Sharell Giddens
Conyers,GA
Summary
Compassionate Registered Nurse recognized for productive and efficient task completion. Skilled in patient assessment, emergency care, and pain management. Possess strong communication skills, adaptability to high-stress environments, and ability to work effectively in team settings. Excel in providing exceptional patient care through empathy, patience, and active listening.
Overview
14
14
years of professional experience
Work History
Care Coordinator Ccsp
Visiting Nurse
Atlanta, GA
01.2024 - 07.2024
- Assesses and determines the level of care and appropriateness of community-based service for prospective clients
- Schedules/Conducts comprehensive face-to-face interviews with prospective Clients at their residence, hospital, or long-term care facility according to the standard of promptness set forth by DCH policy
- Collaborates with SW Care Manager in determining appropriate CCSP and non-CCSP community-based services
- Coordinates hospital transition process with hospital discharge planners, MDs, Members, Caregivers, and others as appropriate and develops appropriate path for clients Level of Care
- Documents assessments, case activity, hospitalization, disease management, care transitions, denials, services and follow up activities in a format with DCH and VNHS standards per policy
- Approves type and frequency of services appropriate to the client's needs while assuring that costs do not exceed the limitations established by program stands or fund sources
- Demonstrates knowledge and understanding of care management regulations, Medicare, and Medicaid guidelines
- Participates actively in interdisciplinary conferences to coordinate care, problem-solve, and exchange views and information; documents case conference activities and follow-up
Registered Nurse Student
Piedmont Rockdale
10.2023 - 12.2023
- Assessed and determined the level of critical care required for ICU patients, ensuring appropriate interventions and resource allocation
- Conducted detailed assessments of critically ill patients, monitoring vital signs, fluid balance, and hemodynamic stability using ICU monitoring equipment
- Assisted with Nasogastric Tube insertion, and placement
- Monitored administration of high-alert medications, including titration of vasoactive drips, Sedatives and Anesthetics, under preceptor supervision
- Participated in emergency response interventions, including code blues, CPR, and airway management
- Supported ventilator management, performed endotracheal suctioning, and monitored lab results to assess respiratory function
- Provided patient and family education on ICU procedures and care plans
- Collaborated with interdisciplinary ICU team members to develop and adjust patient care plans
- Documented patient assessments, treatments, and interventions in the electronic health record (EHR) system
Home Health Nurse
Suncrest Home health
Covington, GA
01.2023 - 12.2023
- Responsible for providing skilled home health visits, provided education of disease process according to plan of care and diagnosis
- Assesses conditions of patients on a day-to-day basis for any changes in condition of patients
- Performs various nursing procedures as ordered by provider including Wound care and dressing, Blood glucose monitoring, PT-INR testing, Catheterization, Ostomy care, Blood pressure monitoring, Tracheostomy Suctioning-Tube Feedings & Care, Respiratory Treatments & Assessments, and IV Therapy
- Traveled throughout 40-mile territory to provide home-healthcare services to adults and elderly patients diagnosed with chronic/terminal conditions, convalescing from surgical procedures, or recovering from serious illnesses and injuries
- Reviews all medications, identify possible interactions, Conducts health teachings according to plan of care and diagnosis
- Reports to MD for any change of condition and carrying out MD’s order
- Updates and performs electronic charting after every visit accomplishment practiced and enhanced nursing skills in performing nursing procedures including patient progress, symptoms, and vital signs
- Educated clients and families on the safe treatment of injuries, illness and conditions
Retro Behavioral Investigator
Optum
Atlanta, GA
11.2020 - 01.2023
- Responsible for triaging, investigating, and resolving instances of healthcare fraud and/or abuse conducted by medical providers and/or members
- Investigate, recover, and resolve all types of claims related to behavioral health and recovery and resolution for health plans, commercial customers, and government entities
- Conduct investigation based on tips from members, hotline, internal stakeholders, analytics, and law enforcement
- Review medical records to gather relevant facts to drive investigations, Triage claims data to send for medical coding review, Monitor investigation status throughout the process
- Collaborate with a variety of external sources to identify current and emerging patterns and schemes related to FWA
- Conduct data mining and analysis for potential provider flags
- Ensure adherence to state and federal compliance policies, reimbursement policies, and contract compliance
- Collaborate with clinical coding consultants for the purposes of educating and communicating to providers
