Quincy Pantaleon

• Works collaboratively with MD to coordinate and screen for the appropriateness of admissions and continued stays.
• Makes recommendations to the physicians for alternate levels of care when the patient does not meet the medical necessity for Inpatient hospitalization.
• Interacts with the family, patient, and other disciplines to coordinate a safe and acceptable discharge plan. Functions as an indirect caregiver, patient advocate and manages patients in the most cost-effective way without compromising quality.
• Transfers stable non-members to approved health care facilities.
• Collaborates with the Multidisciplinary team with discharge planning and continuation of care post discharge.
• Recommends alternative levels of care and ensures compliance with federal, state, and local requirements.
• . Reviews, analyses, and identifies utilization patterns and trends, problems or inappropriate utilization of resources and participates in the collection and analysis of data for special studies, projects, planning, or for routine utilization monitoring activities.
• Coordinates, participates and or facilitates care planning rounds and patient family conferences as needed. Participates in committees, teams or other work projects/duties as assigned.

• Support the mission of the department, which is to provide support to patients in maintaining health and wellness in the outpatient setting
• Ensure that services are provided based on standardized procedures including coordination of care with specialists, community resources.
• Perform a blended function of utilization management (UM) and care management (CM) activities demonstrating clinical judgement and independent analysis, collaborating with members and those involved with members’ care including clinical nurses and treating physicians.
• Participated in Pilot program to enhance care management team with collaboration with Social Services and Care Navigators.
• Completes and documents timely clinical reviews based on assessment of medical necessity
• Communicates with attending physician regarding appropriateness of admissions, resource utilization, and when documentation does not support continued stay
• Seeks consultation from appropriate disciplines to expedite care/ facilitate discharge
• Identification of discharge planning needs and facilitates transfers to acute and post-acute venues/transitions to community settings
• Led process improvement initiatives aimed at enhancing efficiency in case management operations while maintaining excellent clinical outcomes.
• Collaborated with physicians and other healthcare providers to ensure appropriate resource utilization for complex cases.
• Evaluated patient progress and adjusted care plans accordingly, ensuring continuity of care across all healthcare settings.
• Provided education and support to patients and families, empowering them to make informed decisions regarding their healthcare needs.
• Improved patient outcomes by consistently providing comprehensive assessments and developing tailored care plans.
• Evaluated healthcare needs, goals for treatment, and available resources of each patient and connected to optimal providers and care.
• Streamlined care coordination processes to reduce hospital readmissions and emergency department visits.
• Participated in on-call rotations to deliver after-hours care.
• Authored initial assessments of patients and family to develop plans for individual home care needs.
• Conducted comprehensive assessments of patients'' physical, emotional, and social needs in order to develop individualized care plans that facilitated optimal health outcomes.
• Enhanced interdisciplinary team communication through regular case conferences, promoting effective collaboration for optimal patient care.

• Accountable for a designated patient caseload: planning to meet patient needs, management of length of stay, and efficient utilization of resources

• Completes and documents timely clinical reviews based on assessment of

medical necessity

• Communicates with amending physician regarding appropriateness of admissions, resource utilization, and when documentation to support continued stay

• Seeks consultation from appropriate disciplines to expedite care

facilitate discharge

• Identification of discharge planning needs and facilitates transfers to higher level of care, acute, subacute, SNF and Coordination of Home health

• Facilitates ICT with multiple insurance companies, provides updates on daily utilization, length of stay and daily clinical changes.

• Coordinated care conferences with interdisciplinary team members, ensuring all perspectives were considered in the development of comprehensive treatment plans.
• Managed support services and fostered communication among social workers, therapists, hospital staff, and patients.
• Advocated for patients'' rights and preferences, working diligently to align care with individual values and goals.
• Conducted thorough assessments of patients'' needs, enabling more accurate diagnoses and targeted interventions.
• Streamlined discharge planning processes, ensuring a smoother transition for patients back to their homes or other facilities.
• Mentored new nursing staff, facilitating a faster learning curve and increased overall team efficiency.
• Negotiated with healthcare providers to ensure services were provided at best possible cost without compromising on quality.
• Served as a key liaison between patients, families, and healthcare providers, fostering open communication and trust among all parties involved in the care process.

• Direct care of critically ill patients in a fast paced, acute setting
• Total nursing care; utilization of nursing process: assessment, planning, implementation, and evaluation of each assigned patient
• Performed various nursing interventions such as wound dressing, vital sign monitoring, and specimen collection.
• Implemented medication and IV administration, catheter insertion, and airway management.
• Administered medications via oral, IV, and intramuscular injections and monitored responses.
• Monitored patients' conditions and reported changes in physical presentation, appearance, and behavior to discuss treatment with physicians.
• Assessed physical, psychological, physiologic, and cognitive status of patients.
• Consistently maintained accurate documentation of all relevant information related to patient progress, treatments administered and other pertinent data.
• Increased patient satisfaction by consistently delivering high-quality nursing care with a focus on empathy, communication, and professionalism.
• Achieved timely medication administration by utilizing effective time management skills and prioritizing critical tasks.
• Precepted student nurses and oriented new hires, providing guidance and mentorship when teaching on hospital policies, emergency procedures, and nursing best practices.
• Responds quickly and accurately to changes in condition/response to treatment

• Responsible for overall coordination of care management program for members
• Worked collaboratively with the healthcare team to manage and coordinate care to ensure quality and cost-effective member centered care
• Created care plans addressing member’s prioritized needs and goals
• Monitored and evaluated effectiveness of care plans and modifies as necessary to meet NCQA requirements
• Interfaced with Medical Director as needed and attended weekly case management rounds
• Ensured regulatory and accreditation compliance, monitoring member’s health care status, progress to care plan goals, monitoring avoidable utilization and outcome reporting
• Educated patients and families on available community resources, facilitating access to necessary support services.