Sheila Talley
Seminole,FL
Overview
14
14
years of professional experience
1
1
Certification
Work History
Nurse Case Manager Senior Analyst
Mindlance/Cigna
Seminole , Florida
09.2024 - Current
- Maintained accurate documentation of all case management activities in accordance with regulatory standards.
- Assisted patients in navigating through the healthcare system by providing support throughout their treatment process.
- Provided education to patients and their families on disease management, medications and other treatments.
- Analyzed data from various sources including claims information, laboratory results and medication histories to identify potential risks or gaps in care.
- Conducted comprehensive health risk assessments to identify patient needs and improve care outcomes.
- Performed detailed health risk assessments to evaluate patient conditions and guide care planning.
RN Case Manager
Centene (A line Staffing) Utica, MI
Utica, MI
05.2024 - 09.2024
- Managing complex cases for Medicare and Medicaid populations.
- Implement individual case management plans based on total patient assessments, addressing both immediate and long-term healthcare needs.
- Oversee and coordinate all aspects of case management to ensure that patients receive comprehensive and continuous care throughout their healthcare journey.
- Maintain detailed and accurate case management records, including care plans, patient progress, and outcomes, to ensure continuity of care and compliance with regulations.
- Extensive background includes evaluating and coordinating care across various settings, such as acute care inpatient, LTAC, SNF, and home health services.
- Ensure that all case management practices comply with healthcare regulations, standards, and best practices. Participating in quality improvement initiatives.
Case Manager (Direct Hire)
Humana at Home - Saint Petersburg, FL
Louisville, KY
09.2022 - 04.2024
- Provided telephonic Care Management with responsibilities include the following:
- managing complex cases for Medicare and Medicaid populations.
- Implement individual case management plans based on total patient assessments, addressing both immediate and long-term healthcare needs.
- Oversee and coordinate all aspects of case management to ensure that patients receive comprehensive and continuous care throughout their healthcare journey.
- Maintain detailed and accurate case management records, including care plans, patient progress, and outcomes, to ensure continuity of care and compliance with regulations.
- Extensive background includes evaluating and coordinating care across various settings, such as acute care inpatient, LTACH, SNF, and home health services.
- Ensure that all case management practices comply with healthcare regulations, standards, and best practices. Participating in quality improvement initiatives.
- Complete health risk assessments to determine members' current health needs. Identify and help to resolve barriers that hinder effective care.
- Complete post-discharge assessments, and coordinate with providers and the interdisciplinary team to prevent readmissions.
- Identifies and resolves barriers that hinder effective care.
- Create member care plans to assist members with health goals, and ensure the patient is progressing toward desired outcomes by monitoring patient care through assessments and/or evaluations.
- Provide both verbal and written education to assist members in managing chronic conditions such as diabetes, CHF, COPD, CVD, diabetes, and complex care needs.
- Collaborate with Social Services to assist members resources a little over a year ago to meet Social Determinants of Health needs.
Nurse Navigator (Direct Hire)-Remote
Amerisource Bergen, Conshohocken, PA, Remote
Amerisource Bergen, Conshohocken, PA
02.2022 - 09.2022
- Education on the medication use of Dupixent.
- Implemented evidence-based protocols that promote cost-effective care delivery models.
- Guided patients through adverse reactions, providing essential care and coordination.
- Educated patients on proper medication administration techniques.
Disease Management Nurse/Care Management- Remote
Optum Care /DaVita - Saint Petersburg, FL
Saint Petersburg, FL
01.2019 - 03.2022
- managing complex cases for Medicare and Medicaid populations.
- Implement individual case management plans based on total patient assessments, addressing both immediate and long-term healthcare needs.
- Oversee and coordinate all aspects of case management to ensure that patients receive comprehensive and continuous care throughout their healthcare journey.
- Maintain detailed and accurate case management records, including care plans, patient progress, and outcomes to ensure continuity of care and compliance with regulations.
- extensive background includes evaluating and coordinating care across various settings, such as acute care inpatient, LTACH, SNF, and home health services.
- Ensure that all case management practices comply with healthcare regulations, standards, and best practices. Participating in quality improvement initiatives.
- Care management in a large four-provider physician office, which served over 1,400 patients, provided post-discharge assessment and education.
- Arranging for home healthcare, DME, or other resources needed.
- Collaborated with Medical Directors, Providers, Pharmacists, and other members of the interdisciplinary team to help provide quality and continuity of care to patients.
- Processed patient referrals/authorizations.
- Enrolled eligible patients in the Disease Management program consisting of diabetes, COPD, CAD, CHF, high risk, and CCM.
- Utilizing ongoing assessment skills, education in disease processes, while promoting health and prevention, including preventative screenings.
- Developed patient-involved personalized plans of care for patients. Discussed social and economic needs, and provided resources as needed.
- Performed all duties in alignment with NCQA standards, HEDIS measures, and CMS guidelines.
- Evaluated effectiveness of interventions by tracking changes in clinical indicators over time.
Case Manager (Direct Hire)-Remote
Humana at Home
Saint Petersburg, FL
12.2010 - 12.2018
- managing complex cases for Medicare and Medicaid populations.
- Implement individual case management plans based on total patient assessments, addressing both immediate and long-term healthcare needs.
- Oversee and coordinate all aspects of case management to ensure that patients receive comprehensive and continuous care throughout their healthcare journey.
- Maintain detailed and accurate case management records, including care plans, patient progress, and outcomes, to ensure continuity of care and compliance with regulations.
- Extensive background includes evaluating and coordinating care across various settings, such as acute care inpatient, LTACH, SNF, and home health services.
- Ensure that all case management practices comply with healthcare regulations, standards, and best practices. Participating in quality improvement initiatives.
- Provided telephonic outreach to eligible members and engaged participation in the self-management of patients with chronic medical conditions.
- Ongoing. Assessment and education in both disease processes and health promotion, adhering to the model of care.
- Collaborated with an interdisciplinary team to provide quality patient care.
- Consistently met and exceeded member engagement of 80% in the management of over 200 members, and developed care plans.
- Adhered to NCQA standards, HEDIS measures.
Education
Associate of Science - Associate's Degree in Nursing
Galen College of Nursing-Tampa Bay
Saint Petersburg, FL02-2009
Skills
- Case management and care coordination
- Health risk assessment
- Patient education
- Data analysis and collection
- Regulatory compliance
- Allscripts and EMR systems
- Microsoft Office applications
- HEDIS and NCQA standards
- Managed care strategies
- Triage and motivational interviewing
Certification
- Certified Case Manager
- Registered Nurse of Florida (Multistate) # RN9289444 - Board of Nursing, Date Expires 07/31/2026
Timeline
Nurse Case Manager Senior Analyst
Mindlance/Cigna
09.2024 - Current
RN Case Manager
Centene (A line Staffing) Utica, MI
05.2024 - 09.2024
Case Manager (Direct Hire)
Humana at Home - Saint Petersburg, FL
09.2022 - 04.2024
Nurse Navigator (Direct Hire)-Remote
Amerisource Bergen, Conshohocken, PA, Remote
02.2022 - 09.2022
Disease Management Nurse/Care Management- Remote
Optum Care /DaVita - Saint Petersburg, FL
01.2019 - 03.2022
Case Manager (Direct Hire)-Remote
Humana at Home
12.2010 - 12.2018
Associate of Science - Associate's Degree in Nursing
Galen College of Nursing-Tampa Bay
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