Shonda Reid
Monroe,NC
Summary
Accomplished Registered Nurse Case Manager with over 20 + years of experience dedicated to quality care of diverse patients. Skillfully blend of hands-on skills along with an extensive career background in Case Management and Managed Care. Certified as a Managed Care Nurse, I work effectively with all levels of healthcare providers, physicians and administrators to address patient needs.
Overview
23
23
years of professional experience
Work History
Registered Nurse Care Navigator (Hybrid)
Humana - CenterWell Senior Primary Care
11.2022 - Current
- Chronic Care and Transitional Care Management within the Primary Care Organization offices in North Carolina.
- Serve as liaison between the patient and Providers.
- Serve as the Care Plan Lead for patients that are enrolled in the High Risk Patient Management Program utilizing the 5Ms Geriatric Model.
- Collaborated with interdisciplinary teams to develop comprehensive treatment plans for complex patients with multiple comorbidities.
- Reduced hospital readmissions through effective discharge planning, patient education, and follow-up care coordination.
- Educated patient and caregivers on management of chronic conditions.
- Knowledge of Medicare and managed care guidelines and NCQA standards.
- Assisted the Las Vegas market for 3 months along with my current market.
- Assisted in the training and mentorship of new team members, contributing to a positive work environment and high-quality patient care.
- Lead interdisciplinary team meetings by presenting relevant clinical data about patients'' progress toward reaching established goals of care.
- Participate in weekly acute care length of stay meetings with Humana’s Utilization Management leaders.
Registered Nurse Case Manager
Novant Health Matthews Medical Center
11.2018 - Current
- Coordinate care and create a safe discharge plan for assigned patients to the appropriate level of care upon discharge.
- Educate patients and families of the insurance appeal process for post-acute care rehab along with initiating the appeal process on the patients behalf.
- Enhanced interdisciplinary team communication through regular case conferences, promoting effective collaboration for optimal patient care.
- Evaluate patient progress and adjusted care plans accordingly, ensuring continuity of care across all healthcare settings.
- Provided education and support to patients and families, empowering them to make informed decisions regarding their healthcare needs.
- Collaborated with physicians and other healthcare providers to ensure appropriate resource utilization for complex cases.
- Advocate for patients'' rights, facilitating access to necessary services and resources within the community.
- Maintained detailed documentation of patient encounters, supporting accurate billing practices and data-driven decision making.
- Recognized as an expert resource on organizational policies related to case management practice, regularly consulted by colleagues seeking guidance.
- Advocated for patients by communicating care preferences to practitioners, verifying interventions met treatment goals and identifying insurance coverage limitations.
- Contributed substantially to successful department JCAHO accreditation by consistently operating to highest standards of care.
Population Health Care Manager
Duke University Health System - Contractor
02.2022 - 06.2022
- Provide individual treatment to address barriers and identified concerns by accessing systematically identified data from multiple sources
- Perform targeted interventions to assist patients with connection to primary care providers and other health care resources
- Use a patient-centric, collaborative partnership approach to assist the patient with improved self-management and identifying barriers by addressing the patients needs
- Utilize proven processes to measure a patient’s understanding and acceptance of the proposed plan(s), his/her willingness to change, and his/her support to maintain health behavior change
- Apply teaching and learning theories to assist patients and families with physical and emotional impact of body changes and chronic illness
- Communicate and coordinate with all provider(s) and member(s) of the care team as needed to minimize fragmented care and foster appropriate utilization of services
- Navigating transitions of care generally from hospital to home or community facilities
- Facilitate interdisciplinary communication with the patient’s care team
- Provide telephonic outreach to patients, providers, and community stakeholders
- Provide feedback to management and executive leadership that will enhance negotiations with payers, improve care management, and/or address gaps in care
Clinical Assessment Nurse
Somatus
11.2020 - 02.2021
- Assessed the member’s knowledge and understanding of his/her renal disease process.
- Performed comprehensive assessments telephonically of participating members.
- Serve as patient advocate and liaison between the patient and Providers.
- Improved the member’s understanding of their disease process and management through patient education.
- Develop and create patient care plans -assist patients with creating goals of care and interventions to attain goals.
- Collaborate with the care team for care management of participating members
- Work collaboratively with physicians, nurses, social workers, dieticians, pharmacists, and community health workers
- Successfully assist members with obtaining resources and assistance for care management.
Acute RN – Dialysis
Fresenius Kidney Care
07.2018 - 11.2018
- Performed hemodialysis treatments in an acute care setting.
- Educated patients about End Stage Renal Disease and hemodialysis.
- Completed patient assessment prior to treatment including assessing the various dialysis access types.
