Beverly Kmetz
Wallington,NJ
Summary
Dynamic Nurse Case Manager with extensive experience at Horizon NJ Health, excelling in care coordination and clinical assessment. Proven track record in policy development and patient advocacy, effectively managing over 200 members. Skilled in resource management, ensuring optimal service delivery and compliance with healthcare standards.
Overview
37
37
years of professional experience
Work History
Nurse Case Manager MLTSS RN II
Horizon NJ Health
Trenton, New Jersey
04.2013 - Current
- Conducted assessments of patient clinical needs against guidelines for medically appropriate services.
Managed a caseload exceeding 200 members in nursing facilities and assisted living environments.
Evaluated the necessity and efficiency of long-term support services delivered to members.
Coordinated development and implementation of individualized plans of care for members.
Engaged with families, physicians, hospitals, and other stakeholders to discuss care appropriateness.
Monitored all aspects of patient care activities regardless of service location for effectiveness.
Advocated on behalf of members/families to coordinate resources effectively throughout care continuum.
Ensured accurate documentation in line with organizational policies and professional practice standards.
Director
5 Boroughs Diagnostic Testing Facility, 5 Boroughs DME and 5 Boroughs Medical Plaza
Brooklyn, New York
12.2011 - 11.2012
- Established and opened six-bed sleep center, implementing efficient policies and procedures.
- Coordinated patient appointments with physicians and scheduled sleep studies.
- Verified insurance coverage, obtaining necessary precertifications and referrals.
- Managed follow-up appointments and referrals to external home care companies.
- Produced marketing materials and conducted outreach visits to new physicians.
- Negotiated contracts with outside vendors to enhance service delivery.
- Scheduled staff while ensuring compliance with QA, Department of Health, JCAHO, and AASM standards.
- Conducted audits for MCR and MCAID accreditation to maintain regulatory compliance.
Coordinator Podiatry Residency Program
St. Mary's Hospital
Passaic, New Jersey
08.2010 - 11.2011
- Oversaw all coordination functions such as scheduling, policy evaluations, and personnel file upkeep.
Ensured adherence to compliance standards via consistent communication with CPME, COTH, and New Jersey Department of Licensure.
Assisted in organizing meetings and preparing seminars to improve engagement.
Coordinated CASPR crypt information distribution for all program attendees.
Served on Podiatry Residency Committee to enhance residency education.
Manager
The Center for Sleep Medicine at St. Mary's Hospital
Passaic, New Jersey
03.2007 - 11.2011
- Implemented new policies and procedures that streamlined unit operations.
Coordinated patient appointments alongside scheduling for sleep studies.
Verified insurance coverage, securing required precertifications and referrals efficiently.
Handled follow-up appointments while managing external home care referrals.
Created marketing collateral and visited new doctors for outreach initiatives.
Negotiated with vendors to establish beneficial contracts.
Oversaw staff scheduling to align with operational needs.
Maintained quality assurance standards aligned with regulatory requirements from Department of Health, JCAHO, and AASM.
Manager
PBI Regional Medical Center
Passaic, New Jersey
12.1994 - 03.2007
- Enhanced unit efficiency by implementing a comprehensive reorganization strategy.
Directed coordination of patient appointments, referrals, and sleep study procedures.
Scheduled personnel to support operational demands effectively.
Secured and maintained contracts with external vendors for essential services.
Established QA standards in alignment with Department of Health and AASM requirements.
Coordinator Pre-Admission Testing
PBI Regional Medical Center
Passaic, New Jersey
01.1993 - 12.2004
- Performed all aspects of a Pre-Admission Testing Nurse, including comprehensive nursing interview and assessment, veinpuncture, EKG. Performed phone interviews with patients unable to travel to the hospital. Established all new policies and procedures to make a more efficient work area. Acted as liaison between Patient, Doctor and Hospital.
Staff RN
PBI Regional Medical Center
Passaic, New Jersey
07.1989 - 12.1992
- Conducted pre- and post-operative tasks in Same Day Surgery unit, ensuring patient readiness.
Assisted with minor surgical procedures, maintaining high standards in Minor Procedure room.
Implemented a charge and pack system that significantly increased surgical room efficiency.
Acted as gastroenterology nurse during endoscopy procedures, providing critical support.
Formulated new policies and revised existing ones to elevate overall unit effectiveness.
Provided training for new staff nurses on operational protocols and best practices.
Designed a charge system to improve resource management within the unit.
Staff RN
Newark Beth Israel Medical Center
Newark, New Jersey
09.1988 - 07.1989
- Delivered comprehensive care to emergency room patients in level II trauma facility while serving as charge nurse when necessary
Education
AS - Nursing
Bergen Community College
Paramus, New Jersey12.1988
Skills
- Care coordination
- Clinical assessment
- Policy development
- Patient advocacy
- Resource management
- Data analysis
Timeline
Nurse Case Manager MLTSS RN II
Horizon NJ Health
04.2013 - Current
Director
5 Boroughs Diagnostic Testing Facility, 5 Boroughs DME and 5 Boroughs Medical Plaza
12.2011 - 11.2012
Coordinator Podiatry Residency Program
St. Mary's Hospital
08.2010 - 11.2011
Manager
The Center for Sleep Medicine at St. Mary's Hospital
03.2007 - 11.2011
Manager
PBI Regional Medical Center
12.1994 - 03.2007
Coordinator Pre-Admission Testing
PBI Regional Medical Center
01.1993 - 12.2004
Staff RN
PBI Regional Medical Center
07.1989 - 12.1992
Staff RN
Newark Beth Israel Medical Center
09.1988 - 07.1989
AS - Nursing
Bergen Community College
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