Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Rachel Oraha RN BSN CCM

Valparaiso,IN

Summary

Dedicated and compassionate nurse case manager offering experience working with patients and families to facilitate smooth transitions following discharge from acute care medical facilities. Committed to working collaboratively with healthcare staff, leadership and department coordinators to achieve highest quality of patient satisfaction. Well-versed in developing individualized care plans and advocating patient welfare.

Overview

6
6
years of professional experience
1
1
Certification

Work History

Telephonic RN Care Manager

Optum Services, Inc.
11.2023 - Current
  • Educated patients on self-management techniques to promote independence and improve quality of life.
  • Streamlined communication between healthcare providers, ensuring seamless coordination of care for optimal patient outcomes.
  • Conducted thorough follow-up calls to assess the effectiveness of treatment plans, making adjustments as needed for optimal results.
  • Collaborated with interdisciplinary teams to optimize patient-centered interventions and ensure continuity of care.
  • Reduced hospital readmission rates by closely monitoring patients'' progress and addressing potential complications in a timely manner.
  • Provided emotional support to patients coping with chronic illness or end-of-life decisions, fostering resilience during difficult times.
  • Managed complex cases involving multiple comorbidities, requiring close monitoring and coordination of various healthcare services.
  • Educated patients and families on available community resources, facilitating access to necessary support services.
  • Served as a key liaison between patients, families, and healthcare providers, fostering open communication and trust among all parties involved in the care process.
  • Participates in pilot programs to improve efficiency and quality. Part of the catastrophic care team to take long term complex programs to maintain NCQA standards.
  • Mentoring and providing support to new hires.

RN Case Manager

Northwest Health Porter
03.2022 - 01.2024
  • Completed initial assessments of patients and family to determine and address individual home care needs. ·
  • Effectively communicated with physicians and nurses regarding patient needs, performance, medications and changes.
  • Advocated for patients by communicating care preferences to practitioners, verifying interventions met treatment goals and identifying insurance coverage limitations.
  • Liaised with physicians regarding patient needs, performance and changes.
  • Solved problems related to abrupt changes in discharge, coordinated updates and communicated discharge plans.
  • Worked with utilization review to establish prior authorization for timely discharges.
  • Communicated with referral providers about new referrals and verified receipt of necessary information prior to arrivals.
  • Documented case notes daily and coordinated follow-up for seamless case management.
  • Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
  • Submitted cases for criteria failures and helped facilitate resolutions and approvals.
  • Supervised and maintained all utilization review documentation through cerner/morcare


Charge Nurse

St. Mary Medical Center
07.2019 - 03.2022
  • Coordinated nursing care on unit through staff assignments, assisting and rounding with physicians, monitoring patient orders and communicating with ancillary departments.
  • Educated patients and caregivers of various available external resources to support wound management, disease management and medication administration.
  • Documented information in patients' electronic medical record, relaying information to clinicians and care providers to facilitate continuity of care.
  • Implemented quality patient care techniques to align with safety, health and organizational regulations.
  • Trained new nurses in proper techniques, care standards, operational procedures and safety protocols.

Admissions/Discharge RN

St. Mary Medical Center
07.2019 - 03.2022
  • Assessed new patients' care plans and administered prescribed medications and treatments.
  • Assisted floor nurses with medication administration and prescribed treatments.
  • Provided physicians and other medical personnel with patient assessment details and answered patient care-related questions.
  • Directed patient admission and discharge tasks while managing patients and coordinating care.
  • Settled incoming patients into rooms and verified adequacy of medical supplies and treatment equipment.
  • Worked collaboratively with clinical and non-clinical team members to solve complex discharge issues.

Education

Bachelor of Science - Nursing

Valparaiso University
Valparaiso, IN
05.2019

H.S. Diploma -

Big Valley Grace High School
Modesto
2008

Skills

  • Patient Assessments
  • Case Management
  • Discharge Planning Coodination
  • Orthopedics Knowledge
  • Medical Surgical Knowledge
  • Oncology Knowledge
  • Patient Advocacy
  • HIPAA compliance
  • Compassion and empathy
  • Clinical judgment
  • Readmission Reduction
  • Quality Management
  • Knowledge Of Medicare, Medicaid, Advantage Plans, Commercial Plans
  • Determine Medical Necessity
  • Obtaining Authorizations
  • Aerial, EPIC, Cerner, Morcare, Milliman Care Guidelines (MCG)

Certification

Board Certified Case Manager #4271284


MCG CE completed for Inpatient & Surgical Care

MCG CE completed for General Recovery Care


AHA and Red Cross BLS/CPR Up To Date


Compact RN Multi State License (IN)

License #28252608C

Timeline

Telephonic RN Care Manager

Optum Services, Inc.
11.2023 - Current

RN Case Manager

Northwest Health Porter
03.2022 - 01.2024

Charge Nurse

St. Mary Medical Center
07.2019 - 03.2022

Admissions/Discharge RN

St. Mary Medical Center
07.2019 - 03.2022

Bachelor of Science - Nursing

Valparaiso University

H.S. Diploma -

Big Valley Grace High School

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Rachel Oraha RN BSN CCM