- Collaborated with the care team to discuss treatment plan and patient's tolerance of treatment.
- Administered medications and blood products per physician’s orders during treatment.
- Assessed the patient's vital signs and hemodynamics prior, during, and after treatment.
- Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing conditions.
- Independently operate the dialysis unit including equipment troubleshooting and disinfection.
- Completed required quality control measures prior and during patient treatments.
- Participated in after hours on-call schedule.
Home Therapies Nurse
Fresenius Medical Care NA
09.2011 - 07.2018
- Train and educate patients and caregiver how to properly and safely perform home dialysis treatment including, how to properly cannulate or access dialysis access for treatment.
- Provided nursing care for patients with End Stage Renal Disease, who are performing their dialysis treatments at home.
- Performed accurate documentation of patient assessments, interventions, and outcomes in compliance with regulatory standards.
- Utilized nursing knowledge to adjust patient’s treatment prescription based upon lab results.
- Served as Anemia and Phosphorous Manager for the unit.
- Conduct assessment interviews with prospective patients educating on Peritoneal and Home Hemo dialysis, visiting patient's home to assess appropriateness.
- Implemented infection control measures that significantly reduced hospital-acquired infections.
- Educated patients on disease management, self-care techniques, and wellness strategies to improve long-term health outcomes.
- Utilized strong clinical judgment in prioritizing patient needs during high-stress situations, ensuring optimal outcomes.
- Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing conditions.
- Collaborated with interdisciplinary teams for optimized patient treatment plans and outcomes.
- Completed company required ICD – 10 coding training
- Work independently providing care for patients with minimal supervision, participated in on-call schedule rotation.
Nurse Care Manager
Humana
11.2013 - 06.2018
- Provided telephonic care management for Medicare members from a home-based office.
- Successfully managed a member roster of over 200 members while meeting metric guidelines monthly.
- Collaborated with Interdisciplinary Team Members within the organization for care coordination and care plan creation.
- Educated patient and caregivers on management of chronic conditions.
- Knowledge of managed care guidelines and NCQA standards.
- Followed NCQA guidelines and HEDIS measures and protocols.
- Successfully assisted members with obtaining medical equipment, resources, and authorization approval from insurance provider.
- Improved patient outcomes by implementing comprehensive care plans and coordinating with interdisciplinary healthcare teams.
- Enhanced patient satisfaction through timely communication, empathetic listening, and personalized education on health management.
- Served as team point person in manager’s absence.
- Served as Subject Matter Expert for Care Plans for team.
- Completed training to provide Care Management for members with Chronic Kidney Disease or End Stage Renal Disease (ESRD).
- Served as a Subject Matter Expert for patients with ESRD or on dialysis for the organization.
RN Team Leader - Outpatient Dialysis
Fresenius Medical Care
08.2010 - 09.2011
- Provided direct patient care in an outpatient hemodialysis setting.
- Completed patient assessment prior to treatment.
- Assessed and cannulate dialysis access.
- Assessed and access dialysis catheter.
- Provided catheter care and dressing changes.
- Provided patient education regarding hemodialysis, ESRD, and lifestyle management.
- Supervised dialysis technicians.
- Assumed daily charge nurse duties when assigned.
Nursing Assistant Instructor
South Piedmont Community College
05.2009 - 03.2011
- Instructed students in a classroom setting by lecture format according to program and state guidelines
- Taught required skills to students according to program and state guidelines.
- Provided clinical instruction to program participants.
- Assisted students to prepare for the state certification exam.
- Evaluated proficiency of skills performance.
- Enhanced Nursing Assistant training by incorporating simulations and hands-on activities.
- Collaborated with colleagues to develop comprehensive lesson plans addressing various learning styles.
Staff Nurse – Pre-op/Holding
Novant Health Matthews Medical Center
08.2009 - 10.2010
- Prepare surgical patients for scheduled procedure including obtained informed consent, answering any questions or concerns regarding procedure and care.
- Completed patient assessment prior to surgery and after recovery
- Administer medications, complete dressing changes, and collaborated with the care team for patient management and care.
- Utilized strong clinical judgment in prioritizing patient needs during high-stress situations, ensuring optimal outcomes.
- Assisted physicians in performing diagnostic tests and procedures to facilitate prompt diagnosis and treatment.
- Assist other team members with tasks as needed.
- Promoted a safe and comfortable healing environment by addressing patient concerns promptly and professionally.
- Implemented infection control measures that significantly reduced hospital-acquired infections.
- Educated patients on disease management, self-care techniques, and wellness strategies to improve long-term health outcomes.
