Years of clinical and managerial nursing experience
Tonya V. Lighter
Manager Medicare Case and Condition Management
Collingdale,PA
Summary
Mission-driven Manager of Case Management with 17 years of progressive experience in Medicare Case Management - 12 years as a manager. In-depth knowledge of telephonic case management, including transition of care assessment, disease management, motivational interviewing, and care coordination to positively impact patient outcomes and STAR performance. Proficient in Word, Excel, Outlook, Teams, and Sharepoint, with skill in data management, documentation and reporting metrics.
Overview
37
37
5
5
years of post-secondary education
Work History
Manager of Medicare Case and Condition Management
Independence Blue Cross
Philadelphia, PA
01.2012 - Current
- Structured standardized case management processes to comply with regulatory agency statutes and standards.
- Guided and supervised case rounds to enhance the interdisciplinary team care coordination.
- Collaborated with multidisciplinary teams to facilitate client care and reduce case management barriers.
- Fostered professional networks and relationships with service and resource providers to promote continuity and quality of care for clients.
- Recruited, interviewed and hired staff members offering exceptional talent and brought great skills to team.
- Developed and created programs and monitored effectiveness against individual participant needs.
- Streamlined, standardized and implemented case management processes and techniques to maximize revenue cycle.
- Created innovative processes to improve the onboarding of newly hired talent.
Senior Case Manager
Independence Blue Cross
Philadelphia, PA
11.2007 - 12.2011
- Performed telephonic case management for Dually Eligible, Medicare, Commercial, and FEP population.
- Assessed, developed, and implemented plans of care suited for the medically complex members.
- Provided support, education, and performance management of registered nurse and social work staff.
- Assisted in the development and implementation of new case management programs/initiatives.
- Provided pre- and post-hospitalization patient management varying from young adult to geriatric population.
- Coordinated patient care with patients, families, physicians, and home care agencies.
- Identified care needs of individual patients and coordinated services based on physician advice, insurance limitations and procedural costs.
Registered Nurse Case Manager
Independence Blue Cross
Philadelphia, PA
09.2005 - 01.2007
- Advocated for patients by communicating care preferences to practitioners, verifying interventions met treatment goals and identifying insurance coverage limitations.
- Created individualized care plans based on nursing diagnosis and incorporated appropriate nursing methods to achieve positive outcomes.
- Coordinated with interdisciplinary professionals to develop plans of care, administer tests and monitor patient status.
- Developed care plans based on nursing diagnosis and incorporated therapeutic, preventive and rehabilitative nursing methods.
- Educated patients and loved ones about different treatment options and outside care approaches to reduce burden on hospital resources.
- Effectively communicated with physicians regarding patient needs, performance, medications and changes.
RN - Telemetry Unit
Mercy Fitzgerald Hospital
Darby, PA
09.2003 - 08.2005
- Provided exceptional care to highly-acute patients needing complex care such as ventilator management, extensive wound care, intravenous medications, telemetry monitoring, and rehabilitation.
- Monitored patient reactions after administering medications, IV therapies. and blood products.
- Explained course of care and medication side effects to patients and caregivers in easy-to-understand terms.
- Educated family members and caregivers on patient care instructions.
- Used first-hand knowledge and clinical expertise to advocate for patients under care and enacted prescribed treatment strategies.
- Quickly responded to situations impacting safety and security to unit, actualizing crisis prevention interventions to control and de-escalate situations.
- Communicated with healthcare team members to plan, implement and enhance treatment strategies.
- Advocated for and strived to protect health, safety and rights of patient.
- Managed patients recovering from medical or surgical procedures.
- Offered exceptional care and support to individuals recovering from acute incidents and dealing with chronic conditions.
Director of Nursing
Pennsylvania Hospital Adult Day Care Center
Philadelphia, PA
01.1998 - 01.2002
- Collaborated with staff, management and external groups to coordinate patient care.
- Performed rounds to observe care and interview staff, residents and families.
- Created customized care plans, working with center staff and families to assess and meet individual needs.
- Assisted in the hiring and training of all staff, providing direct supervision, ongoing staff development and continuing education to employees.
- Conducted routine facility inspections, identifying areas needing improvement and eliminating hazards posed to staff and residents for continued compliance with associated regulations.
- Monitored and inspected staff processes to eliminate hazards posed for both residents and staff while ensuring continuous compliance with regulations.
- Developed and updated policies and procedures, maintaining compliance with statutory, regulatory and local, state and federal guidelines relating to HIPAA, benefits administration and general liability.
- Developed educational newsletter to promote improved health behaviors in staff, patients, and families.
Education
Associate of Science in Nursing - Nursing
Drexel University College of Nursing
Philadelphia, PA 08.1984 - 12.1986
Bachelor of Science in Nursing - Nursing
Colorado Technical University
Colorado Springs, CO 11.2020 - 01.2022
No Degree - Organizational Leadership And Development
St. Joseph's University
Philadelphia, PA 09.2013 - 05.2015
Skills
- Transitions of care
- Readmission reduction
- Care coordination
- Quality Management
- Quality Improvement
- Budget Management
- Written and verbal communication
- Interviewing skills
- Program Development
Affiliations
- Sigma Theta Tau Nursing Honor Society
- Chi Eta Phi Sorority, Inc.
- Case Management Society of America
- American Nurses Association
Timeline
Bachelor of Science in Nursing - Nursing
Colorado Technical University
11.2020 - 01.2022
No Degree - Organizational Leadership And Development
St. Joseph's University
09.2013 - 05.2015
Manager of Medicare Case and Condition Management
Independence Blue Cross
01.2012 - Current
Senior Case Manager
Independence Blue Cross
11.2007 - 12.2011
Registered Nurse Case Manager
Independence Blue Cross
09.2005 - 01.2007
RN - Telemetry Unit
Mercy Fitzgerald Hospital
09.2003 - 08.2005
Director of Nursing
Pennsylvania Hospital Adult Day Care Center
01.1998 - 01.2002
Associate of Science in Nursing - Nursing
Drexel University College of Nursing
08.1984 - 12.1986
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