Care Transitions Coordinator
AMEDISYS HOME CARE
02.2014 - 08.2014
- Clinical liaison between health care providers to ensure continuity of care for patients transitioning from a facility to home care or hospice environment.
Todd Warren
Healthcare Professional
Rochester,NY
Summary
Dedicated to promoting quality patient care and satisfaction and offering experience in nursing and healthcare administration. Possesses proven track record of developing and implementing comprehensive nursing policies, providing excellent leadership and mentoring, and maintaining compliance with regulatory standards. Patient-focused manager offering 8-year background driving quality improvements and coaching nursing staff to reach full potential. Strong organizational, communication and multitasking abilities. Expertise in managing medical records, evaluating staff performance and developing continued care plans.
Work History
Registered Nurse
VETERANS ADMINISTRATION
04.2010 - 08.2014
- Provided the highest quality of care to our veterans
- Experience in both long-term care care in geriatrics/ palliative care and in the acute setting.
Director of Nursing
Ontario Center for Rehabilitation and Nursing
Canandaigua., NY
11.2023 - 04.2024
- Monitored and evaluated nursing staff performance, providing feedback and guidance to support standards of care.
- Built and maintained positive working relationships with physicians and staff to support seamless healthcare operations.
- Oversaw and approved recruitment, hiring and orientation of new nursing staff.
- Participated in management team meetings to discuss resident status, census changes, and client complaints or concerns.
- Worked closely administration to develop and implement best practices to improve patient outcomes.
Assistant Director of Nursing
Premier Center for Rehabilitation and Nursing
06.2018 - 07.2023
- Perform professional supervisory nursing practice for a140 bed facility, while maintaining the quality and adequacy of nursing practices
- Report directly to the Director of Nursing with numerous direct reports
- Coordination with medical professionals including providers, pharmacists, social work and physical therapists
- Assessing and completing accident and injury reports
- Notification to providers and family members when situations arise concerning residents
- Maintaining stringent infectious disease control protocol
- Staffing of nursing personnel.
- Participated in management team meetings to discuss resident status, census changes, and resident complaints or concerns.
- Established and monitored infection control programs to provide safe, sanitary environment to prevent transmission of disease and infection.
- Monitored and evaluated nursing staff performance, providing feedback and guidance to support standards of care.
Manager, Medical Management
CENTENE CORPORATION
05.2016 - 03.2018
- Oversee operations of the referral management, telephonic utilization review, prior authorization functions, and case management programs
- Ensure compliance government and contractual guidelines and the mission, philosophy and objectives of Corporate and the health plan
- Perform case management, disease management and on site concurrent review functions as necessary
- Provide support to Provider Relations issues related to Utilization issues for hospitals and physician providers
- Coordinate efforts with the Member Services and Connections Departments to address members and providers issues and concerns in compliance with medical management requirements
- Maintain compliance with National Committee for Quality Assurance (NCQA) standards for utilization management functions for the prior authorization unit
- Develop, implement and maintain policies and procedures regarding the prior authorization function
- Identify quality and risk management issues and facilitate the collection of information for quality improvement and reporting purposes
- Compile and review multiple reports for statistical and financial tracking purposes to identify utilization trends and assist in financial forecasting.
Utilization Review Nurse, Inpatient
FIDELIS CARE
10.2014 - 05.2016
- Review medical records to determine medical necessity based upon pre-determined Milliman Criteria
- Obtain member's medical records and work with providers in order to facilitate a safe discharge plan and ensure all necessary services and equipment are in place
- Evaluate requested outpatient services for medical necessity and setting, search for appropriate participating providers and negotiate rates
- Maintaining a 98 % or better audit quality score while averaging 34 reviews daily.
Division General Manager
HOUSEHOLD FINANCE CORP
09.1993 - 05.2008
- Directed comprehensive sales efforts to exceed revenue targets consistently while maintaining customer satisfaction levels.
- Analyzed market trends and competitor activities to create competitive advantages.
Education
ASSOCIATE OF APPLIED SCIENCE in NURSING -
Genesee Community College
Batavia, NY12.2013
Certification
- RN License
- BLS Certification
- ACLS Certification
- RN, 05/01/24, NY
Personal Information
- Military Service Branch: United States Army
- Military Service Rank: E3
Timeline
Director of Nursing
Ontario Center for Rehabilitation and Nursing
11.2023 - 04.2024
Assistant Director of Nursing
Premier Center for Rehabilitation and Nursing
06.2018 - 07.2023
Manager, Medical Management
CENTENE CORPORATION
05.2016 - 03.2018
Utilization Review Nurse, Inpatient
FIDELIS CARE
10.2014 - 05.2016
Care Transitions Coordinator
AMEDISYS HOME CARE
02.2014 - 08.2014
Registered Nurse
VETERANS ADMINISTRATION
04.2010 - 08.2014
Division General Manager
HOUSEHOLD FINANCE CORP
09.1993 - 05.2008
ASSOCIATE OF APPLIED SCIENCE in NURSING -
Genesee Community College
Skills
- Long-Term Care
- Multidisciplinary Team Collaboration
- Practice Standards
- Quality Assurance
- Nursing Recruitment
- Effective Multitasking
- Team Supervision
- Employee Coaching
- Seasoned in Medical Clinical Procedures
- Regulatory and Statutory Compliance
- Clinical Staff Management
- Case Management
- Acute Care
- Hospital Admissions
- Critical Thinking
- Utilization Management
- Risk Management
- Verbal and Written Communication
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