TRICIA SMITH
Wheeling
Summary
Dedicated, professional patient focused Registered Nurse with 28+ years of experience, and an accomplished Pre-service Coordinator, adept at handling high caseloads without sacrificing quality of care. Demonstrates strong medical ethics and critical thinking, enhancing patient care and operational efficiency.
Overview
28
28
years of professional experience
1
1
Certification
Work History
Pre-service Coordinator
Optum (ECS, Home & Community, Navihealth)
08.2021 - Current
- Reviewing pre-authorization requests for skilled nursing and and determining if requests meet medical necessity for the requested level of care.
- Coordinate the transition of patients from the community or acute setting to the next appropriate level of care while following established facility polices and procedures and following CMS guidelines.
- Facilitated communication between departments for streamlined service processes.
- Improved service coordination with effective resource management.
- Collaborated with team members to address and resolve complex issues.
- Managed a high volume of client requests, ensuring timely and effective service delivery.
Case Manager/Clinical Reimbursement Coordinator
Bridgeville Rehabilitation and Care Center
10.2018 - 08.2021
- Partnered with physicians, social workers, activity therapists, nutritionists, and nurses to develop and implement individualized care plans and document all patients interactions and interventions in electronic charting system.
- Contact insurance companies for continued stay reviews.
- Responsible for sending over medical records to QIO and provider appeals.
- Continuous teaching and education to patients.
- Obtain authorizations for SNF stays as needed.
- Schedule and complete federally required minimum data set assessments in compliance with Medicare and Medicaid guidelines.
Unit Manager/Supervisor/Charge Nurse/CRC
Country Meadows/Bridgeville Rehab & Care Center
06.2012 - 10.2018
- Monitored patient's conditions and reported changes in physical ability, appearance, and behavior to discuss treatment with physicians.
- Assisted in all these rolls as needed-Responsible for overseeing day to day patient care while supervising, directing, and reporting to director of nursing.
- Identified patient care requirements by establishing personal rapport with patients and families.
- Conferred with physicians to discuss diagnoses and devise well-coordinated treatment approaches.
- Delivered medications via oral, IV, and intramuscular injections, monitoring responses to address new concerns.
- Reported patient's status and delegated nurse assignments to achieve optimal outcomes.
- Directed patient care by initiating and following through with plan of care, continuing care, and discharge instructions.
- Trained new nurses in proper techniques, care standards, operational procedures, and safety protocols to optimize performance and safety.
Unit/Treatment/Admissions/LPNAC Nurse
Country Meadows Nursing Center
10.2001 - 06.2012
- Provided direct patient care, stabilized patients, and determined next course of action.
- Delivered medications via oral, IV, nd intramuscular injections, monitoring responses to address new concerns.
- Assessed all new patients on admission and collaborated with interdisciplinary team for plan of care.
- Flow sheet and computerized charting.
- Assisted RNAC's with minimum data sets, care conference, and care planning.
- Reported off to RN Supervisor.
Agency Licensed Practical Nurse
Community Care Inc.
10.2000 - 10.2001
- Supported patients'' emotional well-being with empathetic communication and active listening skills.
- Provide basic patient care and treatment, such as administering medications, taking vital signs, and dressing wounds.
- Helped long-term care residents with bathing, dressing, feeding, and other daily living activities.
- Responded to patient requests with appropriate clinical and personal assistance.
- Collaborated with charge nurse on evaluation of care plan outcomes, implementing or adjusting interventions accordingly.
- Flexible and worked multiple units in several long-term care facilities as needed.
LPNAC, Unit LPN
Moundview Health Care Center
10.1996 - 10.2000
- Provided patient care for improving overall health outcomes.
- Monitored vital signs to ensure patient stability.
- Administered medications, following physician instructions closely.
- Supported patient recovery by assisting with daily activities.
- Completed minimum data sets assigned by RN
- Collaborated with interdisciplinary team to establish care plan.
- Attended care conference and reviewed plan of care with patient/family.
- Reported off to RN Supervisor.
Education
Registered Nurse - Associate Degree in Nursing
West Virginia Northern Community College
Wheeling, WV05-2012
Licensed Practical Nurse - Nursing
BM Spurr School of Practical Nursing
Glendale, WV05-1996
Skills
- ICD-10 and computerized knowledge
- Interdisciplinary collaboration
- Geriatric knowledge
- Core values such as integrity, respect, responsibility, honesty, purpose, accountability, and impact
- Effective communication skills and interpersonal relations
- Strong medical ethnic
- independent worker and work well within a team
- detailed oriented and use critical thinking skills
- Acute and Rehabilitative Care
- Computerized and flow sheet charting
- Medication administration Expert
- Case Management Proficiency
- Appeals and DENCs
- Functional assessment and predictive analytics
Certification
- Registered Nurse, state of West Virginia (Multistate) 2021-present
- Registered Nurse, state of Pennsylvania 2012-2021
- Licensed Practical Nurse, state of Pennsylvania 2001-2012
- Licensed Practical Nurse, state of West Virginia 1996-2001
Timeline
Pre-service Coordinator
Optum (ECS, Home & Community, Navihealth)
08.2021 - Current
Case Manager/Clinical Reimbursement Coordinator
Bridgeville Rehabilitation and Care Center
10.2018 - 08.2021
Unit Manager/Supervisor/Charge Nurse/CRC
Country Meadows/Bridgeville Rehab & Care Center
06.2012 - 10.2018
Unit/Treatment/Admissions/LPNAC Nurse
Country Meadows Nursing Center
10.2001 - 06.2012
Agency Licensed Practical Nurse
Community Care Inc.
10.2000 - 10.2001
LPNAC, Unit LPN
Moundview Health Care Center
10.1996 - 10.2000
- Registered Nurse, state of West Virginia (Multistate) 2021-present
- Registered Nurse, state of Pennsylvania 2012-2021
- Licensed Practical Nurse, state of Pennsylvania 2001-2012
- Licensed Practical Nurse, state of West Virginia 1996-2001
Registered Nurse - Associate Degree in Nursing
West Virginia Northern Community College
Licensed Practical Nurse - Nursing
BM Spurr School of Practical Nursing
Similar Profiles
Linda FazilatLinda Fazilat
Manager - Medical Clinical Operations at Optum home & Community, formerly naviHealthManager - Medical Clinical Operations at Optum home & Community, formerly naviHealth
Tricia MillerTricia Miller
Home Health Care Coordinator at naviHealth/Home & Community Care with OptumHome Health Care Coordinator at naviHealth/Home & Community Care with Optum
Melinda DejeuMelinda Dejeu
Senior Manager, Provider Relations at NaviHealth/Optum Home & Community Care TransitionsSenior Manager, Provider Relations at NaviHealth/Optum Home & Community Care Transitions