Master’s level Advance Practice Clinician with over 25 years of combined experience in Medical Claims Review, Medical Appeals, Home Health, Managed Advantage - Risk Adjustment Model, Medical/Surgical Nursing and Woman’s Oncology. Additionally, successfully lead a team of thirty-five Advance Practice Clinicians performing Health Risk Assessments for Medicare Advantage members. Well organized and able to collaborate well with teams and/or independently in remote settings. Highly-motivated employee with desire to take on new challenges. Strong worth ethic, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
40
40
years of professional experience
Work History
Nurse Practitioner
Via HealthPartners
Fort Mill , SC
02.2024 - Current
Provided comprehensive physical examinations.
Provided guidance during end-of-life decisions for terminally ill patients and their families.
Prescribed medications based on patient needs and current clinical standards of care.
Managed acute illnesses such as infections, respiratory disorders, or chronic diseases like diabetes or hypertension.
Coordinated with members of multidisciplinary teams to provide integrated services for complex cases.
Educated patients and families about medical treatments and self-care management techniques.
Prescribed medication and treatment regimens to manage acute and chronic conditions.
Nurse Practitioner
Agape Care Group
Lancaster, SC
11.2022 - 02.2024
Assess and manage patients with terminal illness.
Perform serious ill conversations
Conduct Advance Care Planning discussions with patient and families.
Provide education about chronic illness disease trajectory and life expectancy.
Participate in Interdisciplinary Group meetings
Perform Medicare Face to Face recertification visits to determine eligibility for Hospice services.
Assessed need for, ordered, obtained and interpreted appropriate lab tests.
Managed patients with acute and chronic conditions to relieve symptoms.
Make referrals for Hospice Service
HouseCalls Clinical Team Manager
United HealthCare
Minnetonka, MN
01.2014 - 11.2022
Manage the daily operations of the field staff Nurse Practitioners
Under the direction of the Regional Manager, I assisted in planning strategies that result in efficiently managing specific markets while ensuring high quality services to our members
Responsible for monitoring key performance metrics and quality improvement as well as procure internal and external relationships which will support expansion and success of House Calls business initiatives
Serve as a mentor and coach to House Calls Providers (Physicians Assistants and Nurse Practitioners); Demonstrate clinical expertise and guidance, program insight, and support in all aspects of the role; Conduct mandatory training and team meetings; Participated in committee activity to foster innovation and improve clinical processes
Plan and conduct Supervisory Ride Along visits in accordance with guidelines set forth by senior leadership; Assist in hiring and training new HCP’s; Ensure enterprise, department, HIPPA, and regulatory compliance: Maintaining security of Protected Health Information (PHI) and Intellectual Property (IP)
Responsible for all GSS functions: Update status change, terminations, PTO management, population, and network development reconciliation, perform yearly common reviews and continually manage performance
Implement coaching plans and/or corrective action plans related to standards set forth by business initiatives
Regular meetings and collaboration with supporting departments to ensure operational efficiency
Provide solutions to scheduling, assignments, and staffing plans, Plan and develop compelling market strategies and present to Senior Leadership during Business Reviews
Workforce management: Manages demands of a rapidly changing staffing environment with resilience
Analyzes and makes fact-based decisions utilizing forecasting model
Host monthly team meetings to communicate updates on company goals and performance: Monitor and address field concerns and communicate to senior leadership
Mentor and coach Clinical Advisor APC for the region.
HCP’sHouseCalls Nurse Practitioner, Sunbelt Staffing and XL Health, United HealthCare
Baltimore, MD
01.2009 - 01.2014
Perform in-home assessments on health plan member’s predominantly adult and geriatric populations in their homes and in facilities, Review past medical history, Review of patient systems, perform comprehensive physical examination, provide medication review, education and compliance teaching, perform depression screening, pain assessment and provided education, performed vital signs, conduct routine foot exam including monofilament test and vibratory testing and performed urine dipstick
Identify diagnoses based on patient symptoms and prescribed medications, formulate a list of current and past medical conditions using clinical knowledge and judgment and clinical findings, communicate assessment finding to PCP to help close potential gaps in care
Identify member specific needs and generated appropriate clinical referrals to Primary Care Providers, Care management, Social Services and Clinical Hot Line to facilitate appropriate follow up
Educate members on topics such as disease process, medication adherence and compliance
Compliance with all HIPAA regulations and maintain security of protected health information (PHI)
Maintain satisfactory clinical quality and patient satisfaction
Completed all mandatory compliance and training in accordance with company policy and procedure, Participates in pilot program for electronic medical record of health assessments.
