Summary
Overview
Work History
Education
Skills
Affiliations
Timeline
Generic

Theresa "Tessa" Anderson

Kingsport,TN

Summary

Seasoned Nurse Case Management Lead Analyst with a proven track record, excelling in care coordination and chronic health condition management. Proficient in Medicare and HIPAA standards, blending strong clinical judgment with effective motivational interviewing techniques. Achieved significant customer engagement and adherence improvements, showcasing resilience, exceptional communication skills and emotional intelligence. A compassionate professional known for being an effective advocate for customers. Team player consistently recognized for performance excellence and contributions towards achieving company goals.

Overview

33
33
years of professional experience

Work History

Nurse Case Management Lead Analyst/Onsite RN Coach

Evernorth Direct Health
12.2017 - Current
  • Support client's corporate wellness initiatives by providing onsite health coaching services through in-person and virtual coaching sessions tailored to employees' needs within the workplace setting.
  • Implemented and maintained collaborative partnership with client's onsite health partners including client's EAP onsite counselors, onsite physical therapist and onsite Executive Chef, teaming with these health partners in designing and delivering health education services to customers.
  • Consistently collaborates with internal and external matrix partners and health care providers to ensure coordinated care for customers with chronic health conditions including diabetes, hypertension, hyperlipidemia, asthma, COPD, CAD, depression, low back pain.
  • Act as a customer advocate by assisting customers in navigating health care system by connecting individuals with program services and resources, ensuring customer needs are met and effectively communicated with other healthcare providers involved in their care.
  • Conduct onsite and virtual wellness events to promote health coaching services resulting in successful engagement, and retention, of customers in the health coaching programs.
  • Empower customers to achieve their health goals through regular coaching sessions, goal-setting, and progress tracking. Increased customer adherence to health goals by addressing barriers and offering solutions in a supportive environment.
  • Create health and wellness seminars, wellness challenges and other health education materials utilizing CANVA program and other modalities to promote health awareness and preventive health practices.
  • Lead virtual group classes focused on topics such as nutrition, exercise, stress management, tobacco cessation, chronic disease prevention and chronic disease management for improved health outcomes in client's U.S. domestic and global employees.
  • Efficiently adapted to working in a work-from-home virtual environment for 18 months during Covid pandemic. Maintained productivity and customer engagement by proactively creating virtual wellness classes and conducting virtual coaching sessions utilizing Microsoft Teams and WebEx platforms.
  • Streamlines documentation processes using electronic medical records systems while maintaining strict confidentiality standards required under HIPAA regulations.

RN Field Case Manager/ Medicare

Humana
09.2012 - 12.2017
  • Delivered high level of quality care to diverse populations enrolled in Humana's Medicare Advantage Plans, in their home setting including assisted living facilities.
  • Managed complex cases involving multiple comorbidities, requiring close monitoring and coordination of various healthcare services.
  • Maintained quality care and comfort for patients with diabetes, hypertension, hyperlipidemia, COPD, CAD, PAD, heart failure, pulmonary hypertension, and other chronic health conditions.
  • Managed patient caseloads effectively, ensuring timely interventions and thorough follow-ups to mitigate potential complications.
  • Coordinated home health services for patients requiring ongoing care outside the hospital setting.
  • Collaborated with interdisciplinary teams to ensure seamless delivery of case management services across various settings.
  • Served as a key liaison between patients, families, and healthcare providers, fostering open communication and trust among all parties involved in the care process.
  • Advocated for patients by communicating care preferences to practitioners, verifying interventions met treatment goals and identifying insurance coverage limitations.
  • Assisted patients in navigating complex insurance systems, resolving barriers and ensuring access to necessary treatments and obtain community services without undue financial strain. Advocated for patients with insurance companies, securing coverage for necessary treatments and medications.
  • Provided emotional support to patients and families coping with chronic illness or end-of-life decisions, fostering resilience during difficult times.
  • Enhanced patient care by developing comprehensive care plans and coordinating with interdisciplinary healthcare teams. and adjusting treatment plans as needed to promote optimal patient outcomes.
  • Reduced hospital readmission rates through effective case management and patient education on self-care techniques.
  • Conveyed and reviewed treatment options, diagnosis information and home care techniques to patients and caregivers to continue care consistency.
  • Educated family members and caregivers on discharge plan objectives, patient care instructions, medication management, disease management and navigating health care system in easy-to-understand terms.
  • Developed strong relationships with patients, families and caregivers, providing emotional support while addressing concerns or questions about care plans. Equipped patients with tools and knowledge needed for speedy and sustained recovery.
  • Promoted adherence to treatment plans by conducting regular weekly follow-up visits and providing ongoing support to patients.
  • Conducted thorough assessments of patient's needs, enabling more accurate diagnoses, targeted interventions and effective care planning. Used critical thinking skills to break down problems, evaluate solutions and make decisions.
  • Streamlined documentation processes to ensure accurate record-keeping and compliance with regulatory standards.
  • Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
  • Participated in professional development opportunities regularly to stay current on best practices within the field of case management.
  • Maintained excellent rapport and collaborative relationship with team mates, managers, directors and other members of the team.
  • Supported and participated in team building activities.
  • Maintained compliance with company's Work-at-Home policies including conducting work in a locked room to ensure privacy, maintaining a hard-wired connection to an internet source for computer work, fire safety, etc.

