TAMARA CHARLES
PEMBROKE PINES,FL
Summary
Talented RN Case Manager with over 8 years of experience working with Medicaid, Medicare, Private, and Commercial Health plans. Hardworking, passionate, with 19 years of nursing experience. Operates in high-pressure environments while recommending best resources and courses of action to benefit patient needs and return each to optimal quality of life.
Overview
17
17
years of professional experience
1
1
Certification
Work History
Case Manager/Utilization Reviewer
Jackson Health System
09.2016 - Current
- Performs concurrent review, medical necessity reviews to determine appellate potential of clinical disputes/denials or those eligible for clinical review.
- Demonstrates proficiency in utilization of electronic tools including Cerner, EQ Health, Authorization log, InterQual 21, 22, and 23 edition as well as competency in Microsoft Office, Powerpoint, and Excel.
- Conducted thorough assessments of clients' situations, identifying issues, goals, and necessary interventions.
- Serves as resource to non-clinical personnel. Provides CRC leadership with solutions related to process improvement
- Reviewing clinical notes and other supporting documents from patient medical records
- Prepare feedback to clients and participate in interdisciplinary meetings
Registered Nurse
University of Miami Hospital
07.2015 - 09.2016
- Administered medications via oral, IV, and intramuscular injections and monitored responses.
- Demonstrates proficiency in utilization of electronic tools including Meditek and EPIC
- Utilized critical thinking skills to prioritize nursing interventions based on patients'' acuity levels and individual needs.
- Administered medications safely according to established guidelines while closely monitoring for side effects or adverse reactions requiring intervention.
- Collaborated with interdisciplinary teams to develop comprehensive treatment plans for complex patients with multiple comorbidities.
- Provided direct patient care, stabilized patients, and determined next course of action.
Case manager, Home Health
Memorial Home Health
01.2014 - 07.2015
- Monitored clients' progress and tracked client services to provide crisis interventions.
- Demonstrates proficiency in utilization of electronic tools including EPIC
- Monitored ongoing cases closely, adjusting case management strategies as needed based on evolving circumstances or new information.
- Conducted thorough assessments of client's situations, identifying issues, goals, and necessary interventions.
- Collaborated with an interdisciplinary team to determine timely delivery of services.
- Developed and implemented safety plans for clients at risk of harm to provide protection.
- Maintained accurate documentation on all cases, ensuring compliance with regulations and confidentiality requirements.
- Identified care needs of individual patients and coordinated responses based on physician advice, insurance limitations, and procedural costs.
- Facilitated successful transitions between levels of care by developing detailed discharge plans and coordinating resources.
- Coordinated individual referrals to obtain community services, advocate for client needs and resolve roadblocks.
Case Manager, Home Health
Peace River Medical Center
12.2012 - 01.2014
Registered Nurse, Float Pool/Charge Nurse Overflow
Doctors Hospital
06.2007 - 02.2011
Education
Master of Science - Nursing
Walden University
Minneapolis, MN12.2024
Bachelors of Science in Nursing -
Florida International University
Miami, FL12.2004
High School Diploma -
William H. Turner Technical Arts High School
Miami, FL06.2000
Skills
- Excellent communication skills (verbal and written)
- Typing (50 wpm)
- Proficiency in application of medical necessity criteria with McKesson InterQual
- Ability to conduct research regarding State/Federal appellate guidelines and regulatory processes related to the appellate process
- EPIC, CERNER superuser
Certification
- Clinical Certified Transplant Nurse (CCTN)
- Registered Nurse, State of Florida
- Basic Life Support (BLS)
Awards Skills
Sigma Theta Tau Nursing Honor Society, Computer Literacy (Internet, Intranet, Microsoft Word, Word Perfect), Typing (45 words per minute), Bilingual (English/Creole), Electronic Charting (Mckesson/Epic/Interqual/Cerner)
References
Available Upon Request
Languages
Haitian Creole
Professional Working
Timeline
Case Manager/Utilization Reviewer
Jackson Health System
09.2016 - Current
Registered Nurse
University of Miami Hospital
07.2015 - 09.2016
Case manager, Home Health
Memorial Home Health
01.2014 - 07.2015
Case Manager, Home Health
Peace River Medical Center
12.2012 - 01.2014
Registered Nurse, Float Pool/Charge Nurse Overflow
Doctors Hospital
06.2007 - 02.2011
Master of Science - Nursing
Walden University
Bachelors of Science in Nursing -
Florida International University
High School Diploma -
William H. Turner Technical Arts High School
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