- Manage confidential interviews and may conduct on-site provider reviews to gather and analyze all necessary information and documentation that is related to the investigation
Complex Customer Care Rep Senior
United Health Group, Optum
Atlanta, GA
12.2016 - 11.2020
- Provides comprehensive support to members in the navigation of medical plans, claims, case management and services via phone and email communications
- Provides detailed plan information to members including deductibles, copayments and pharmacy benefits; identifies network providers and offers financial assistance to maximize member cost savings
- Utilizes internal systems to investigate consumer inquiries related to medical claims processing, eligibility, claims cost and authorizations; works with appropriate teams to resolve or escalate issues to management/vendors as necessary
- Reviews and reconsiders claim coding including CPT, HCPS and ICD-10 while providing interpretation of coding to members
- Assists members with interpretation of medical, pharmacy and reimbursement plan as well as flexible spending accounts; collaborates with case management team and other internal resources to provide service recommendations and referrals while meeting member needs
- Establishes relationships with individual members, member companies and medical providers in effort to minimize gaps in care
- Serves in a lead capacity by mentoring team members and serving as a resource; trains and coaches new hires and current staff regarding internal processes; utilizes PowerPoint presentations to support training for Advocate, and listen/review quality audit standards
- Clinical Liaison (clinical problem solver with facilities, providers, carriers; resolution of issues concerning members, benefit interpretation, program definition and clarification
- Participates in monthly compliance training to ensure adherence to applicable laws and regulations including HIPAA, CMS, ERISA, etc
- Answered customer inquiries over the phone and via email.
- Provided accurate, valid, and complete information to customers.
- Resolved customer complaints promptly and professionally.
Nurse Advocate
United Health Group, Optum
Atlanta, GA
02.2014 - 12.2016
- Served as a one-stop resource to members regarding issues related to medical plans and health care support
- Utilized a counseling approach supported by medical knowledge and defined policies and procedures to uncover and collect critical information regarding conditions, treatment, medication usage, recovery etc
- Reviewed case files and completed medical interviews to collect required information used to interpret medical plans and benefits
- Clinical Program implementation and/or on-going management administration of a clinical need
- Provides strategic oversight and support, measurement standards and revisions as needed for delivery of programs focused on quality, affordability and outcomes
- Monitors and analyzes medical management activities; provides analytical support to clinical team; perform clinical assessments and review clinical audits
- Ensured HIPAA compliance in the execution of client interactions while using tact and compassion in the exchange of personal health information
Charge Nurse
Signature HealthCARE
Atlanta, GA
09.2010 - 02.2014
- Evaluated patient care needs while prioritizing treatment; responded to emergency situations
- Assist with wound care, foley catheter, wound vac, fluid intake/output, medication administration
- Recorded patient’s medical history, vitals, lab results and condition changes in medical records
- Collaborated with physicians to monitor and communicate changes in patient conditions; ensured immediate attention by physicians when needed
- Administered patient admission and discharge processes in conjunction with care teams
- Delegate duties to other personnel in delivery of patient care with consideration for patient needs
- Assisted in the development and implementation of departmental policies and procedures.
- Evaluated patient outcomes against established standards of care.
- Coordinated communication between physicians and other healthcare professionals regarding patient care.
Education
Associate of Applied Science - Registered Nurse
Albany State University
ALBANY, GA12-2023
Licensed Practical Nurse (LPN) -
Brown Mackie College
Fort Wayne, IN05-2008
Skills
- Wound Care
- Respiratory Management
- Organizational Skills
- Catheterization
- NG Tube Insertion
- Emergency Interventions
- Infection Control
- EHR Epic
- Homecare Homebase EMR
- Microsoft Office Suite
- Intermediate Excel
- Multidisciplinary team collaboration
- Patient Education
- Case Management
- Care Planning
- Quality Assurance
- Policy Adherence
Timeline
Care Coordinator Ccsp
Visiting Nurse
01.2024 - 07.2024
Registered Nurse Student
Piedmont Rockdale
10.2023 - 12.2023
Home Health Nurse
Suncrest Home health
01.2023 - 12.2023
Retro Behavioral Investigator
Optum
11.2020 - 01.2023
Complex Customer Care Rep Senior
United Health Group, Optum
12.2016 - 11.2020
Nurse Advocate
United Health Group, Optum
02.2014 - 12.2016
Charge Nurse
Signature HealthCARE
09.2010 - 02.2014
Associate of Applied Science - Registered Nurse
Albany State University
Licensed Practical Nurse (LPN) -
Brown Mackie College
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