RN Community Health/Diabetes Care Manager

Mountain States Health Alliance
09.2008 - 09.2012
  • Participated in community outreach events promoting public health resources and services available to local residents.
  • Collaborated with other health-focused organizations and agencies to promote community health.
  • Managed immunization clinics along with a team of Community Health and Wellness nurses, ensuring timely administration of vaccinations and reducing spread of communicable diseases.
  • Conducted mobile biometric screenings within the community along with a team of Community Health and Wellness nurses collecting fingerstick blood samples to obtain Lipid panel results via a Cholestec machine. Educated clients on disease management and self-care techniques, promoting lifestyle changes for improved health.
  • Enhanced community health through delivering educational presentations on disease prevention, nutrition, and healthy lifestyles.
  • Maintained professional demeanor by staying calm when addressing unhappy or angry customers.
  • Assisted with day-to-day operations, working efficiently and productively with all team members.
  • Participated in team projects, demonstrating an ability to work collaboratively and effectively in a team setting, providing support and guidance.
  • Exercised leadership capabilities by successfully motivating and inspiring others.
  • Managed on onsite health clinic at a manufacturing plant with a Nurse Practitioner providing occupational health services managed by a Medical Director.
  • Provided Diabetes Care Management and diabetes management education to employees (and their dependents) with diabetes condition employed with the Mountain States Health Alliance hospital systems within East TN and Southwest VA areas.
  • Managed patient caseloads effectively, ensuring timely interventions and thorough follow-ups to mitigate potential complications.
  • Conducted assessments of social determinants of health impacting patient wellbeing and factored these into holistic care approaches designed around each individual's unique circumstances.
  • Promoted patient and family comfort during challenging recoveries to enhance healing and eliminate non-compliance problems.
  • Employed critical thinking and problem-solving skills when faced with complex or ambiguous patient situations, leading to the identification of creative solutions that promoted optimal health outcomes.
  • Streamlined documentation processes to ensure accurate record-keeping and compliance with regulatory standards.
  • Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.

