, RN) for further evaluation regarding patients medical history and contraindications
- Strengthened training, nursing knowledge by taking part in CDC continuing education modules for COVID-19 vaccinations
- Provided education to patients; answered questions regarding side effects and comfort measures for post vaccination care
- Participated in proper dosage and prepping of vaccines prior to and throughout day of clinic
- Provided skilled timely emergent response, collaborated with EMT
Covid Crisis Case Manager
Penn State Holy Spirit Medical Center- NuWest
01.2021 - 03.2021
- Initial assessments completed for newly admitted Covid patients within 24 hours
- Managed 15-25 cases for Covid patients in cardiac center
- Level II Trauma center
- Coordinated care for DME, Home Health
- Provided outpatient case management follow-up for Covid patients
- Assisted with rehabilitative, preventive nursing processes and procedures
- Utilized EPIC EHR system, MS Outlook for email communication
- Collaborated with interdisciplinary teams, patients and families to implement effective treatment plans
- Created individualized discharge plans to manage safe transition back into community, home environments
- Arranged referrals
- Daily documentation, intervention, with coordinated follow-up for seamless case management
Inpatient Case Manager
Long Beach Memorial Medical Center
11.2020 - 01.2021
- Discharge planning, placement needs (SNF, Home Health, LTAC, IRF, home) DME, assessments on new patient admissions
- Managed 15-30 cases depending on census. Level 1 Trauma Center
- Assisted with inter-facility transfers to other acute care facilities; handled insurance authorizations
- Utilized EPIC EHR and Perfect-Serve for MD communication
- Attended Interdisciplinary care-briefing rounds, length-of-stay meetings, huddles
- Collaborated with different disciplines to provide cohesive care to patients
- Educated patients/family members regarding different treatment options, outside care approaches, reducing burden on hospital resources
Inpatient Case Manager- Travel/Striker
US Nursing-Riverside Community Hospital
06.2020 - 07.2020
- Coordinated discharge planning for NICU, Maternity, and L&D units
- Managed 15-30 cases daily
- Collaborated with interdisciplinary teams, patients/families to implement effective treatment plans for discharge
- Coordinated appropriate placement for patient; home, home health, SNF, acute rehab
- Provided education to Pt/Family as needed
- Documentation via Meditech, Midas EHR systems
- Coordinated follow-up, maintained continuity of care
Crisis Care Nurse- Krucial Staffing
NYC Health + Hospitals Coney Island
03.2020 - 05.2020
- Bedside care in NICU; admission to discharge, including patient assessments, care planning, health education, discharging.
- Managed isolated patients to rule-out Covid infection
- Utilized EPIC EHR
- Delivered medications via oral, IV, IM injection routes; monitored responses to address new concerns
- Collaborated with physicians to quickly assess patients, delivered appropriate treatment while managing rapidly changing conditions
- Monitored patient reactions after administering medications, IV therapies
- Utilized infection control measures to implement emergency actions for virulent or widespread infections
- Collaborated closely with patient's mental health team to determine proper methods and medications for treatment
Inpatient Case Manager-Utilization Review Nurse
O'Connor Hospital
10.2019 - 03.2020
- Assisted patients with coordination of services for post-discharge needs. Coordinated services such as determining/arranging placement, DME, insurance, social needs
- Managed 15-35 cases daily
- Resolved complex needs case by case basis via face-to-face interviews, telephonic route
- Participated in various interdisciplinary meetings, huddles, general meetings
- Attended educational classes
- Utilized EPIC EHR, Microsoft applications; Word and Outlook. Internal communication utilized via Skype business application
- InterQual criteria system for reviews
- Coordinated with Social Services to assist with complex populations needs, i.e., homeless, uninsured; ensuring connection to appropriate resources within community
Telephonic Nurse Care Manager II
LA Care Health Plan
01.2019 - 08.2019
- Coordinated services for Medicare-Medicaid population, disease management cases
- Caseload management 15-50 daily depending on census
- Referrals triaged by case manager, along with assisting members with coordination of services, such as appointment compliance, DME, medications, financial, social needs
- Assisted members with medical needs, referrals, authorizations, appeals-grievances. Participated in interdisciplinary ICT meetings
- Provided social services referrals to homeless members needing housing and financial resources
- Provided education; mailed educational resources regarding patient's medical concerns
