Shelley Verner

• Coordinated service schedules and appointments with clients.
• Provided customer service to ensure client satisfaction.
• Maintained accurate records of services provided for each client.
• Handled incoming calls and inquiries from customers regarding services offered.
• Created detailed reports on quality assurance metrics related to service delivery.
• Ensured compliance with standards of professional practice as well as state and federal regulations related to health care delivery services.
• Participated in multidisciplinary team meetings to discuss patient care plans.
• Provided emotional support and comfort to families during difficult times.
• Counseled patients regarding medication side effects or lifestyle changes necessary for improved health outcomes.

• Completes comprehensive assessments of members per regulated timelines and determines who may qualify for case management based on clinical judgment, changes in member's health or psychosocial wellness, and triggers identified in the assessment.
• Develops and implements a case management plan in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals and member's support network to address the member needs and goals.
• Performs ongoing monitoring of the care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly.
• Maintains ongoing member case load for regular outreach and management.
• Promotes integration of services for members including behavioral health care and long term services and supports/home and community to enhance the continuity of care for Molina members.
• Conducts face-to-face or home visits as required.
• Developed patient care plans, overall patient health assessments and evaluations.
• Determined and coordinated appropriate level of care to meet individual patient needs.
• Incorporated appropriate nursing methods to create individualized care plans.
• Coordinated with vendors and suppliers and negotiated medical equipment and supply prices.
• RNs are assigned cases with members who have complex medical conditions and medication regimens

• Administer medications and treatment to patients and monitoring responses while working to adjust care plans
• Informs patients and families of effective treatment options and at-home care strategies, enhancing long-term outcomes
• Trach/GB experience
• Delivered in-home care to disabled children
• Ensured safety and well-being of patient
• Assisted patients with proper ADL care
• Engaged patients with games, crafts, music, reading, and other activities
• Evaluated healthcare needs, goals for treatment and available resources of each patient and connected to optimal providers and care

• Oversaw and managed clinical and support staff in patient care activities while maintaining high level of staff morale and professionalism
• Case Management of Star+Plus, Medicare, Medicaid, Superior managed Care HMO Populations
• Supervised Clinical Staff and ensured quality of patient care under federal, state, and local regulation
• Used Clinical judgment to identify physical and behavioral health needs and worked with member and caregiver to establish appropriate plan of care and services that minimized needs based on medical necessity criteria and benefit guidance
• Managed case load of 120 + patients
• Facilitated appropriate member referrals to special programs such as Disease Management, Behavioral Health, Advanced Illness, and Social Services
• Monitored Clinical documentation for completeness and accuracy and assured that it met standards or good documentation and successful billing
• Oversaw completion and implementation of Plan of care
• Responsible for effective utilization of staff including assignment and reassignment of duties
• Provided excellent customer service and communication skills

• Delivers outstanding care to patients with various diagnoses and managed care from treatment initiation through to completion
• Provides care for patients with wide scope of chronic and acute co-morbidities
• Performs all tasks with patient-centered focus while seeking opportunities for improvement of processes and treatments
• Responsible for primary care and medication management
• Evaluates patient care needs, prioritize treatment, and maintain patient flow
• Documented patient information obtained from interviews concerning symptoms, medications and prior treatment
• Provided patient education
• Manage case load of 5-6 patients, treatments, medications, discharge instructions, and follow-up care
• Manage care for post-operative patients through discharge
• Ensue safety and well-being of patients
• Follow infection control procedures

• Responsible for case management. Set re-assessment schedules. Worked closely with various Star Plus, Superior, Medicaid Programs, MCO, Respite (MDCP, and private insurance companies to obtain authorizations for Private Duty Nursing and Attendant Services.
• Supervise the care of patients including performing supervisory visits to patient's home
• 
  QA Nurse's notes
• Educated Family and Patient on Disease processes
  
• Conducted orientations /education for all new hires including RNs and Lvns

Responsible for case management, set re-assessment schedules, worked closely with various Star+Plus, Superior, Medicaid Programs, MCO, Respite (MDCP) and private insurance companies to obtain authorizations for Private Duty Nursing and attendant care

• Supervised care of 100 plus patient including performing supervisory visits to patient's home
• QA nurse's notes and enter them into payroll system to ensure field worker pay
• Educated family and patient on disease processes
• Documented patient information obtained from interviews
• Conducted orientations/education for all new hires including RNs, LVNS, and Home Health Aides in the offices as well as in home setting

• Developed patient care plans, overall patient health assessments and evaluations.
• Determined and coordinated appropriate level of care to meet individual patient needs.

• Developed patient care plans, overall patient health assessments and evaluations.
• Actively participated in family and patient planning processes.
• Determined and coordinated appropriate level of care to meet individual patient needs.

• Developed patient care plans, overall patient health assessments and evaluations.
• Actively participated in family and patient planning processes.
• Determined and coordinated appropriate level of care to meet individual patient needs.
• Collaborated with physicians on patient medications, medical needs and performance.