- Meditech
- Cerner
- Epic
- Jiva
- Kinsler
- Interqual
- Allscripts
- Sharepoint
- Microsoft office [Word, Excel, Outlook]
Wilgeena Ruth
Columbia,SC
Summary
Experienced and well-rounded health care professional. Performs well autonomously, however, team-oriented when applicable. Reliable with a wealth of healthcare knowledge and understanding of Medicare/Medicaid guidelines. Clear verbal and written communication skills as it relates to care management and care coordination. Sound clinical judgement.
Overview
38
38
years of professional experience
1
1
Certification
Work History
Nursing Supervisor
Wellpath (Mental Health Facility)
03.2022 - Current
- Administrative Nursing Supervisor at a 374-bed mental health prison.
- Delegated tasks and provided leadership for 6 to 8 charge nurses and 24 to 30 mental health technicians.
- Maintained proper staff levels within budget parameters to deliver safe levels of care for patients and to ensure staff safety.
- Investigated and reported all incidents per hospital polices and DMH (Department Mental Health) guidelines.
RN LTAC @ Continue Care Inside of PRISMA Baptist
Favorite Health Staffing
02.2022 - 03.2022
- Worked with intubated and ventilated patients, monitoring and reporting on conditions to maintain stats within optimal levels.
- Responded rapidly to critical codes to coordinate stabilization treatments and restore vital functions.
- Operated critical care equipment to keep patients stable and promote recovery.
- Managed needs of chronically ill and acute patients with well-coordinated treatment strategies.
RN LTAC
Favorite Nurses Healthcare Staffing
08.2021 - 01.2022
- Worked with intubated and ventilated patients, monitoring and reporting on conditions to maintain stats within optimal levels.
- Responded rapidly to critical codes to coordinate stabilization treatments and restore vital functions.
- Operated critical care equipment to keep patients stable and promote recovery.
- Managed needs of chronically ill and acute patients with well-coordinated treatment strategies.
Nurse Case Manager/Acute Care Setting
American Mobile Network
03.2020 - 08.2020
- Developed and modified patient care plans and assisted interdisciplinary team in identifying client needs and goals to determine priorities of care.
- Managed support services and fostered communication among social workers, therapists, hospital staff and patients.
- Collaborated with healthcare leaders and physicians to support and offer resources in performance of duties to maintain high-quality and efficient patient care.
Registered Nurse Adolescent Psychiatry
Three Rivers Behavioral Health
11.2019 - 03.2020
- Provided direct quality care to patients by monitoring, recording and evaluating psychiatric conditions.
- Oversaw care of suicidal patients and acted swiftly to reduce risk of harm to themselves or others.
- Responded to numerous volatile situations and violent outbreaks to restore safety and security of patients and staff.
- Performed patient assessments to monitor expected response to medications and altering treatment plans.
Care Coordinator
AMERIHEALTH CARITAS FAMILY OF COMPANIES
03.2016 - 10.2019
- Coordinate care for over 150 assigned case-load of dual-eligible (Medicare/Medicaid) population in State. Facilitate care coordination between providers (primary care physicians, pharmacies, home health agencies, hospice agencies, rehabilitation hospitals, mental health facilities, community care homes, skilled nursing facilities, infusion centers, hospitals and DME companies)
- Knowledgeable of long-term community support services, LTSS, as it relates to Medicaid
- Communicated with State waiver managers reviewing two to five level of care assessments and service plans daily to ensure that members maintain an acceptable quality of life at home as it pertains to safety and health maintenance
- Advocate for, educate and empower members and families enabling them to navigate thru healthcare systems
- Communicate with utilization review team to promote safe and cost effective transitions from one level of care to another. Expert in chart audit review to obtain information needed for Interqual
- Communicate with providers to obtain medical information or have same documented to help UM with authorizations and approval for episodic care, admissions and continued stay
- Engage with multidisciplinary team of pharmacists, community health navigators, personal care connectors and a physician advisor to help members gain access to routine and preventive healthcare aiming to reduce emergency room visits and avoidable hospitals stays