Telephonic Nurse Case Manager I
Conifer Health Solutions- Tenet
08.2017 - 12.2018
- Telephonic Case Manager managed pediatric population within AltaMed (formerly Omni Care) medical group. Care coordination provided to families to ensure connection with discharge follow-up compliance, i.e., appointments, medications, services and DME
- Caseload 15-40 cases daily based on census
- Assisted CCS-eligible members with authorizations and services
- Provided education and support to families
- Case management services for Community Family Care Medical Group; adult population
- Follow-up conducted for post-discharged; Medicare, Medi-Cal eligible members
- Utilized EZ Care, EZ Cap EMR systems
- Provided reviews on high-dollar cases, authorizations for PMD, specialist referrals
Public Health Nurse Consultant
Department Of Children & Family Services-LA County
12.2007 - 04.2016
- PHN consultant to social workers regarding children with critical medical needs
- Caseload assignments ranged from 15-30 or more depending on census
- Conducted joint home visits with social workers to hospitals, schools, offices, Skid-row; dependent upon placement of child
- Interviewed families (parents/caregivers) to ensure children had access to medical providers, services
- Reviewed medical records along with documenting in Child Welfare System (CWS-EMR)
- Involved in multidisciplinary team-decision meetings; consisted of various healthcare professionals and community agents
- Telephonic consultations conducted for referral and follow-up purposes
- Assisted families by connecting them to resources within their communities
- Host of other duties dependent on families needs
Registered Nurse
Premier Nursing Services
01.2004 - 01.2008
- Primary care nursing employed by nursing registry. Assigned to various hospitals in Los Angeles, Orange Counties
- Primary care nursing of Neonate population; direct patient care.
- Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing conditions
Clinical Registered Nurse
UCLA Medical Center, Santa Monica
01.2003 - 05.2006
- Primary care of premature infant in Neonatal Intensive Care Unit; providing direct patient care
- Assessed needs of patients, administered medications, treatments, ordered by treating medical provider
- Education, discharge planning discussed with families per shift
- Managed 1-3 patients depending on acuity of care
- Delivered medications via oral, IV and intramuscular injections, monitoring responses to address new concerns
- Advocated for patients by communicating care preferences to practitioners, verifying interventions met treatment goals and identifying insurance coverage limitations
- Implemented interventions, including medication and IV administration, catheter insertion and airway management
- Educated patients, families and caregivers on diagnosis and prognosis, treatment options, disease process and management and lifestyle options
- 266-Bed facility
Education
Bachelor of Science - Nursing
California State University - Long Beach
Long Beach, CA12.2004
Associate of Science - Nursing
Santa Monica College
Santa Monica, CA12.2002
Skills
- Patient-Client assessments
- Community outreach
- Independent judgment and decision-making
- Patient and Family support
- Health Education
- Patient Evaluation and Intervention
Timeline
Utilization Review Nurse
Santa Rosa Memorial Hospital
05.2023 - 08.2023
RN Case Manager-Utilization Review Nurse
Mercy Hospital Downtown - Bakersfield
02.2023 - 05.2023
RN Case Manager-Utilization Review Nurse
Community Hospital Of San Bernardino
08.2022 - 10.2022
Utilization Review Specialist-Case Management
NCW Staffing- Kaiser Permanente
05.2022 - 07.2022
RN Case Management-Utilization Review Nurse
St. Bernadine Medical Center
01.2022 - 04.2022
RN Vaccinator- LA County
Favorite Healthcare Staffing
05.2021 - 07.2021
RN Vaccinator- Orange County
ProLink Healthcare
04.2021 - 06.2021
Covid Crisis Case Manager
Penn State Holy Spirit Medical Center- NuWest
01.2021 - 03.2021
Inpatient Case Manager
Long Beach Memorial Medical Center
11.2020 - 01.2021
Inpatient Case Manager- Travel/Striker
US Nursing-Riverside Community Hospital
06.2020 - 07.2020
Crisis Care Nurse- Krucial Staffing
NYC Health + Hospitals Coney Island
03.2020 - 05.2020
Inpatient Case Manager-Utilization Review Nurse
O'Connor Hospital
10.2019 - 03.2020
Telephonic Nurse Care Manager II
LA Care Health Plan
01.2019 - 08.2019
Telephonic Nurse Case Manager I
Conifer Health Solutions- Tenet
08.2017 - 12.2018
Public Health Nurse Consultant
Department Of Children & Family Services-LA County
12.2007 - 04.2016
Registered Nurse
Premier Nursing Services
01.2004 - 01.2008
Clinical Registered Nurse
UCLA Medical Center, Santa Monica
01.2003 - 05.2006
Bachelor of Science - Nursing
California State University - Long Beach
Associate of Science - Nursing
Santa Monica College
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