Rachel Ann Houston
Valrico,FL
Summary
Licensed Registered Nurse with expertise in management and supervision of medical staff. Skilled in inpatient teaching with a strong emphasis in critical care, case management and administration. Reputation as self-directed professional with superior problem-solving, communication and leadership skills. Successful in managing time, prioritizing tasks and organizing projects to improve the quality of patient care. Responsible and motivated student ready to apply education in the workplace. Offers excellent technical abilities with software and applications, ability to handle challenging work, and excellent time management skills.
Overview
8
8
years of professional experience
1
1
Certification
Work History
Utilization Review/Case Management
Humana
Work From Home, Florida
10.2021 - Current
- Prepared reports summarizing utilization activities for departmental use.
- Assisted in the review of medical records for utilization management purposes.
- Maintained current knowledge of health care regulations, policies, and procedures related to utilization management.
- Compiled and organized data from various sources to facilitate case reviews.
- Developed in-service educational materials.
- Supported healthcare applications by monitoring security, performance and reliability.
- Enhanced electronic records management systems to meet new needs and forecasted demands.
- Met needs of physicians and other treating team members with timely retrievals of patient medical records.
- Remained up-to-date on various benefit plans, medical policies and state-specific clinical guidelines or criteria.
- Applied medical criteria and clinical judgement to researched cases to evaluate and establish determinations.
Emergency Room Registered Nurse
BayCare
Winter Haven, FL
07.2020 - 09.2021
- Provided emergency care to critically ill patients in a timely manner.
- Assessed patient condition and developed individualized care plans.
- Administered medications and treatments as prescribed by physicians.
- Performed triage, prioritizing treatment of incoming patients based on acuity level.
- Monitored vital signs and other indicators of patient health status.
- Collaborated with multidisciplinary teams to ensure optimal patient outcomes.
- Educated families about their loved ones' conditions and provided emotional support.
- Managed intravenous lines, wound dressings, catheters, and other medical devices.
- Ensured compliance with all hospital policies, procedures, standards, and regulations.
- Maintained accurate records of patient care services rendered utilizing the electronic medical record system.
- Facilitated communication between physicians, nurses, technicians, therapists, social workers, family members and other healthcare providers.
- Reviewed laboratory results promptly for accuracy and followed up on abnormal findings with physicians.
- Delivered compassionate end-of-life care when needed according to established hospice guidelines.
- Coordinated care with physicians and other clinical staff to prepare for treatment, carry out interventions and enhance continuum of care.
- Maintained open and clear communication with physicians to coordinate effective patient care.
Staff Development Coordinator/ Risk Manager
Gulfshore Care Center
Gulfport, FL
08.2020 - 08.2021
- Provided professional development and training opportunities to staff members.
- Created, implemented and evaluated staff development programs.
- Organized in-service training sessions for staff members.
- Assisted with the recruitment, selection, and onboarding of new staff members.
- Managed performance reviews to ensure that objectives are met efficiently.
- Maintained accurate records of all employee training activities.
- Collaborated with managers to develop career paths for employees based on their individual strengths and weaknesses.
- Advised management on best practices in staff development initiatives.
- Provided guidance on job roles, responsibilities, expectations.
- Developed strategies to recognize high-performing employees.
- Served as a mentor and coach for newly hired personnel.
- Planned and led training programs on staff development to enhance employee knowledge, engagement, satisfaction and performance.
- Assisted with onboarding new employees by conducting orientation and company-wide or job-specific training.
- Managed training calendar for entire fiscal year, including setting course plans, training spaces and department rotations.
- Analyzed each department's training needs and developed new training programs based upon data collected.
- Oversaw training courses and promotional paths for professionals and leaders.
MDS Coordinator
Consulate Health Care
Brandon, FL
10.2015 - 06.2020
- Conducted assessments to determine the resident's functional and cognitive abilities, as well as their level of care needs.
- Monitored residents' progress and updated MDS records accordingly.
- Developed individualized plans of care for each resident based on assessment findings.
- Collaborated with interdisciplinary teams to develop comprehensive care plans.
- Provided training and education to nursing staff on current MDS regulations.
- Assisted in developing and implementing quality assurance programs related to MDS completion.
- Interpreted physician orders for accuracy and completeness prior to submitting them electronically into the MDS system.
- Reviewed clinical documentation to ensure accuracy of information reported on the MDS forms.
- Coordinated timely submission of all required documents including Minimum Data Set forms, Care Area Assessments, Quarterly Assessment Reconciliation, Annual Assessment Reconciliations and other regulatory paperwork.
- Participated in survey preparation activities by ensuring that all necessary documents were available during surveys conducted by state agencies or accreditation organizations.
- Facilitated team meetings with members from other departments such as Social Services, Dietary, Activities, Rehabilitation services, to discuss resident issues and concerns related to the MDS process.
- Helped develop comprehensive resident assessment and care plans for moderate-large facilities
- Verified quality of assessments in accurately reflecting physical, mental and psychosocial status of each resident.
- Managed comprehensive, interdisciplinary assessments for patient admissions and annual reviews.
- Provided direct patient care and monitored vital signs.
- Assessed patient needs, developed individualized plans of care, and implemented treatments accordingly.
- Monitored and evaluated the effectiveness of medications and treatments administered to patients.
- Facilitated referrals between community resources such as hospice services or social workers.
- Served as an advocate for residents who were unable to speak for themselves regarding their medical care decisions.
- Managed multiple tasks simultaneously while ensuring quality resident outcomes.
- Collaborated across departments to meet residents' long-term care needs.
- Attended continuing education classes related to geriatric nursing practices.
- Developed and implemented patient management plans and helped provision continuity of care.
- Responded promptly to changes in conditions and emergency situations to deliver expert care in line with good practices and patients' wishes.
- Managed medication passes and treatment schedules to verify proper administration.
Education
Bachelor of Science -
St. Petersburg College
St. Petersburg, FLMaster of Science -
Nova Southeastern University
Clearwater, FLSkills
- Medical Coding
- HIPAA Compliance
- Utilization Review
- Healthcare Regulations
- Ethical Standards
- Quality Improvement
- Documentation and Reporting
- Home Health Care
- Patient Care Plans
- Utilization Management
- Inpatient Care
- Palliative Care
- Performing Assessments
Certification
- RN9539527
- BLS
Accomplishments
- Sigma Theta Tau member
Timeline
Utilization Review/Case Management
Humana
10.2021 - Current
Staff Development Coordinator/ Risk Manager
Gulfshore Care Center
08.2020 - 08.2021
Emergency Room Registered Nurse
BayCare
07.2020 - 09.2021
MDS Coordinator
Consulate Health Care
10.2015 - 06.2020
Bachelor of Science -
St. Petersburg College
Master of Science -
Nova Southeastern University
Similar Profiles
Lindsey WilsonLindsey Wilson
Grievance & Appeals Representative 3 at HumanaGrievance & Appeals Representative 3 at Humana
Monifah CocroftMonifah Cocroft
Healthcare Customer Service Representative at HumanaHealthcare Customer Service Representative at Humana
Jacqueline AugustinJacqueline Augustin
Lead Medical Assistant 4 at HumanaLead Medical Assistant 4 at Humana
Adeshola K Adewunmi, M.DAdeshola K Adewunmi, M.D
Regional Medical Director at HumanaRegional Medical Director at Humana
Fednold ThelisdortFednold Thelisdort
Online Adjunct Instructor at SNHUOnline Adjunct Instructor at SNHU