- Knowledge of CMS Quality Initiatives. Mindful of HEDIS Measures set by the NCQA and how personal work performance affects the organization 's ability to meet those measures
Endoscopy Pre-op/PACU Nurse
CAROLINA COLONOSCOPY CENTER
01.2015 - 03.2016
- Provided direct patient care, stabilized patients and determined next course of action
- Initially contracted thru a staffing agency after moving back to Columbia, S.C. Offered full-time position once 13-week contracted ended
- Interim DON
- Trained new nurses in proper techniques, care standards, operational procedures and safety protocols to optimize performance and safety
- Provided individualized care and dedicated oversight to 15 patients per day on average in post-operative recovery room
Hospital Case Manager/ Home Health Case Manager
AMN (AMERICAN MOBILE NETWORK)
06.2014 - 01.2015
- Performed case management full-time in 13 week increments thru a traveling medical profession agency. Assignments included hospital case management and home health case management
- Compassionate about patients and their safe transition to alternate levels of care. Knowledge of Medicare and private insurance guidelines enabled adherence to CMS measures and hospital guidelines
- Offered full-time employment with both companies when contracts were completed
Registered Nurse Case Manager
PRISMA HEALTH BAPTIST
06.2008 - 06.2014
- Nurse Case Manager on a 30+ bed oncology unit
- Ensured Medicare and private insurance criteria were met for approval for inpatient stay and continued stay
- Utilized Interqual as a tool to determine severity of illness and intensity of care. Submitted clinical information to insurance companies to acquire authorization for admission to inpatient stay and continued stay
- Assisted Medical Social Worker with discharge planning : home health, home infusion therapy, rehab. referrals, skilled nursing placement and hospice evaluation
- Facilitated weekly interdisciplinary team meetings with unit physician, medical social worker, dietician, physical therapy, occupational therapy, hospice if appropriate and family members
- Chosen by manager to participate in hospital's first HCAHPS team to assist organization with quality performance and more importantly increasing patient satisfaction
Nurse Liaison/Account Executive
CRITICAL CARE SYSTEMS, INC.
01.2007 - 06.2008
- Hired part-time initially as a clinical nurse liaison for a specialty pharmacy that provided a variety of home infusion therapies to patients. Coordinated care between physicians, home health agencies and hospitals
- Interacted daily with nurse practitioners, physicians, nurse case managers and discharge planners,
- Knowledgeable of core therapies and their delivery (anti -infective therapy, chemotherapy, TPN and pain management). Met with patients in facilities prior to their discharge to educate same on therapy, route of therapy, central line maintenance and infection control
- Driven to help patients be knowledgeable in order to self-manage their own care
- Offered and accepted full-time Account Executive position within 6 months of hire as Clinical Liaison
- Tailored state-wide plan to generate revenue for company and help build successful work relationships with care providers
Registered Nurse Case Manager
PROVIDENCE HOSPITAL
05.2005 - 01.2008
- Nurse case manager on Medical Critical Care Unit and a Post-Cardiac Intervention Unit
- Confirmed adherence to Medicare and private insurance guidelines using Interqual as a tool to document severity of illness and intensity of care
- Submitted clinical information via Allscripts to private insurance companies for review and authorization of days for admission and continued stay
- Worked closely with discharge planner in developing safe care transition to home, SNF, rehab. and hospice
Registered Nurse/Charge Nurse
SISTERS OF CHARITY PROVIDENCE HOSPITAL
08.1999 - 05.2005
- Contracted initially at 13 week intervals to staff various units throughout the hospital
- Contracts continually renewed for 6 years
- Worked full-time staffing medical surgical, orthopedic surgery, IICU, telemetry units, post- intervention unit, transitional care unit, pre-cath unit and outpatient surgery
- Precepted newly hired staff even as a contract nurse
- Charge nurse for two years on medical surgical unit
- Accepted nurse case management position when offered by management
Nurse Administrator II
WILLIAM S HALL PSYCHIATRIC HOSPITAL
