Renata Ward

• PRN position providing healthcare to individuals incarcerated in jails focusing on both physical and mental health needs within a secure environment.
• Functions include intake assessments, sick call, providing acute and chronic disease management; assisting MD with treatments, medication administration, emergency response and record- keeping.

• Assessed the need for continued stay by reviewing clinical documentation in order to determine if the continued stay is medically necessary. Referred cases to secondary review for failure to meet criteria.
• Utilized InterQual, Careweb, and CMS guidelines criteria to make determinations of medical necessity based upon member benefits plan design and other relevant information.
• Documented all utilization review activities, findings, and decisions in patient records and databases: SalesForce, Intake98, and Que Manager accurately and promptly.
• Identified opportunities for cost savings through utilization management techniques such as discharge planning, case management, and alternate level of care.
• Maintained current knowledge of state regulatory requirements pertaining to UM activities.
• Remained up-to-date on various benefit plans, medical policies and state-specific clinical guidelines or criteria.
• Liaised between patients, healthcare providers, and insurance companies to clarify coverage and authorize services.
• Participated in quality improvement initiatives.
• Collaborated with case managers to facilitate timely discharge planning and transition of care.
• Maintained a working knowledge of CMS coverage determinations, LCDs and NCDs, CPT codes and modifiers.

• Managed patient intake processes for the organization. Responsible for the coordination of care for patients admitted to hospice in accordance with professional licensure, established procedures and regulatory requirements.
• Established relationships with local hospitals, nursing homes and long term care facilities to facilitate referrals into the hospice program.
• Exercised independent judgment consistent with professional licensure in order to formulate an individualized plan of care for the patient in coordination with referring physician.
• Assisted the administrator, director of nursing, and office manager with leadership tasks and responsibilities. Wrote reports, and maintained books for quality measures and improvement to ensure compliance with regulatory standards.
• Managed compliance with regulatory requirements for hospice operations.
• Participated in strategic planning initiatives focused on expanding the scope of services offered by the hospice program.
• Conducted periodic audits of medical records
• Built work schedules and staff assignments, taking workload, space and equipment availability into consideration.
• Created an environment that fostered open communication among staff members regarding patient care concerns.

• Completed admissions, discharges, and assessments for patients while documenting via e-charting.
• Established comprehensive care plans and educated staff and family members on patient needs.
• Conducted regular home and nursing facility visits for effective symptom management.
• Administered specialized treatments, including intravenous fluids, medications, urinary catheterization, and complex wound care.
• Collaborated with patients, families, physicians, and interdisciplinary team members to enhance care quality.
• Supervised LPNs and Home Health Aides in delivering patient services.
• Ensured accurate documentation of patient interactions and treatment plans within electronic health records.

Conducted telephonic triage for effective symptom management.

• Managed comprehensive clinical and palliative care for assigned patients.
• Assessed physical, psychological, social, and spiritual needs of patients.
• Performed post-mortem care and coordinated funeral arrangements.
• Collaborated with medical director and interdisciplinary team to enhance patient care planning.
• Provided skilled nursing care and support for families in home or facility settings.
• Educated families on end-of-life care and available emotional support resources.
• Maintained precise electronic medical records of patient assessments and treatments.

• Operated as a clinical leader in an ambulatory setting, supervising LPNs and MAs to ensure safe and comprehensive care was delivered to patients.
• Scheduled clinic staff to optimize patient care and operational efficiency.
• Developed clinical practice guidelines and protocols to enhance unit performance.
• Supported patient decision-making, education, and service coordination for optimal outcomes.
• Triaged patient calls to ensure swift access to physicians.
• Conducted independent flu clinics with minimal MD oversight.
• Managed supply ordering and provided staff education on infection control standards.