Staff Nurse – Acute Hemodialysis
Presbyterian Hospital
08.2006 - 10.2010
- Performed hemodialysis and therapeutic plasma exchange apheresis to patients in an acute care setting.
- Educated patients about End Stage Renal Disease and hemodialysis.
- Completed patient assessment prior to treatment including assessing the various dialysis access types.
- Collaborated with the care team to discuss treatment plan and patient's tolerance of treatment.
- Administered medications and blood products per physician’s orders during treatment.
- Assessed the patient's vital signs and hemodynamics prior, during, and after treatment.
- Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing conditions.
- Independently operate the dialysis unit including equipment troubleshooting and disinfection.
- Completed required quality control measures prior and during patient treatments.
- Participated in after hours on-call schedule.
Director of Nursing
ProNurse Medical Care
02.2005 - 02.2006
- Supervise over 40 employees of a home care agency
- Assist with recruiting and hiring of new employees
- Ensured compliance of state and federal regulations were maintained
- Direct the care of clients receiving home care services
- Conduct initial admission assessments of clients requesting services
- Create the plan of care for clients based upon assessment and client needs
- Perform diabetic and diet education
- Communicate client’s care with physician
- Created a skills review program for in home care staff (Patient Care Technicians and Certified Nursing Assistants)
- Provided CPR certification classes for employees
- Certified CPR Instructor.
Staff Nurse
Gambro Healthcare
03.2003 - 12.2005
- Provide direct patient care in an outpatient hemodialysis setting
- Complete a patient assessment prior to treatment
- Assess and cannulate dialysis access
- Assess and access dialysis catheter
- Provide catheter care and dressing changes
- Provide patient education regarding hemodialysis, ESRD, and lifestyle management
- Supervise dialysis technicians
- Assume daily charge nurse duties when assigned
- Assist other team members with tasks as needed.
ICU - Staff Nurse
Union Regional Medical Center
07.2001 - 09.2003
- Provide patient care for patients that are critically ill in a hospital setting
- Complete patient assessment of assigned patients at the beginning of each shift
- Perform dressing changes, skin care, and ventilator management as needed
- Assist physicians with the insertion of invasive lines and procedures at the bedside
- Assess vital signs and hemodynamic monitoring
- Collaborate with physicians and Interdisciplinary Care Team
- Assist other team members with tasks as needed.
Education
Bachelor of Science - Nursing
Jacksonville University
Jacksonville08.2020
Associate of Applied Science - Nursing
University of South Carolina
Lancaster05.2001
Skills
- Chronic Disease Management
- Case Management
- Care Coordination
- Patient Education
- Care Plan Development
- Discharge Planning
- Managed Care
- Utilization Management
- Geriatric Care
- Critical Thinking
- Patient Assessment
- Teamwork and Collaboration
license and certifications
- 07/2001 - 10/2024: Registered Nurse (RN) - North Carolina Board of Nursing
- 12/2023 - 12/2026: Certification in Managed Care Nursing (CMCN) - American Board of Managed Care Nursing
- 11/2023: Kidney Health Coach - American Kidney Fund
- 01/2023 - Present: Basic Life Support (BLS) Provider - American Heart Association
- 05/2017: Certificate in Legal and Ethical Issues in Healthcare
Timeline
Registered Nurse Care Navigator (Hybrid)
Humana - CenterWell Senior Primary Care
11.2022 - Current
Population Health Care Manager
Duke University Health System - Contractor
02.2022 - 06.2022
Clinical Assessment Nurse
Somatus
11.2020 - 02.2021
Registered Nurse Case Manager
Novant Health Matthews Medical Center
11.2018 - Current
Acute RN – Dialysis
Fresenius Kidney Care
07.2018 - 11.2018
Nurse Care Manager
Humana
11.2013 - 06.2018
Home Therapies Nurse
Fresenius Medical Care NA
09.2011 - 07.2018
RN Team Leader - Outpatient Dialysis
Fresenius Medical Care
08.2010 - 09.2011
Staff Nurse – Pre-op/Holding
Novant Health Matthews Medical Center
08.2009 - 10.2010
Nursing Assistant Instructor
South Piedmont Community College
05.2009 - 03.2011
Staff Nurse – Acute Hemodialysis
Presbyterian Hospital
08.2006 - 10.2010
Director of Nursing
ProNurse Medical Care
02.2005 - 02.2006
Staff Nurse
Gambro Healthcare
03.2003 - 12.2005
ICU - Staff Nurse
Union Regional Medical Center
07.2001 - 09.2003
Bachelor of Science - Nursing
Jacksonville University
Associate of Applied Science - Nursing
University of South Carolina
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