08.1996 - 08.1999
- Interviewed to recommend hire and supervised staff on a 14-bed children's psychiatric unit
- Successfully developed unit-based program to engage children and encourage good behavior with an aim to help foster life skills
RN Case Manager
BAPTIST HOMECARE RESOURCES
07.1994 - 08.1996
- Managed caseload of 25-30 patients in the maternal/child and women's health division
- Provided home-based care to women with high-risk pregnancies before and after delivery
- Followed infants discharged to home from NICU (Neonatal Intensive Care) and assessed caregiver knowledge and ability to manage care at home
Registered Nurse NICU
PRISMA HEALTH BAPTIST
08.1990 - 07.1994
- Employed full-time on a 20-bed level III NICU
- Cared for premature infants and other neonates in need of intensive care interventions
- Proficient in skills related to ventilator assistance and interpretation of lab values
- PALS certified
RN: Labor, Delivery, Recovery, Postpartum/ Level II NICU
BON SECOURS SAINT FRANCIS HEALTH SYSTEM
08.1989 - 08.1990
- Staffed LDRP Monday thru Friday
- Staffed Level II NICU on alternate weekends
RN Neonatal Intensive Care
MEDICAL UNIVERSITY OF SOUTH CAROLINA
08.1986 - 08.1989
- Staffed Level III NICU full-time
- Acquired skills in ventilator assistance and interpretation of lab values to include ABGs
- Utilized the nursing process to quickly respond to minute changing status of critically ill neonates
- Participant in the first double-blind surfactant study
- Trained to provide and care for infants receiving ECHMO (extracorporeal membrane oxygenation)
Graduate Nurse/Registered Nurse
PRISMA RICHLAND
08.1985 - 08.1986
- Full-time graduate nurse on a medical surgical/stepdown unit
- Hired as an RN once boards taken and license obtained in January 1986
Education
Master of Science - Nursing
Walden's University
Minneapolis, MNAssociate of Science - Medical Technology
University South Carolina
Sumter, SCSkills
- CARE COORDINATION WITHIN MANAGED CARE ENVIRONMENT COMMUNICATE WITH STATE CARE MANAGERS TO FOLLOW CARE GUIDELINES AND SUPPORT CLIENTS
- KNOWLEDGEABLE OF MMP PLANS AND OTHER DUAL-ELIGIBLE PRODUCTS
- KNOWLEDGEABLE OF MEDICARE ADVANTAGE PLANS
- UTILIZATION REVIEW SPECIALIST
- CASE MANAGEMENT (hospital, insurance and home health)
- CARE PLANNING AND GOAL SETTING
- LTSS COORDINATION FOR MEDICAID RECIPIENTS ABLE TO REVIEW PHOENIX PLANS OF CARE AND AUTHORIZE SAME
- SPECIALTY PHARMACY LIAISON AND MARKETING ABLE TO COORDINATE CARE BETWEEN PROVIDERS (dme, home infusion, home health, daycare for applicable clients)
Software
Cerner
Epic
Jiva
Kinnser
Interqual
Allscripts
Microsoft Office [Word, Excel, Outlook]
Sharepoint
Certification
- ACM
-
CCM
Affiliations
- American Nurses Association (ANA)
- South Carolina Nurses Association (SCNA)
- American Case Management Association (ACMA)
- Commission for Case Management Association (CCMA)
- Capitol Nurse Practitioner Group
- National Psychiatric Association
Timeline
Nursing Supervisor
Wellpath (Mental Health Facility)
03.2022 - Current
RN LTAC @ Continue Care Inside of PRISMA Baptist
Favorite Health Staffing
02.2022 - 03.2022
RN LTAC
Favorite Nurses Healthcare Staffing
08.2021 - 01.2022
Nurse Case Manager/Acute Care Setting
American Mobile Network
03.2020 - 08.2020
Registered Nurse Adolescent Psychiatry
Three Rivers Behavioral Health
11.2019 - 03.2020
Care Coordinator
AMERIHEALTH CARITAS FAMILY OF COMPANIES
03.2016 - 10.2019
Endoscopy Pre-op/PACU Nurse
CAROLINA COLONOSCOPY CENTER
01.2015 - 03.2016
Hospital Case Manager/ Home Health Case Manager
AMN (AMERICAN MOBILE NETWORK)
06.2014 - 01.2015
Registered Nurse Case Manager
PRISMA HEALTH BAPTIST
06.2008 - 06.2014
Nurse Liaison/Account Executive
CRITICAL CARE SYSTEMS, INC.
01.2007 - 06.2008
Registered Nurse Case Manager
PROVIDENCE HOSPITAL
05.2005 - 01.2008
Registered Nurse/Charge Nurse
SISTERS OF CHARITY PROVIDENCE HOSPITAL
08.1999 - 05.2005
Nurse Administrator II
WILLIAM S HALL PSYCHIATRIC HOSPITAL
08.1996 - 08.1999
RN Case Manager
BAPTIST HOMECARE RESOURCES
07.1994 - 08.1996
Registered Nurse NICU
PRISMA HEALTH BAPTIST
08.1990 - 07.1994
RN: Labor, Delivery, Recovery, Postpartum/ Level II NICU
BON SECOURS SAINT FRANCIS HEALTH SYSTEM
08.1989 - 08.1990
RN Neonatal Intensive Care
MEDICAL UNIVERSITY OF SOUTH CAROLINA
08.1986 - 08.1989
Graduate Nurse/Registered Nurse
PRISMA RICHLAND
08.1985 - 08.1986
Master of Science - Nursing
Walden's University
Associate of Science - Medical Technology
University South Carolina
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