Roberta Edington

• Led regional clinical operations, enhancing service delivery and patient outcomes across multiple facilities.
• Developed and implemented strategic initiatives to improve clinical protocols and compliance standards.
• Mentored clinical staff, fostering professional development and improving team performance through targeted training programs.
• Collaborated with cross-functional teams to streamline workflows and optimize resource allocation in clinical settings.

• Accountable for coordinating clinical and financial outcomes of an assigned population
• Works collaboratively with all interdisciplinary staff to achieve timely, cost efficient and effective-management of patient care
• Ensures specific patient outcomes are achieved through overall supervision of the care provided to patients
• Assess appropriateness of patient referrals to skilled intermittent needs, potential safety issues, both for patient and home care staff
• Identifies deficiencies in intake information and takes appropriate action for clarification information/orders
• Monitors assigned deficiency reports to ensure quality and compliance
• Triage patient and provider calls and urgency level of referrals
• Ensures clinically appropriate, timely and efficient visits are being provided to patient population
• Conducts quality audits as assigned, evaluates and communicates outcomes
• Provides direct patient care in accordance with policies and procedures which include patient assessment, teaching, performance of specified procedures and evaluation of patient/caregiver response to instructions
• Demonstrates and provides comprehensive documentation of services rendered
• An active role in development and the betterment of the associate and the organization

• Supervised staff members and provided periodic performance evaluations.
• Employed active listening and interpersonal talents to effectively interact with various individuals, including physicians, patients and fellow employees.
• Enforced compliance with local, state and federal healthcare regulations, including Medicare and Medicaid requirements, HIPAA and OSHA.
• Collaborated with healthcare professionals to deliver high-quality patient care.
• Managed patient care and clinic services, quality assurance, safety and risk management and facility maintenance.
• Drove attainment of optimal outcomes through case management focused on appropriate treatment, clinical quality assurance and service utilization.

• Responsible for organizing, coordinating, and providing care coordination and care management services to patients within the practice who are most at risk for health deterioration, sentinel events and/or poor outcomes
• Identify high risk patients through EMR, referrals, registries from health insurance payers
• Develop tracking system for patient care coordination and care management across the continuum
• Act as clinical liaison for payer based care management programs
• Conduct Comprehensive assessment of patients' physical, mental and psychosocial needs
• Develop care plants to prevent disease exacerbation, improve outcomes, increase patient engagement in self-care, decrease risk status, and minimize hospital and ED utilization
• Assist patients to adopt healthy behaviors and improve self-care in chronic disease management. Promote self goals

Assist patients in navigating the health care system.

Partner with external case management programs to coordinate care.

Ongoing evaluation and documentation of patient progress/risk status. Document in EMR and communicate with care teams.

• Coordinates the integration of social services/case management functions into the patient care, discharge and home planning processes with other hospital departments, external service organizations, agencies and health care facilities
• Collaborates with clinical staff in the development and execution of the plan of care and achievement of goals
• Utilization Review, Quality and Compliance Monitoring
• Conducts concurrent medical record review using specific quality indicators and clinical decision support criteria as approved by the medical staff, , CMS and other regulatory agencies and document findings
• Serves as liaison with Physician Performance Improvement (PPI) to ensure the reporting of quality indicators and care concerns
• Reviews all new admissions daily against inpatient screening criteria and communicates necessary changes in status designation to ordering physician and Patient Access
• Identifies all observation patients with observation alert sticker, reviews status no less frequently than daily, and communicates directly with the attending physician if severity of illness and intensity of service meet criteria for inpatient admission or when observation hours threaten to exceed 48 hrs