Teleca Ester
Department Of Corrections
Donaldsonville,LA
18
years of professional experience
Knowledgeable Registered Nurse with solid background in case management within healthcare settings. Proven ability to coordinate patient care and navigate complex healthcare systems effectively. Demonstrated expertise in patient advocacy and communication.
Work History
RN-Case Manager
3 Years 2 Months- Care Coordination: Managed active caseload, collaborating with physicians, therapists, and social services to design and execute individualized care plans that addressed patient needs.
- Discharge Planning: Facilitated timely patient transitions to post-acute settings, including skilled nursing facilities and home health, while coordinating DME and transport for seamless care.
- Utilization Review: Performed rigorous concurrent reviews utilizing evidence-based criteria to confirm medical necessity, optimize resource utilization, and secure proper payer reimbursement.
- Patient Advocacy: Acted as primary liaison between patients, families, and insurance providers to manage expectations, resolve barriers, and educate on post-discharge self-care.
- Documentation and Compliance: Maintained accurate, real-time EHR documentation, ensuring adherence to state, federal, and joint commission standards for quality and compliance.
Practical Nursing Adjunct Instructor
1 Year 9 Months- Developed instruction aligning with course student learning outcomes.
- Created classroom materials that enhance course objectives.
- Advises students through feedback, coaching, remediation, and engagement.
- Provided feedback, coaching, and remediation to engage students effectively.
- Matching patient needs with student learning objectives and skill levels.
- Completing evaluation forms and providing written feedback on student progress.
- Assessed patient needs to align with student learning objectives and skill levels.
- Filled out evaluation forms and provided detailed written feedback on student progress.
RN Medical Surgical- In House Contract
1 Year 11 Months- Implemented comprehensive patient care for up to 6 patients per section, ensuring adherence to treatment plans and promoting patient recovery.
- Scheduled and coordinated patient admissions and discharges to streamline workflow and enhance patient experience.
- Interact with departments regarding patient care.
- Collaborated with various departments to coordinate patient care effectively.
- Educated patients and families on health care needs and options, fostering understanding and encouraging adherence to treatment plans.
Utilization Management
2 Years 11 Months- Analyzed patient records for legitimacy of admission, treatment, and length of stay to ensure compliance with government and insurance reimbursement policies.
- Analyzes insurance, governmental, and accrediting agency standards to determine criteria concerning admissions, treatment, and length of stay of patients.
- Reviews application for patient admission and approves admission or refers case to facility utilization review committee for review and course of action when case fails to meet admission standards.
- Compared inpatient medical records against established criteria, collaborating with medical and nursing personnel to validate treatment legitimacy and length of stay.
- Determines patient review dates according to established diagnostic criteria.
Registered Nurse
2 Years 11 Months- Supervised nursing staff in planning and delivering patient care
- Directed and evaluated care provided by licensed nurses and staff
- Educated staff, assessed patient needs, and planned, implemented, and documented individualized care
RN Utilization Review
2 Years 5 Months- Analyzed patient records to verify admission, treatment, and length of stay legitimacy, ensuring compliance with government and insurance reimbursement policies and criteria from accrediting agencies.
- Compares inpatient medical records to established criteria and confers with medical and nursing personnel and other professional staff to determine legitimacy of treatment and length of stay.
- Compared inpatient medical records to established criteria, collaborating with medical and nursing personnel to assess treatment legitimacy and appropriate length of stay.
- Determines patient review dates according to established diagnostic criteria.
- Assisted review committee in planning and holding federally mandated quality assurance review
Prior Authorization RN
1 Year 9 Months- Reviewed and collected medical information to determine medical necessity of requested services by applying specific medical criteria.
- Ensures that services provided to eligible members are within benefit plan, and appropriate contracted providers are being utilized.
- Initiated and maintained direct communication with health care providers to obtain complete and accurate information for member care.
- Initiates and continues direct communication with health care providers involved with the care of the member to obtain complete and accurate information.
- Identified and referred cases to case management for appropriate follow-up and support.
- Identifies and refers cases appropriate for case management.
- Followed regulatory requirements for assigned market. and apply all necessary regulatory requirements for assigned market.
- Followed and applied all regulatory requirements for the market.
Director of Nursing
1 Year 11 Months- Establishes, organizes, plans and directs department functions to comply with facility philosophy, objectives, policies and regulations pertaining to nursing administration
- Ensured delivery of high-quality and efficient nursing care through staff training and supervision
- Directs and supervises department personnel; recruits, interviews and evaluates applicants
- Establishes and supervises performance evaluations, disciplines and terminates personnel when necessary
- Investigates irregularities and policy violations and takes corrective action
- Receives and reviews incident reports and takes appropriate action
- Engaged directly with residents in care processes to elevate quality of care through continuous feedback and improvement initiatives
- Fostered collaborative relationships with departments, medical staff, residents, families, and the public to enhance care coordination
- Coordinates department activities with other departments to assure continuity of quality care; serves as consultant
DIRECTOR OF NURSING
5 Years- Assist with the development and implementation of nursing services, objectives, policies and procedures in accordance with Federal and State regulations.
- Planning, developing and supervising the activities of licensed and non-licensed personnel who provide health care and nursing services to our residents.
- Recruited nursing department staff, completed employee appraisals, resolved employee disciplinary issues, and conducted new hire orientations, in-services, and ongoing education.
- Created monthly staff schedules to ensure adequate coverage and efficiency.
- Oversees admits and discharges for accurate documentation, perform pre-admission assessments with patients and families.
- Conferred with residents' physicians to clarify medical orders and oversee direct care delivery.
- Oversaw admissions and discharges to ensure accurate documentation and conducted pre-admission assessments with patients and families.
Education
Bachelor of Science - Nursing
Associate of Science - Nursing
Diploma - Practical Nursing
Diploma - General Studies
Skills
Case Management/ Utilization Management Skills
Care coordination
Discharge planning
Direct patient care
EMR / EHR
Chronic Care Management
RN Licensure
Computer literate: Microsoft
Excel
Power Point
Interqual
MCG
Critical Thinking
Leadership skills
Effective Communication Skills
Discharge planning
Timeline
RN-Case Manager
Department Of Corrections
08.2023 - CurrentRead More
Practical Nursing Adjunct Instructor
River Parishes Community College
08.2023 - 05.2025Read More
RN Medical Surgical- In House Contract
Ochsner Medical Center
09.2021 - 08.2023Read More
Utilization Management
Anthem
09.2019 - 08.2022Read More
Registered Nurse
Promise Hospital-Part-time
12.2018 - 11.2021Read More
RN Utilization Review
United Healthcare
04.2017 - 09.2019Read More
Prior Authorization RN
Louisiana Healthcare Connections
07.2015 - 04.2017Read More
Director of Nursing
Heritage Manor of Baton Rouge
08.2013 - 07.2015Read More
DIRECTOR OF NURSING
GONZALES HEALTH CARE CENTER
08.2008 - 08.2013Read More
DONALDSONVILLE HIGH SCHOOL
Diploma from General Studies
Read More
LOUISIANA TECHNICAL COLLEGE
Diploma from Practical Nursing
Read More
EXCELSIOR COLLEGE
Associate of Science from Nursing
Read More
Western Governor University
Bachelor of Science from Nursing
Read More