Registered Nurse, Labor and Delivery

Holston Valley Medical Center
05.1991 - 04.2008
  • Enhanced patient satisfaction by providing compassionate and knowledgeable care during labor and delivery.
  • Performed triage on incoming pregnant patients and determined severity of injuries and illnesses.
  • Identified potential high-risk pregnancies early in the process, allowing for proactive intervention and specialized care as necessary.
  • Assisted obstetricians and midwives with deliveries and cared for newborns directly after birth. Assessed infant health directly after birth using APGAR and monitored health for specified amount of time for any changes in status. Performed vital signs checks and administered antibiotic eye ointments and Vitamin K injections to infants following birth.
  • Managed care of low and high-risk laboring women of childbearing age and immediate stabilization of newborn following delivery.
  • Provided emotional support and guidance to new mothers and families during labor, delivery and postpartum. Streamlined communication between patients, family members, and healthcare providers to maintain a supportive environment during labor and delivery.
  • Aided with induction of labor for women suffering from complications such as preeclampsia and fetal demise. Monitored patient reactions after administering medications and IV therapies.
  • Provided skilled, timely and level-headed emergency response to critically-ill patients.
  • Assisted in emergency situations such as fetal distress, maternal hemorrhage, or neonatal resuscitation by following established protocols and working closely with fellow healthcare providers.
  • Supported physicians in both planned and emergency Cesarean section procedures. Managed patients recovering from these surgical procedures including Tubal Ligation procedures. Managed patients recovering from general, spinal and epidural anesthesia.
  • Promoted patient and family comfort during challenging recoveries to enhance healing.
  • Collaborated with interdisciplinary teams to ensure optimal patient outcomes throughout the labor and delivery process.
  • Quickly responded to situations impacting safety and security to unit, actualizing crisis prevention interventions to control and de-escalate situations.
  • Improved patient safety by adhering to infection control protocols and maintaining a clean work environment.
  • Coached new mothers with breastfeeding techniques, postpartum self-care and infant care to promote easier transition into motherhood.
  • Collaborated with social workers, mental health professionals, and other community resources to address the psychosocial needs of at-risk patients during their pregnancy or postpartum period.
  • Promoted breastfeeding success through early initiation, ongoing support, and lactation consultation referrals when needed.
  • Served as a preceptor for new hires or student nurses or medical residents, fostering their competence in labor and delivery care through hands-on training experiences.
  • Facilitated smooth transitions of care from antepartum to postpartum units through detailed documentation and clear handoff reports.
  • Completed certifications in BLS, ACLS, NALS and Fetal Heart Rate Monitoring.
  • Maintained up-to-date knowledge on best practices in labor and delivery nursing through professional development opportunities such as conferences, workshops, or reading relevant literature.
  • Efficient use of electronic medical record complying with all HIPAA laws.

Education

Bachelor of Science - Nursing

King University
Bristol, TN

Diploma - Nursing

St. Mary's School of Nursing
Huntington, WV

Skills

  • Accomplished in Case Management and Care Coordination with expert experience in managed care of Adults and Senior Population with Chronic Health Conditions
  • Proficient knowledge of Medicare, HIPAA and NCQA standards
  • Highly skilled in Motivational Interviewing and Behavior Change Strategies
  • Strong clinical judgment and critical thinking skills with proven ability to work well under pressure and within constantly changing priorities
  • Effective communication skills and excellent time management skills with ability to multi-task effectively
  • Team player Able to work well independently and act proactively with minimal supervision
  • Emotionally Intelligent and internally motivated who demonstrates integrity, honesty, trustworthiness and tactfulness Operates effectively even when things are not certain or the way forward is not clear
  • Reliable and dependable professional with proven ability to improve performance through management feedback
  • Resilient Resourceful Responsible
  • Proficient with use of Electronic Health Record (EHR)
  • Proficient in utilizing Microsoft Office including Excel, Outlook, PowerPoint, SharePoint and Word
  • Certified in BLS/CPR/AED

Affiliations

  • Cigna Volunteer Site Lead for Northeast TN Girls on the Run council.
  • Cigna Volunteer Lead for Warrior's Canvas and Women's Veterans Art Center.
  • Board Member of Cigna WIN Nashville Chapter ERG.
  • Member of Cigna's Asian/Pacific Islander ERG.
  • Captain of a bowling team within Eastman Recreation's Bowling League.

Timeline

Nurse Case Management Lead Analyst/Onsite RN Coach

Evernorth Direct Health
12.2017 - Current

RN Field Case Manager/ Medicare

Humana
09.2012 - 12.2017

RN Community Health/Diabetes Care Manager

Mountain States Health Alliance
09.2008 - 09.2012

Registered Nurse, Labor and Delivery

Holston Valley Medical Center
05.1991 - 04.2008

Bachelor of Science - Nursing

King University

Diploma - Nursing

St. Mary's School of Nursing

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Theresa "Tessa" Anderson