Nurse Practitioner, Physician
ElderCare, Fidelis Secure Care
Charlotte, NC
01.2008 - 01.2010
Clinical Practitioner for wound care team of Long-Term Care facility including wound care nurse, staff nurses and physical therapist
Function as Primary Care Practitioner for members/residents of Long-Term Care Facilities, obtained detailed medical histories and perform patient examination on residents of Long-Term Facilities and Subacute rehab facilities, Performed Comprehensive Health Assessments on elderly residents
Participated in system wide call rotation for the practice including specialized triage system covering over forty facilities
Ordered and interpreted laboratory tests and x-rays, Provide and recommend treatment plans
Manage chronic health conditions such as diabetes, hypertension, and COPD, etc
Provide preventative care and promote wellness practices
Prescribe medications, other therapies and monitored response to treatment
Responded to medical emergencies within the facility
Facilitated family conference to update family members on patient’s condition
Refer patients to specialist and other health care providers as needed
Performed in facility home assessment on geriatric resident and documented HCC twice a year.
Registered Nurse
Carolinas Medical Center
Charlotte, NC
01.2006 - 01.2007
Provide primary nursing care to gynecology/oncology patients
Served as Charge Nurse when required
Provided patient and family education
Supervised Nurses and Nurse Technicians
Registered Nurse, Staff Nurse
Gaston Medical Center
Gastonia, NC
01.2005 - 01.2006
Performed Charge Nurse duties as required
Performed primary nursing duties, clinical procedures and provided direct patient care
Provided patient and family education
Medical Appeals Nurse
CIGNA HealthCare
Charlotte, NC
01.2002 - 01.2006
Research, resolved and responded to medical appeal request in accordance with company policy, state and government laws and utilized InterQual and Milliman guidelines
Review, compile and presented clinical documentation and provided succinct narrative for physician medical reviewer
Maintained federal and state compliance by resolving appeals in a timely manner
Consultant to claim/appeals processor
Identified potential fraud and abuse cases and reported to appropriate department
Registered Nurse
Total Care Home Health
Myrtle Beach, SC
01.1999 - 01.2000
Completed OASIS assessments documentation at Start of Care
Completed nursing assessments and provided nursing care to patients in their homes
Supervised Licensed Practical Nurses and Nursing Assistants
Provided patient and family education
Counseled patients and families
Medical Appeals Nurse
Blue Cross Blue Shield of South Carolina
Surfside Beach, SC
01.1993 - 01.1996
Research, Resolved and responded to medical appeal request for military personnel using Department of Defense guidelines
Reviewed / audited medical claims to assess for potential fraud and abuse cases
Review, compile and presented clinical documentation for physician medical reviewer
Maintained federal and state compliance guidelines to resolve medical appeals in a timely manner
Consultant to claim/appeals processor.
Staff Nurse
Grand Strand Regional Hospital
Myrtle Beach, SC
01.1990 - 01.1993
Performed clinical nursing duties for patients on a medical/surgical unit
Utilized the Nursing process to provide direct patient care
Assisted physicians with clinical procedures
Pharmacy Assistant
Front Street Pharmacy
Georgetown, SC
01.1985 - 01.1990
Filled prescriptions under direct pharmacist supervision, Maintained pharmacy inventory, Leader of expired inventory control program
Education
Polysomnography Technician Course -
Greenville Technical College
01.2021
UNCC Coding for HealthCare Professionals -
01.2016
Master of Science - Nursing
East Carolina University
01.2007
Certificate in Cardiac Care Technician -
Midland Technical College
01.2004
Bachelor of Science - Nursing
Medical University of South Carolina
01.1998
Certificate in Health Science -
01.1996
Diploma - Practical Nursing
Horry-Georgetown Technical College
01.1990
Skills
Geriatric Treatment
Patient-Centered Care
Preventive Care
Health and Wellness Expert
Problem Solving
Critical Thinking
Physical Examinations
Attention to Detail
Diagnosis and Treatment
Patient Education
Drug Regimen Counseling
Care Planning
Medication Prescribing
Judgement and Decision Making
Support Staff Supervision
Standards of Care
Treatment Planning
Timeline
Nurse Practitioner
Via HealthPartners
02.2024 - Current
Nurse Practitioner
Agape Care Group
11.2022 - 02.2024
HouseCalls Clinical Team Manager
United HealthCare
01.2014 - 11.2022
HCP’sHouseCalls Nurse Practitioner, Sunbelt Staffing and XL Health, United HealthCare