Tammy Roy

RN Complex Care Manager (10/2022-present)

• Clinical nurse lead for complex care managers
• Provided patient and family health education focusing on self-management, prevention and wellness.
• Referred patients to specialized health resources or community agencies to furnish additional assistance.
• Trained and mentored new RNs on best practices, hospital policies and standards of care.
• Educated patients on health maintenance, disease prevention, and treatment options.
• Approached patients and engaged in conversation through use of effective motivational interviewing skills.

RN Care Manager, Bundles Payment Specialist (1/2022-10/2022)

• Notified Chief of Hospital medicine regarding inappropriate referrals and safety concerns
• Ability to review electronic medical record and investigate cause/concern for readmissions to hospital
• Collaborated with attending physicians, Chief of Hospital Medicine, case managers, and social workers to ensure hospital care needs, appropriate next site of care, and safety issues.

Utilization Review Nurse;Appeals & Denials/Case Manager (3/2020-1/2022)

• Notified Medical Director/Manager of delays in discharge or hospital care
• Wrote appeal letters for denied hospital stays to MA Medicaid insurer
• Performed Utilization review on all inpatient hospital stays and provided clinical documentation to insurance carriers
• Met with patients to determine appropriate discharge needs and communicated any barriers to attending physician

Clinical Nurse Abstractor, outpatient practices (6/2018-3/2020)

• Reviewed printed EMR records and abstracted information to create problem list for patients in outpatient setting.

• Provided utilization review for Renal and medical Telemetry 55 bed unit (9/2013-11/2015)
• Provided Utilization review and discharge planning for patients on 32 bed unit (11/2015-5/2018).

Director of Utilization Review (9/2010-9/2013)

• Oversaw the Utilization Review Department while continuing to review cases as well
• Staff size 1 RN and 1 administrative assistant
• Wrote and submitted Utilization Review Agent application as required by Department of Industrial Accidents yearly; submitted audit information as required and provided response and any corrective actions needed
• Credentialed list of Healthcare providers needed for appeal cases(PT, OT, MD, DO, DC)
• Provided Utilization Reviews and Completed requested appeals on Workers Compensation Claims following DIA guidelines

Utilization Review Nurse (6/2006-9/2013)

• Provided Utilization Reviews and Completed requested appeals on Workers Compensation Claims following DIA guidelines

Telephonic and Field Case Management (1/2006-9/2013)

• Maintained caseload of patients for Telephonic Case Management
• Field Case Management visit with patients as needed

• Provided first aid, reviewed and ensured immunizations were present as by DPH requirements for 500 elementary age children; responded to emergencies for students and staff; education to staff as needed.

• Provided first aid to college age students; immunizations and allergy injection as needed.

• Assisted with oral surgeries, extractions utilizing conscious sedation; obtained x-ray certification.

Evangelical Community Homecare Services (1997-1999, PA)

Community Homecare Services (1996-1997, PA)

• Provided nursing visits to patients in their homes with a variety of chronic illnesses and surgeries (COPD, MI, post CABG).

Rochester VNA (1992-1995, NH) Home Health Nurse/Home Health Supervisor/Orientation Nurse

• Provided nursing visits to patients in their homes with a variety of chronic illnesses and surgeries (COPD, MI, post CABG)
• Supervised 12 home health aides
• Orientated all new staff/revised orientation program for field staff

Portsmouth Regional VNA (1992-1993, NH)

• Provided nursing visits to patients in their homes with a variety of chronic illnesses and surgeries (COPD, MI, post CABG).

• Provided nursing care on a medical surgical unit with 12 telemetry beds; Telemetry and ACLS certification.