Zohra Ali
Sugar Land,TX
Summary
Compassionate Nurse Case Manager offering 7 years of experience working with patients and families to facilitate smooth transitions following discharge from medical facilities. Committed to working collaboratively with health plan, leadership and department coordinators to achieve highest quality of patient satisfaction. Well-versed in developing individualized care plans and advocating patient welfare. Skilled in creating and implementing processes to improve patient care and cultivate support teams.
Overview
10
10
years of professional experience
1
1
Certification
Work History
RN Case Manager - Acute Care
Southern New Hampshire Medical Hospital
07.2023 - 12.2024
- Conduct thorough patient assessment to determine their support system capabilities and available community resources to determine a safe discharge plan of care
- Evaluate the patient's health status and patient/family/significant other's response to illness and caregiver capabilities to facilitate the discharge planning process
- Collaborate with clinical staff in developing and coordinating the discharge plan of care
- Ensure compliance with regulatory agency requirements regarding discharge planning and patient needs for care, treatment, and services after discharge or transfer are met
- Ensure that patients and families have a choice in agency/facility selection by providing resource lists and documenting patient choice
- Integrate the functions of utilization review, discharge planning, and resource management to optimize care
- Participate in interdisciplinary care planning to optimize patient discharge to an appropriate care setting
- Act as a resource to physicians/hospitals regarding utilization review process, and appropriately follows-up with concurrent appeals
- Mobilize resources to achieve clinical outcomes within desired time frame
- Issue Important Message from Medicare within 48 hours of discharge consistently
- Determine appropriate level of care utilizing InterQual criteria
- Conduct timely concurrent medical record review to determine medical necessity and appropriate level of care for both federal and managed care insurance
- Facilitate interdisciplinary patient-care team huddles to review treatment goals, optimize resource utilization, provide family education, and identify post-hospital needs
- Coordinate patient centered discharge care planning meetings with the care team
RN Case Manager -Mental Health and Substance Abuse
Iqbal Dhanani MD LLC
01.2016 - 01.2023
- Effective counseling in health maintenance and disease management
- Liaise between patients and physicians to ensure patient comprehension of treatment plan
- Closely monitor acute conditions
- Contribute substantially to successful department JCAHO accreditation
- Ensure HIPAA Compliance
- Diagnose and treat patients with chronic and acute Mental Health and Substance Abuse and Acute Rehab and Skilled Nursing/ Discharge Planner
- Develop and implement nursing care plans
- Review cases for setting appropriateness and Medical Necessity using nursing judgment
RN Intake and Discharge Planner
UHS Facility Anchor Hospital
02.2017 - 08.2021
- Review and coordinate referrals
- Responsible For admissions and the nursing assessment process for all incoming patients
- Coordinate care based on medical and psychiatric needs
- Formulate treatment plans
- Coordinate with Advanced Provider for orders related to admissions
- Complete Medical Reconciliation as needed
- Evaluate patient case management plans, identify insurance coverage and sources of payment for treatment and care
- Assessing patient's needs through interaction with the patients, families and other health care providers (Nurse to Nurse)
- Communicate with psychiatrists to develop treatment for mental health problems
- Communicate effectively with referral sources to ensure patient's disposition
- Arrange patient transfer
- Connect vulnerable populations, such as uninsured and homeless, to outpatient healthcare resources
- Ensured that medical orders are properly entered into the hospital database
- Coordinated with appropriate staff to ensure optimal patient care
- Update patient information and verify insurance
- Verified patient histories and corrected any inconsistencies
- Responsible for initial authorization for covered services and coordinate care regardless of payer
- Conducting comprehensive assessments and developing personalized care plans based on medical and psychiatric needs
- Formulate treatment plans
- Collaborate and communicate with patients, family, caregivers, and the interdisciplinary team
- Participate actively in various initiatives aimed at improving member health and wellness.
RN Care Coordinator Center for Spine and Pain Medicine
Center For Spine And Pain Medicine
01.2015 - 01.2016
- Performed patient assessments, safely monitored patients pre and post procedure and administered medication
- Confirmed that patients completed required tests prior to scheduled procedures
- Explain the treatment procedure to the patients
- Assist in procedures
- Maintain confidential patient charts and medical files; successfully organized, updated, and managed patient charts
- Monitor and maintain inventory and supply levels; prepare and submit supply replenishment orders to maintain par levels
- Autoclave medical instruments
- Monitored, examined and recorded patient history, test results, and progress according to the documentation guidelines.
RN Registered Nurse
Trinity Dialysis Clinic
01.2015 - 01.2016
- Promoted and participated in team nursing efforts in all clinic activities
- Implemented and monitored long-term dialysis patient care plans
- Administered intravenous solutions and medications to patients as required
- Documented and verified all physician orders
- Performed pre- and post-dialysis patient monitoring
- Operating the Hemodialysis machines, monitoring patient's vital signs and maintaining a safe environment and reporting any changes in patient's condition to Dr and documenting it in the patient's chart.
Education
Bachelor of Science in Nursing - Nursing
Clayton State University
Morrow08.2009
Skills
- Strong clinical judgment
- Patient centered care
- Disease prevention and intervention specialist
- Patient and family advocacy
- Long term care
- Mental Health and Substance Abuse Case Management Exposure
- Leadership
- HIPAA Compliant
- Record Management
- Infection Control
- Palliative Care
- Clinical Assessment
- Healthcare Regulations
- MS Office
Certification
- Registered Nurse, Georgia (Compact license), Current.
- ACLS, BLS, American heart association healthcare provider, CPR, Current.
Affiliations
American Nurse Association (ANA) member
Timeline
RN Case Manager - Acute Care
Southern New Hampshire Medical Hospital
07.2023 - 12.2024
RN Intake and Discharge Planner
UHS Facility Anchor Hospital
02.2017 - 08.2021
RN Case Manager -Mental Health and Substance Abuse
Iqbal Dhanani MD LLC
01.2016 - 01.2023
RN Care Coordinator Center for Spine and Pain Medicine
Center For Spine And Pain Medicine
01.2015 - 01.2016
RN Registered Nurse
Trinity Dialysis Clinic
01.2015 - 01.2016
Bachelor of Science in Nursing - Nursing
Clayton State University
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