Summary
Overview
Work History
Education
Skills
Timeline
Generic

Tracy Caudle

Beckwourth,CA

Summary

Patient-focused Registered Nurse equipped with administrative and customer service expertise. Helps keep healthcare services proceeding smoothly by coordinating communications, referrals and policy enforcement. Talented in finding balanced solutions and resolving conflicts. Experienced nursing professional bringing demonstrated clinical expertise, leadership skills and technical knowledge. Proficient in updating charts, monitoring medications and working with multidisciplinary teams to optimize patient care. Quality-driven and efficient with strong interpersonal abilities.

Overview

13
13
years of professional experience

Work History

DSNP - Case Management - Nurse

Blue Shield of CA
, CA
02.2023 - Current
  • Provided crisis intervention support for clients in emergency situations.
  • Developed individualized care plans with input from clients and their families.
  • Collaborated with medical professionals to coordinate treatment plans for clients.
  • Collaborated with other healthcare professionals to develop individualized plans of care for each patient.
  • Ensured that all documentation was accurate and up-to-date according to established guidelines.
  • Educated patients on their medical condition, treatment plans, and self-care management techniques.
  • Managed multiple tasks simultaneously while prioritizing urgent requests from physicians or nurses.
  • Participated in quality improvement initiatives in order to improve patient outcomes.
  • Facilitated communication between clients, families, caregivers, social services and other agencies to ensure client needs were met.
  • Assessed clients' needs, developed service plans and monitored progress towards goals.

FEP Registered Nurse Utilization Management

Blue Shield of CA
Rancho Cordova, CA
06.2022 - 02.2023
  • perform prospective utilization review and first level determination approvals for members using evidenced based guidelines, policies and nationally recognized clinical criteria across lines of business or for a specific line of business.
  • Conduct clinical review of claims for medically necessity, coding accuracy, and contract compliance.
  • review member centered documentation and correspondence reflecting determinations in compliance with regulatory and accreditation standards and identify potential quality of care services or treatments and intervene as clinically appropriate.
  • attend staff meetings, weekly huddles and one on one management touchbase.
  • maintain quality and productivity metrics for all case work
  • maintaining HIPAA compliant workspace while working from home/remotely

NIC Registered Nurse Case Manager

Veterans Affairs Medical Center
Reno, NV
01.2021 - 07.2022
  • leading and organizing delivery of care to assure continuity of care and peer accountability for proactive including access to care and discharge planning
  • Used advanced clinical knowledge/judgement to promote staff involvement in planning decision making and evaluating outcomes
  • functioning as an expert in clinical practice and/or in areas related to the assigned roles and responsibilities
  • Systematically evaluating current practice and formulating outcomes for groups of patient and/or organization processes within area of expertise
  • Guiding, developing and supporting staff from a leadership perspective
  • using professional standard of care, scientific evidence, and practice to evaluate programs and service activities

MDS Coordinator

Eastern Plumas Health Care
Loyalton, CA
01.2020 - 01.2021

Assisted in the planning, directing, and evaluation of programs related to resident care and provided consistency in nursing functioning in conjunction with of the Assistant Director of Nursing.

ESSENTIAL JOB DUTIES AND RESPONSIBLITIES WERE

· Revied and assisted in keeping nursing care plans current.

· Assisted with mandated assessment forms and evaluations.

· Assisted with development of nursing staff and scheduling.

· Collaborated with DON to achieve desired outcomes for residents, families, and nursing staff.

· Completed MDS’s and matrix.

· Reviewed with residents and families IDCP at Interdisciplinary Care Conferences.

· Reported QAPI’s. Completedx weekly timecards for LTCC.

· Coordinated and participated in monthly medication review.

· Completed assignment list for monthly nursing summaries at LTCC.

· Coordinated and prepared discharge planning with physicians, midlevel providers, social services, and home health.

· Attended quarterly P&T and antibiotic stewardship meetings.

MDS Coordinator

Veterans Affairs Medical Center
Reno, NV
03.2019 - 01.2020
  • Coordinates/oversees interdisciplinary care planning meetings, assuring timely updates and individualized care plans based on veteran preference, life-long routines and unique needs
  • Maintains calendar for MDS schedule
  • Completes MDS assessments including the short stay assessments (5 assessments within 90 days if short stay)
  • Teaches MDS to new employees, updates & problem solving
  • Oversees quality indicators, including assessing the information, taking appropriate actions such teaching staff, reviewing documentation, and evaluating veteran outcomes
  • Monitors Veteran care plans and documentation in veteran's record to ensure documentation is consistent, reflects veteran's current status, and is written in "I" format
  • Provides training/instruction to nursing staff and interdisciplinary team members regarding MDS as indicated
  • Completes discharge tracking
  • Participates in Peer Reviews
  • Participates in Fall Committee and others, as appropriate or assigned
  • Assures accurate coding for reimbursement and clinical assessment of MDS
  • Makes clinical rounds to assure veteran assessments/care plans reflect current status
  • Assures active involvement of veteran/family/significant other in care planning process.

