Patricia Turner, RN BSN CCM
Summary
Registered nurse twenty plus years with extensive experience in Managed Care Organizations, Medicaid products with an emphasis on special needs populations, and Certified Home Health Agencies. Well versed in DOH regulations for all products. Five years of program building including but not limited to development of policy, organizational workflow and informatics development. Strong background in vendor management, utilization management, with additional care and medical management experience. Additional knowledge includes grievance and appeals, second level review and fair hearing processes. Excellent team building and motivational skills. Knowledgeable of various computer systems used throughout the industry. Proficient in Microsoft products.
Overview
31
31
years of professional experience
Work History
Care Manager
LICH - NYU Langone
04.2022 - Current
- Enhanced patient care by developing and implementing individualized care plans.
- Improved patient satisfaction through effective communication and collaboration with interdisciplinary healthcare teams.
- Reduced hospital readmission rates by providing comprehensive discharge planning and follow-up support.
- Streamlined care coordination processes, resulting in timely referrals and access to appropriate resources.
Manager of Care Coordination
Long Island Select Healthcare
03.2021 - 03.2022
- Implemented successful healthcare program through professionalism, quality of care, medical teaching and patient satisfaction.
- Developed and updated policies and procedures, maintaining compliance with statutory, regulatory and local, state and federal guidelines relating to HIPAA, benefits administration and general liability.
- Initiated recruitment and retention strategies for new hires to reduce staff turnover
- Directed staff development by planning and conducting in-service classes, leadership training and orientation programs.
- Conducted retrospective review assessments to identify problems and gaps in care, health and disease management.
- Supervised 10-member nursing team and assigned daily tasks to provide quality health care services to patients.
Director of Care Coordination
PARTNERS HEALTH PLAN
01.1993 - 09.2020
- Development of professional relationships with service providers and enrollment facilitators.
- Grievance investigations and resolution.
- Development of regional office clinical and organizational workflows / system management.
- Oversight of compliance and regulatory measures.
- Oversight of special need population management.
- Enrollment assignment activities.
- Responsible for oversight of case management / care coordination activities.
- Responsible for direct oversight of clinical and non-clinical professionals.
- Responsible for performance review, hire and training of staff and development of action plans.
Manager
Northwell Health System
02.2016 - 02.2017
- Accomplishes nursing human resource objectives by selecting, orienting, training, assigning, scheduling, coaching, counseling, and disciplining employees, communicating job expectations; planning, monitoring, appraising job contributions; recommending compensation actions; adhering to policies and procedures.
- Meets nursing operational standards by contributing information to strategic plans and reviews; implementing production, productivity, quality, and customer-service standards; resolving problems; identifying system improvements.
- Maintains nursing guidelines by writing and updating policies and procedures.
- Assures quality of care by developing and interpreting hospital and nursing division's philosophies and standards of care; enforcing adherence to state board of nursing and state nurse practice act requirements and to other governing agency Development/ implement departmental workflow to ensure efficiencies.
- Maintains staff by recruiting , selecting , orienting and training employees.
- Responsible for appraising job performance.
- Acts as a mentor / resource by coaching, counseling and providing feedback to ensure improved performance measures.
- Develops / implements action plans for employee discipline.
- Implementation / enforce compliance of departmental policy.
- Maintain communication between governing boards, medical staff, and department heads by attending board/ quality meetings and coordinating interdepartmental functioning.
- Develop or expand and implement medical programs or health services that promote research, rehabilitation, and community health.
- Develop instructional materials and conduct in-service and community-based educational programs.
- Manage change in integrated health care delivery systems, such as work restructuring, technological innovations, and shifts in the focus of care.
Director
INDEPENDENT LIVING SYSTEMS
05.2014 - 09.2016
- Implementation of capitated programs for clientele in New York State.
- Implementation/development of disease management program.
- Development of clinical program requirements.
- Development of certification application for managed long term care program.
- Development of policy and procedure, model of care, program workflow, program documents including plan notices.
- Created computer system support for clinical component (spec.
- Documents and BRD).
- Successful creation and presentation to Department of Health for readiness review of plan program.
- Recruitment of clinical and non-clinical employees , team building activities.
- Development/ implementation of staff orientation program.
- Organized the department in accordance with administrative guidelines in order to provide specified nursing services to meet the legal, organizational and medical staff guidelines.
Manager
AMIDA CARE
10.2013 - 05.2014
- Responsible for constructing MLTC, Medicare and MRT initiatives for clinical departments.
- Led the planning and achievement of goals and objectives consistent with the agency mission and philosophy.
- Served as a subject matter expert in long term care services.
- Modified clinical model to support product regulatory requirements Development of clinical documents, reports and education materials to support the MLTC and FIDA program.
- Responsible for acquisition of staff, clinical and non-clinical.
- Responsible for oversight, management of long term and transitional services.
- Development and monitoring of vendor agencies supporting both MLTC and SNP and FIDA products.
Senior Manager
AFFINITY HEALTH PLAN
06.2013 - 10.2013
- Responsibilities include development of efficient workflow policies and procedures and training for UM, CM, Home care departments.
