Dynamic healthcare management professional seeking to contribute to a forward-thinking organization committed to excellence and community service. Expertise in delivering exceptional care remotely, ensuring compliance with organizational guidelines through the telephonic acquisition of essential medical information for client services and prior authorizations. Proficient in assessment review skills to enhance client safety and promote health awareness and wellness across all life stages. Committed to fostering a culture of continuous improvement and proactive health management.
Overview
34
34
years of professional experience
1
1
Certification
Work History
Home Health Nurse
Family Members
01.2016 - Current
Developed strong rapport with patients and families, fostering trust and open communication during challenging times.
Educated patients and families on disease management, medication safety, and at-home healthcare strategies to promote selfcare.
Documented patient vitals, behaviors, and conditions to communicate concerns to supervising nurse.
Contributed to the overall success of the home health agency by maintaining high levels of patient satisfaction and positive outcomes.
Provided physical assessments, medication, and chronic disease management to home health patients.
Coordinated with other healthcare team members to support patient needs.
Delivered high-quality in-home nursing services, maintaining a safe and comfortable environment for patients.
Identified early warning signs of patient deterioration or complications, promptly notifying physicians to adjust treatment plans accordingly.
Registered Nurse
Manor care rehabilitation
01.2012 - 01.2014
Sub acute care for rehabilitation clients
Geriatrics unit dementia
Proficient with EMR, epic, EHR
Utilize nursing process
Coordinate subordinate staff
Collaborated with interdisciplinary teams for comprehensive patient care and improved treatment outcomes.
Conducted thorough patient assessments to identify changes in condition, promptly notifying physicians and initiating appropriate interventions when necessary.
Utilized critical thinking skills to prioritize nursing interventions based on patients'' acuity levels and individual needs.
Administered medications safely according to established guidelines while closely monitoring for side effects or adverse reactions requiring intervention.
Enhanced patient satisfaction by providing compassionate, holistic nursing care that addressed physical, emotional, and spiritual needs.
Built strong relationships with patients and families for optimized care satisfaction.
Timely Queue Monitoring
Enhanced patient care by implementing evidence-based clinical practices and protocols.
Improved patient care quality by conducting thorough utilization reviews and making recommendations for optimal treatment plans.
Obtained authorizations from multiple insurance carriers for various levels of care.
Streamlined the case management process by effectively prioritizing high-risk cases for timely intervention and followup.
Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
Performed prior authorization review of services requiring notification.
Served as a vital liaison between patients, healthcare providers, and insurance companies, fostering effective communication and coordination among all parties involved in the care process.
Contributed to organizational success by providing expert advice on medical necessity criteria and evidence-based practices in utilization review nursing.
Submitted cases for criteria failures and helped facilitate resolutions and approvals.
Facilitated workgroup meetings with medical personnel to find effective solutions to issues.
Facilitated compliance with federal and state regulations, maintaining high standards of healthcare delivery.
Reduced unnecessary medical costs, ensuring treatments met established medical guidelines and policies.
Ensured regulatory compliance by maintaining accurate documentation, adhering to policies, and participating in audits.
Evaluated patient histories, complaints, and current symptoms.
Communicated with healthcare team members to plan, implement and enhance treatment strategies.
Supervised and managed daily activities of clinical team consisting of subordinate staff.
LPN /RN
ATC Nursing Agency
01.1998 - 01.2003
Relief staffing for nursing homes, assisted living facilities, ambulatory clinics, Hospitals, and hospice centers through city and suburban areas
EMR, Epic
Improved patient outcomes by administering medications, monitoring vital signs, and documenting relevant information.
Cared for wounds, provided treatments, and assisted with procedures.
Assisted with admissions, appointments, transfers, and discharges.
Documented accurate and complete patient information to address patient problems and expected outcomes.
Demonstrated excellent technical skills in wound dressing changes, IV therapy administration, catheter insertion, and other routine nursing procedures.
Managed time-sensitive tasks effectively under pressure while maintaining composure during critical situations or emergencies.
Managed patient care through closely monitoring respiration, blood pressure, and blood glucose levels.
Adapted quickly to changing patient needs, adjusting care plans accordingly to ensure optimal outcomes in diverse clinical scenarios.
Obtained patient vital signs and input/output measurements from inpatients.
Facilitated efficient communication between patients, families, and healthcare providers to promote continuity of care across settings.
Collaborated with interdisciplinary healthcare teams to ensure continuous quality improvement in patient care delivery.
In registry
ST James Olympia Fields hospital
01.1992 - 01.1998
Tele, med-surg, behavioral health units
Education
Associate of Science - Registered Nurse
Joliet Junior College
01-2007
Licensed Practical nurse - undefined
Dawson technical Institute
01.1989
Skills
Medication administration expertise
Compliance with care protocol
Patient evaluation
Understanding of Milliman protocols
Medicare compliance understanding
InterQual guidelines
Effective interpersonal communication
Thorough records evaluation
Documentation and reporting
Effective multitasking
Self motivation
Proficient in Microsoft Office
Prioritization of tasks
Data-driven decision making
Managed care
Prior authorization
Utilization management
Problem-solving
Teamwork and collaboration
Care plan adherence
Records analysis
Certification
Practical Nurse
CPR/ AED Training
BLS
Languages
English
Full Professional
Interests
Enjoy participating in [activity] for overall physical and mental well-being
Gym Workouts
Pilates
Mindfulness Practices
Passionate about balancing physical health with mental and emotional wellness
Committed to improving personal fitness through regular participation in [sport]