Pauline Hill-Downing
Edgewood,NM
Summary
Professional with strong background in nursing and case management, specializing in patient advocacy and care coordination. Adept at developing comprehensive care plans, managing complex medical cases, and working collaboratively with multidisciplinary teams to achieve optimal patient outcomes. Known for adaptability, reliability, and results-focused approach in dynamic healthcare environments. Skilled in patient assessment, discharge planning, and resource utilization.
Overview
7
7
years of professional experience
Work History
RN Case Manager
Community Care
07.2023 - Current
- Coordinated comprehensive care plans for diverse patient populations.
- Conducted thorough assessments to identify patient needs and resources.
- Managed interdisciplinary team meetings to ensure effective communication and collaboration.
- Developed education materials for patients and families on disease management strategies.
- Utilize VHA guidelines, medical review criteria, case management, and utilization management processes to improve the quality of patient care by ensuring that the services rendered are appropriate and timely.
- Effectively communicate with providers, staff, and veterans.
Ensure that consultations with the community have the necessary documentation to expedite the referral process.
RN Outpatient Team Nurse Vascular Surgery Clinic
Presbyterian Healthcare Services
06.2022 - 07.2023
- Utilize approved telephone triage protocols to assess patient needs and provide care advice when indicated.
- Provide safe, direct patient care, utilizing the nursing process in the ambulatory setting.
- Preoperative instructions for vascular procedures. Educate patients about medications to
promote compliance to prevent disease progression. - Effectively communicate with members, employer groups, and office staff.
- Utilize critical thinking that results in good decision-making and appropriate actions to obtain desired outcomes.
- Coordinate care for patients, schedule appointments, order labs, imaging, and referrals.
- Collaborated with interdisciplinary teams to develop and implement individualized patient care plans.
- Administered medications and monitored patient vital signs to ensure optimal health outcomes.
Outpatient Care Manager General Surgery Clinic
Presbyterian Healthcare Services
03.2019 - 06.2022
- Led care coordination initiatives to optimize patient outcomes and enhance service delivery.
- Developed individualized care plans based on comprehensive patient assessments and interdisciplinary collaboration.
- Monitored patient progress and adjusted care strategies to ensure alignment with health goals.
- Facilitated communication between healthcare providers, patients, and families for seamless care transitions.
- Implemented quality improvement measures to streamline processes and enhance patient satisfaction scores.
- Analyzed data trends to identify areas for operational improvements within care management programs.
- Advocated for patients' needs, ensuring access to appropriate services and resources within the healthcare system.
Medical Management Specialist I
Blue Cross Blue Shield of New Mexico
11.2018 - 03.2019
- Analyzed medical claims to ensure compliance with policies and regulations.
- Collaborated with healthcare providers to resolve issues related to patient care and billing.
- Managed patient inquiries, providing accurate information regarding benefits and coverage options.
- Developed training materials for staff on new processes and system updates.
- Mentored junior staff, fostering professional development and enhancing team performance.
- Implemented quality assurance measures to increase accuracy in claims adjudication processes.
- Streamlined reporting procedures using data analysis tools to enhance decision-making capabilities.
Education
Bachelor of Science -
University of New Mexico
Albuquerque, NM05-2013
Associate Diploma in Nursing
University of South Dakota
Rapid City, SD05-1997
High School Diploma -
Stevens High School
Rapid City, SD05-1989
Skills
- Chronic illness management
- Effective discharge strategy development
- Expertise in HIPAA standards
- Integrated problem-solving
- Case review expertise
- Health assessment expertise
- Medication safety monitoring
- Resource allocation expertise
- Familiarity with healthcare policy standards
- Comprehensive case management
- Problem-solving skills
- Team skill enhancement
Timeline
RN Case Manager
Community Care
07.2023 - Current
RN Outpatient Team Nurse Vascular Surgery Clinic
Presbyterian Healthcare Services
06.2022 - 07.2023
Outpatient Care Manager General Surgery Clinic
Presbyterian Healthcare Services
03.2019 - 06.2022
Medical Management Specialist I
Blue Cross Blue Shield of New Mexico
11.2018 - 03.2019
Bachelor of Science -
University of New Mexico
Associate Diploma in Nursing
University of South Dakota
High School Diploma -
Stevens High School