- Oversight of subcontracted case management teams (Health Integrated, Care Core).
- Projects assigned to develop programs PCP referral, cancer care, hospice /palliative care, field team to include nurses, social work, coordinators and nutritionist.
- Responsible for development and oversight of MRT, UAS-NY, Community partnerships for disease development programs (CMMI for Asthma).
- Audit and performance improvement projects, currently SNP audit, CCIP and PIP.
- Educated staff on state and federal statutes, rules and regulations governing homecare services.
- Interpreted and communicated new or revised policies to staff.
Senior Health Service Manager
UNITED HEALTH CARE
01.2012 - 06.2013
- Responsible for constructing MLTC product line for UHC Community and State.
- Worked with National Complex Care Team to create policy, computer support and workflow for clinical implementation. Presented UHC plan certified application to Department of Health.
- Developed orientation and training support for clinical and non-clinical staff who support the MLTC and PCS product lines.
- Provided oversight, management and development of all department staff.
- Responsible for recruitment activities.
- Chart audit and CMS encounter data.
- Track and trending of population / membership benchmarks.
- Oversight of Grievance and Appeal activities.
- Liaison to DOH for clinical issue resolution.
Manager
AMERIGROUP
07.2007 - 01.2012
- Accomplishes department objectives by managing staff, planning and evaluation department activities.
- Maximized productivity by keeping detailed records of daily progress and identifying and rectifying areas for improvement.
Case Manager
Guildnet
01.2008 - 08.2009
- Provide case management services for case load of 80 members enrolled in Managed Medicaid Program.
- Responsible for utilization review and implementation of appropriate service plan benefits to ensure member safety and improve health outcomes.
- Appropriate documentation of member assessments, service reviews, case conference meetings and grievance and appeal determinations.
- Precept new hire on case management principles.
Home Care Nurse
WINTHROP-UNIVERSITY HOSPITAL
08.2005 - 01.2007
- Recorded patients' medical history, vital statistics and test results in medical records.
- Evaluated health education needs of patients and provided necessary training and instruction.
- Provided treatment within scope of practice as defined by state law.
Emergency Room Registered Nurse
WINTHROP-UNIVERSITY HOSPITAL
06.2001 - 01.2005
- Responsible to staff Triage, Pediatric ER, Trauma Room, Fast Track and main floor of the ER dept.
- Responsible to assessment, treatment and evaluation of patients within the scope of a registered nurse for the state of New York.
- Maintain/document patient charts.
- Provide discharge instructions.
Registered Nurse, Emergency Department
LONG BEACH MEDICAL CENTER
05.1995 - 06.2001
- Triaged and attended to diverse patient populations with broad-spectrum illnesses and injuries.
- Evaluated patient care needs, prioritized treatment and maintained patient flow.
- Monitored patients with acute conditions.
- Provided direct care to all presenting patients.
- Instructed patients and family members on proper discharge care.
- Responsible for documentation of patient care.
Education
BACHELOR OF SCIENCE - Nursing
University of Phoenix
Tempe, AZ02.2014
ASSOCIATE OF SCIENCE - Nursing
SUNY Farmingdale
Farmingdale, NY05.1993
Skills
- Care Management
- Utilization Management
- Medicare
- Medicaid
- Managed care
- Program development and oversight
- Vendor Management
- Team development
- EMR
- Microsoft Programs
Accomplishments
- Designed, developed and produced module for case management documentation called iCare, which was successfully implemented by Independent Living Systems for iCircle.
- Implementation of Managed Long Term Care program providing services for the underserved in 22 counties.
- Team Building and Leadership.
- Created new departmental procedures manual.
- Wrote and edited documents to keep staff informed on policies and procedures.
- Assessed organizational training needs.
- Developed several internal tools to automate mundane tasks that were quickly adopted by other developers
Additional Information
CCM certified
Timeline
Care Manager
LICH - NYU Langone
04.2022 - Current
Manager of Care Coordination
Long Island Select Healthcare
03.2021 - 03.2022
Manager
Northwell Health System
02.2016 - 02.2017
Director
INDEPENDENT LIVING SYSTEMS
05.2014 - 09.2016
Manager
AMIDA CARE
10.2013 - 05.2014
Senior Manager
AFFINITY HEALTH PLAN
06.2013 - 10.2013
Senior Health Service Manager
UNITED HEALTH CARE
01.2012 - 06.2013
Case Manager
Guildnet
01.2008 - 08.2009
Manager
AMERIGROUP
07.2007 - 01.2012
Home Care Nurse
WINTHROP-UNIVERSITY HOSPITAL
08.2005 - 01.2007
Emergency Room Registered Nurse
WINTHROP-UNIVERSITY HOSPITAL
06.2001 - 01.2005
Registered Nurse, Emergency Department
LONG BEACH MEDICAL CENTER
05.1995 - 06.2001
Director of Care Coordination
PARTNERS HEALTH PLAN
01.1993 - 09.2020
BACHELOR OF SCIENCE - Nursing
University of Phoenix
ASSOCIATE OF SCIENCE - Nursing
SUNY Farmingdale
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