Telephonic Nurse Case Manager IITelephonic RN Case ManagerHome Health RNTriage NurseInstructor
Work Type
Part Time
Location Preference
Remote
Important To Me
Paid time offFlexible work hours401k matchWork-life balanceWork from home option
Summary
Compassionate Nurse Case Manager offering 19 years of experience working with patients in multiple Acute Care facility roles, Telephonic Nursing, Home Health, and long term facility. Committed to working collaboratively with health plan, leadership and department coordinators to achieve highest quality of patient satisfaction. Well-versed in developing individualized care plans and advocating patient welfare.
Triage RN in Remote Call Center environment
Certificate in Managed Care
Utilized EMR for abstracting patient information to develop care plan and meet NCQA requirements.
Experience with claims procedure codes and ICD coding.
Skilled in creating and implementing processes to improve patient care and cultivate support teams. Seasoned nursing professional offering proven clinical knowledge, natural interpersonal strengths and technical abilities. Knowledgeable about EMR charting, medication administration and interdisciplinary collaboration focused on optimizing patient care and support. Quality-focused and efficiency-driven leader.
22
Years of experience
Work History
Telephonic Nurse Case Manager II
2 Years 11 Months
Elevance Health | 12.2019 - 11.2022
Certificate of Continuing Nursing Education for Managed Care Course - "A Comprehensive Introduction to Managed Care Nursing"
Clinical experience as remote Telehealth Nurse Case Manager for a health plan in call center style with automatic dialer for outbound Case Management calls and accepted inbound calls also.
Utilizing many computer applications simultaneously to outreach members for enrollment and follow up in case management.
Provide guidance and support to members to manage their health related concerns or goals using motivational interviewing and provide resources, education and referrals to available health team as needed.
Experience in Nurse line Triage and guided member's to proper cost effective care.
Case Management for Physician Group and Medicare patients.
Utilized EMR's to abstract patient information
Collaborated with other health care professionals regarding plan of care and variances in plan implementation to achieve outcomes.
Screened medical records and information for necessity and appropriateness and referred for physician review cases not meeting medical criteria.
Evaluated patients referred for case management to determine physical, mental, financial and psychosocial status by utilizing comprehensive, standardized criteria to identify existing and potential needs.
Assessed current treatment plan to identify barriers, clarify or determine realistic goals and objectives and seek potential alternatives.
Clinical RN Supervisor
2 Years 5 Months
CARES Home Health | 05.2016 - 10.2018
Home Health Case Manager RN duties and responsibilities to support patients in their home.
Clinical Supervisor of Home Health Case Managers
Performed Medicare OASIS documentation.
Supervisor of Home health RN's, Quality assurance, ICD 10 experience, Medicare OASIS documentation, scheduling, coordinating care with Providers and insurance companies.
Home Health RN
3 Months
Family Home Health Services | 02.2016 - 05.2016
Home Health Duties and Responsibilities
Performed OASIS Medicare documentation.
Performed Assessment, Care plan, clinical interventions, collaborate with ancillary staff as needed.
Real Estate Sales Associate
2 Years 8 Months
Florida Luxury Realty, with Brokerage | 03.2014 - 11.2016
Self Employed Real Estate Sales agent
Registered Nurse
8 Months
NorthBay Hospital, Float Pool-RN, Pinnacle Home | 03.2014 - 11.2014
Float Pool Registered Nurse in an Acute Care Facility.
Home Health Registered Nurse Case Manager
8 Months
Mobile Personal Services | 07.2013 - 03.2014
Performed Home Health Nurse duties with assessment, care plan, interventions, overcome barriers, education as needed.
Trained and Orientation for Nurse Aids
Float Pool RN
9 Years 2 Months
Robert Packer Hospital | 05.2004 - 07.2013
* Acute Care Facility Float pool in ICU/CCU, Med/Surg, Telemetry, Ambulatory Surgery.
· Monitoring patients’ recovery and compiling reports for the relevant doctors and other stakeholders.
· Manage patients from intake to discharge to ensure patients are getting the proper care they need.
· Administer medications based on patient needs utilizing safety measures.
· Developed nursing plan of care based on nursing diagnosis and interventions utilizing EMR
· Performing wound inspections, changing dressings, and monitoring the patients’ overall wellbeing.
· Ensuring that all equipment and medical supplies are kept sterile and well organized.
*ACLS Certification
6 Years 2 Months
Memorial Hosp | 01.2006 - 03.2012
Travel
RN for Winter Med/Sur/Tele/ED Overflow.-Fish
16 Years 7 Months
01.2010undefined
11-4/6/11 Travel RN position for the
Winter Med
PACU RN
2 Years 10 Months
Wilson Memorial Hospital | 10.2007 - 08.2010
Post Anesthesia nursing including critical care services.
Travel Nurse
6 Months
Fawcet Memorial Hosp | 06.2004 - 12.2004
Float Pool Nursing duties
RN Case Manager
3 Years 6 Months
HUMANA | 999 Work at home, Tampa, FL 33610 | 02.2023 - Current
Coordinated patient care plans with interdisciplinary teams to enhance quality of service delivery.
Assessed patients' needs and developed individualized care strategies to improve health outcomes.
Monitored patient progress and adjusted care plans based on clinical assessments and feedback.
Ensured compliance with regulatory standards while maintaining high-quality care for diverse patient populations.
Education
Associate of Applied Science - Certificate in Managed Care Nursing
American Association of Managed Care Nurses | Glen Allen, Virginia | 12.2019
Associate of Science - Nursing
Corning Community College | Corning, NY | 06.2004
Skills
Educated on Managed Care Nursing with Certificate.
Motivational Interviewing
Multitasking with multiple computer screens and programs
Strong clinical judgment
Preventive health
Chronic disease management
Home care
Patient and family advocacy
Acute care expertise
Patient consultation
EMR / EHR use for documentation and information extraction
Excellent Communication Skills
History of coding Claims and course in ICD-10 codes and CMS requirements.
Affiliations
Previous Certification in ACLS
Additional Information
Compact RN License with home state of Florida
PA RN license
NY RN license
Certificate in Managed Care
Timeline
RN Case Manager
HUMANA
02.2023 - Current
Telephonic Nurse Case Manager II
Elevance Health
12.2019 - 11.2022
Telephonic RN Case Manager
Access Healthcare
10.2018 - 11.2019
Clinical RN Supervisor
CARES Home Health
05.2016 - 10.2018
Home Health RN
Family Home Health Services
02.2016 - 05.2016
Real Estate Sales Associate
Florida Luxury Realty, with Brokerage
03.2014 - 11.2016
Registered Nurse
NorthBay Hospital, Float Pool-RN, Pinnacle Home
03.2014 - 11.2014
Home Health Registered Nurse Case Manager
Mobile Personal Services
07.2013 - 03.2014
01.2010
PACU RN
Wilson Memorial Hospital
10.2007 - 08.2010
Memorial Hosp
01.2006 - 03.2012
Travel Nurse
Fawcet Memorial Hosp
06.2004 - 12.2004
Float Pool RN
Robert Packer Hospital
05.2004 - 07.2013
Corning Community College
Associate of Science from Nursing
American Association of Managed Care Nurses
Associate of Applied Science from Certificate in Managed Care Nursing