Sheila Brewer
Alexandria,VA
Summary
Compassionate Case Manager accustomed to treating diverse patient needs while managing dynamic conditions. Collaborative professional possessing excellent clinical knowledge and judgment combined with strong documentation and problem-solving abilities. Well-versed in managing emergent cases with poise.
Overview
7
7
years of professional experience
Work History
Registered Nurse Case Manager
Bridgepoint Hospital
Washington, DC
04.2023 - Current
- Collaborated with medical professionals to coordinate treatment plans for clients.
- Provided referrals to appropriate health care providers or other community resources.
- Facilitated communication between clients, families, caregivers, social services and other agencies to ensure client needs were met.
- Coordinated support services and optimized communication between healthcare workers and patients.
- Managed caseloads effectively, ensuring timely documentation and reporting.
- Maintained up-to-date knowledge of health plan benefits, policies, procedures, regulations, coding guidelines.
- Monitored pre-authorization requests to ensure that all necessary information was received prior to approval or denial of services.
- Developed case management plans based on individual patient needs and eligibility criteria.
- Performed discharge planning including referrals for post-acute care services when appropriate.
- Conducted reviews of inpatient utilization for compliance with admission criteria and concurrent review requirements.
- Coordinated with healthcare teams to develop care plans that meet patient needs and insurance coverage.
Project Manager
Quality Renovation
Fairfax, VA
06.2018 - Current
- Sustained key relationships with multiple insurance company adjusters and contractors to provide optimum client outcome
- Met with potential clients to evaluate needs and communicate service offerings
- Coordinated project timelines, meeting agendas and next steps to move functional projects forward
- Compiled data and measured performance to assess project success and improve strategies
Discharge Planner
Dr. Gil Kim
Fairfax, VA
09.2021 - 03.2023
- Assisted clients with initiating home health services
- Offered patient and family education on home services, insurance benefits and discharge planning
- Coordinated all follow up care and appointments
- Facilitated referrals for follow up appointments with specialists or primary care providers post-discharge.
- Implemented and monitored customer service standards for consistent interactions with guests
- Demonstrated top-notch communication skills
- Elevated customer satisfaction ratings by promptly resolving client and case issues.
- Reviewed medication regimens with pharmacist and physician in order to ensure accuracy and appropriateness of medications prescribed.
- Maintained impeccable office organization to support efficiency, professionalism and performance objectives.
Case Manager
Sibley Memorial Hospital
Washington, DC
11.2019 - 11.2021
- Developed,implemented and communicated resource referrals to support discharge plan
- Utilized resources to assess patient clinical,psychological and financial needs
- Studied Medicare and Medicaid requirements, managed care and other payor regulations and benefits to support patients
- Partnered with physicians, social workers, activity therapists , nutritionist and case managers to develop and implement individualized care plans and document patient interactions and interventions in electronic charting system
- Provided referrals to appropriate health care providers or other community resources.
Education
Bachelor of Science - Nursing
Fairfield University
Fairfield, CT05.1997
Skills
- Exceptional multi-tasker
- Clinical expertise
- Detail oriented/ Client relations
- Flexible/assertive/adaptive
- Excellent judgement and discretion
- Interdisciplinary collaboration'
- Case needs assessment
- Task Prioritization
- Time Management
- Utilization review
- Insurance knowledge
Timeline
Registered Nurse Case Manager
Bridgepoint Hospital
04.2023 - Current
Discharge Planner
Dr. Gil Kim
09.2021 - 03.2023
Case Manager
Sibley Memorial Hospital
11.2019 - 11.2021
Project Manager
Quality Renovation
06.2018 - Current
Bachelor of Science - Nursing
Fairfield University