Director of Nursing

Eastern Plumas Health Care
Loyalton, CA
01.2017 - 03.2019
  • The Director of Nursing is responsible for leading, planning, organizing, staffing, directing, analyzing and evaluating the nursing services of the department, as well as supervising members of the nurse management team and others as assigned, in order to provide effective nursing services that meet practice and quality standards. The Director of Nursing assumes the charge responsibilities for the facility in the absence of the Administrator.
  • Supervise all levels of nursing personnel and direct resident care
  • Recruit, interview, hire, evaluate, discipline and terminate nursing personnel
  • Assist in orientation and training of all nursing personnel
  • Oversee Scheduling of all nursing personnel to ensure appropriate staff coverage to meet State and Federal standards
  • Schedules and directs regular meetings for professional nurses and nursing assistants per competences
  • Evaluate and enforce proper infection control techniques
  • Attend and contribute to Care Plans as needed, attend QAPI meetings
  • Represents facility and nursing service at professional organizations
  • Evaluates placement of all new residents to the facility
  • Takes responsibility for the facility in the absence of the Administrator
  • Continually seeks methods to upgrade and improve delivery of care to the residents
  • To be subject to call, and carry cellphone, on an as needed basis
  • Any and all other duties assigned by Administrator for the purpose of quality resident care.
  • Clinical, Provides administrative and clinical leadership for nursing staff to promote the delivery of quality care. Maintains knowledge base of current standards of nursing practice. Develops and revises nursing policies and procedures.
  • Financial. Develops, revises, monitors and implements the nursing department budget to promote appropriate utilization of resources. Oversees and adjusts the staffing hours based on acuity, census, and established staffing patterns. Approves staff timecards.
  • Staff Development. Collaborates with staff development and ensures that a staff development program is in place to meet regulatory clinical and staff needs.
  • Quality Improvement. Fosters a culture of continuous quality improvement. Develops, implements, and evaluates the nursing department quality assurance program. This includes patient, family and staff satisfaction; safety and risk management; and strategic planning.
  • Regulatory. Develops and maintains policies and procedures to promote compliance with all state and federal regulations and nursing standards. Stays current with upcoming regulatory changes.
  • Liaison. Serves as a nursing liaison with other departments, Medical Director and residents/families.

MDS Coordinator

Eastern Plumas Health Care
Portola, CA
08.2016 - 01.2017

Assisted in the planning, directing, and evaluation of programs related to resident care and provided consistency in nursing functioning in conjunction with of the Assistant Director of Nursing.

ESSENTIAL JOB DUTIES AND RESPONSIBLITIES WERE

· Revied and assisted in keeping nursing care plans current.

· Assisted with mandated assessment forms and evaluations.

· Assisted with development of nursing staff and scheduling.

· Collaborated with DON to achieve desired outcomes for residents, families, and nursing staff.

· Completed MDS’s and matrix.

· Reviewed with residents and families IDCP at Interdisciplinary Care Conferences.

· Reported QAPI’s. Completedx weekly timecards for LTCC.

· Coordinated and participated in monthly medication review.

· Completed assignment list for monthly nursing summaries at LTCC.

· Coordinated and prepared discharge planning with physicians, midlevel providers, social services, and home health.

· Attended quarterly P&T and antibiotic stewardship meetings.

Was promoted to DON of sister facility

Registered Nurse

Plumas District Hospital
Quincy, CA
10.2013 - 08.2016
  • In this position I was responsible for the delivery of patient care through the nursing process of assessment, diagnosing, planning, implementation, and evaluation. Collaborated with other professional disciplines to ensure effective and efficient patient care delivery and the achievement of desired patient outcomes. Supported the organization vision and mission. Utilized knowledge of patient’s age and cultural diversity into the provision of patient care. Contributed to the provision of quality nursing care through performance improvement techniques that demonstrated positive outcomes in patient care. This position required caring for postpartum and newborn patients.
  • I maintained the ability to utilize the nursing process in the provision of nursing care including but not limited to administering treatments and medications, interpreting diagnostic tests, formulating a plan of care, collaborating with other health care providers and providing education to patients and/or significant others

Registered Nurse

Renown Regional Medical Center
Reno, NV
09.2011 - 10.2013
  • Charge nurse of a busy 52 bed medical/telemetry floor. Managed yup to 9 nurses and 4 CNA's, assigned patient's and assisted with keeping a steady and happy flow with my team and peers, I was responsible for accepting new patients and managing room assignments. When i was working as a floor RN I would work with a team of CNA's and RN's to assist patient with daily ADl's, manage vitals signs, medications and progress. I worked closely with a wide range of providers to aid in my patient's progress.

Education

Associate of Science - Registered Nurse

Carrington College
Reno, NV
08.2011

Skills

  • Data Analysis
  • Decision Making
  • Verbal and Written Communication
  • Process Implementation
  • Employee Work Scheduling
  • Employee Supervision
  • Employee Recruitment and Hiring
  • Critical Thinking
  • Utilization Review
  • Resource Monitoring
  • Utilization Management
  • HIPAA Guidelines
  • Clinical Quality Program Standards
  • Patient Advocacy
  • Patient Care Assessment
  • Resource Allocation

Timeline

DSNP - Case Management - Nurse

Blue Shield of CA
02.2023 - Current

FEP Registered Nurse Utilization Management

Blue Shield of CA
06.2022 - 02.2023

NIC Registered Nurse Case Manager

Veterans Affairs Medical Center
01.2021 - 07.2022

MDS Coordinator

Eastern Plumas Health Care
01.2020 - 01.2021

MDS Coordinator

Veterans Affairs Medical Center
03.2019 - 01.2020

Director of Nursing

Eastern Plumas Health Care
01.2017 - 03.2019

MDS Coordinator

Eastern Plumas Health Care
08.2016 - 01.2017

Registered Nurse

Plumas District Hospital
10.2013 - 08.2016

Registered Nurse

Renown Regional Medical Center
09.2011 - 10.2013

Associate of Science - Registered Nurse

Carrington College
Tracy Caudle