Experienced registered nurse passionate about case management and care coordination. Seeking full-time position to leverage knowledge and skills in dynamic healthcare setting. Committed to driving continuous improvement and providing high-quality patient care. Ready to contribute to team dedicated to enhancing patient outcomes and overall healthcare delivery.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Clinical Care Reviewer, Utilization Management RN
AmeriHealth Caritas
Remote
01.2021 - Current
Conducted independent analysis of medical history and treatment records to determine necessity for inpatient, outpatient, and long-term care.
Maintained strong attention to detail while reviewing numerous documents daily, ensuring consistent quality and accuracy.
Maintained strict confidentiality with sensitive client information, adhering to industry standards and company policies.
Case Manager/Care Coordinator, RN
Kindred-Beaufort Memorial Hospital
Beaufort, SC
01.2019 - 01.2021
Coordinated patient care, managed cases, facilitated referrals to community resources, and planned discharges.
Enhanced communication between clients and providers through consistent follow-ups and progress updates.
Maintained accurate documentation on all cases, ensuring compliance with regulations and confidentiality requirements.
Patient Centered Medical Home Care Coordinator
Beaufort Jasper Hampton Comprehensive Health Services
Ridgeland, SC
01.2018 - 01.2019
Assist with development of structure and staff responsibilities. Make appropriate referrals. Ensures health assessment, medical histories, and medication reconciliation are completed. Assist with closing care gaps. Review daily schedules and identify high risk patients. Ensures staff is tracking diagnostic test and referrals.
Conducted regular follow-ups with patients to ensure satisfaction with provided services and address any concerns or needs.
Advocated for clients'' rights throughout their interactions with healthcare professionals; ensuring they receive the appropriate levels of service according to their unique needs.
Home Health Registered Nurse
Beaufort Jasper Hampton Comprehensive Health Services
Ridgeland, SC
01.2016 - 01.2019
Conducted health assessments and administered medications in home settings.
Assessed patient conditions regularly, promptly reporting changes in status to healthcare providers for timely intervention.
Educated patients and families on disease management, prevention strategies, and self-care techniques.
Provided physical assessments, medication, and chronic disease management to home health patients.
Pre-Operative and Post-Operative Care Unit Registered Nurse
Beaufort Memorial Hospital
Beaufort, SC
01.2014 - 01.2016
Delivered comprehensive pre-operative and post-operative nursing care across various age groups.
Utilized critical thinking skills to prioritize nursing interventions based on patients'' acuity levels and individual needs.
Conducted thorough patient assessments to identify changes in condition, promptly notifying physicians and initiating appropriate interventions when necessary.
Education
Bachelor's in Nursing - Nursing
Western Governors University
Salt Lake City, UT
01.2015
Associates in Nursing - Nursing
Horry Georgetown Technical College
Georgetown, S.C
01.2009
Skills
Microsoft Word
Microsoft Excel
Meditech
Consolo
Succes, EHS
Oasis
Jiva
InterQual
Native Spanish speaker
Adaptability and flexibility
Email communication
Attention to detail
Team contribution
Team collaboration
Certification
Current and unrestricted Compact RN license
Languages
Spanish
Native or Bilingual
Timeline
Clinical Care Reviewer, Utilization Management RN
AmeriHealth Caritas
01.2021 - Current
Case Manager/Care Coordinator, RN
Kindred-Beaufort Memorial Hospital
01.2019 - 01.2021
Patient Centered Medical Home Care Coordinator
Beaufort Jasper Hampton Comprehensive Health Services
01.2018 - 01.2019
Home Health Registered Nurse
Beaufort Jasper Hampton Comprehensive Health Services
01.2016 - 01.2019
Pre-Operative and Post-Operative Care Unit Registered Nurse
Utilization Management, Clinical Care Reviewer, Prior Authorization at Amerihealth CaritasUtilization Management, Clinical Care Reviewer, Prior Authorization at Amerihealth Caritas
Clinical Nurse Reviewer/ Utilization Management at WNS/Health Help RadiologicClinical Nurse Reviewer/ Utilization Management at WNS/Health Help Radiologic