Diligent Nurse Care Manager with solid background in clinical care management. Proven expertise in coordinating patient care and collaborating with multidisciplinary teams to ensure optimal outcomes. Demonstrated problem-solving skills and proactive approach in streamlining care processes and enhancing patient satisfaction.
Overview
18
18
years of professional experience
1
1
Certification
Work History
Clinical Care Manager
VNS HEALTH
07.2022 - Current
Make timely telephonic care management calls based stratified risk levels.
Complete care management and disease specific assessments.
Resolves and coordinates complex issues and member complaints impacting the delivery of services/
Provide health education to member/caregiver.
Assess SDOH and provide care coordination to reduce/remove barriers of care to include ability to allow for changing levels of care based on assessments, trigger events and program data/reports.
Identifies member safety issues and intervenes as necessary to refer to appropriate resources, such as community linkages, dietary (PT/OT/ST) HHA services, behavioral Health, and DME.
Coordinates the delivery of high quality, cost-effective care based on customized population model of care supported by evidence based clinical practice guidelines.
Increases utilization of primary care, specialty care, preventive health and guideline- based treatments including proper pharmacotherapy within network as appropriate.
Participates in interdisciplinary team (IDT) meetings and provide input on customer service-related activities.
Registered Nurse Case Manager
MAGELLAN HEALTH INC.
10.2018 - 07.2022
In an MLTC setting, telephonically coordinate and provide care that is safe timely, effective, efficient, equitable, and client centered.
Manage a case load of over 200 members, initiate service plans, review case progress and determine if attainable close are met.
Assist members to achieve wellness and autonomy.
Help members make informed decisions by acting s their advocate regarding there clinical status and treatment plan.
Record cases information, complete accurately all necessary forms, while adhering to professional standards as outlined by protocols , rules and regulations.
Assess and address motivational and psychosocial issues.
Completes comprehensive UAS assessments of members per regulated timelines and determines who may qualify for case management based on clinical judgement, changes in member’s health or psychosocial wellness, and triggers identified in the assessment.
Registered Nurse Case Manager
ARCHCARE COMMUNITY LIFE.
05.2017 - 10.2018
Maintained on-going telephonic communication with members and care givers, with care plan centered around the needs of members.
Participates and assists as necessary in development of the reassessment plan of care and makes changes in the plan of care based upon findings.
Maintains oversight for the member's care management during inpatient acute episodes necessitating hospital admission. Ensuring effective discharge planning for transfer to the community and resumption of services.
Ensures that utilization of services is reasonable and necessary to member's health and well being.
UAS Assessment RN.
GREATER NEW YORK HOME CARE
11.2015 - 10.2017
Perform UAS routine, reassessments and initial visits for various contracted agencies.
Ongoing monitoring and assessment of members functional and cognitive status, review members UASNY assessments and clinical documentation, appropriateness of person-centered care plan and services provided by MLTC program.
Competent with the ATSP tool to determine needed service hours.
Registered Nurse Care Coordinator
VISITING NURSE SERVICE OF NEW YORK CHOICE MLTC
12.2008 - 10.2015
Assessed and monitored members in the community for effectiveness and compliance with prescribed Plan of Care.
Provided intensive and continuous care management across acute, home, hospital and long term settings.
Identified members needs to develop a safe comprehensive plan with sensitivity to cultural diversities.
Communicated and collaborated with Primary Care Physicians and other disciplines related to members needs.
Consult and educate patient, families and caregivers on disease processes, self care techniques and prevention strategies
Provide nursing services and authorizations within a capitated managed care system.
Proficient with UAS, OASIS and SAAM assessment tools.
Emergency Room Registered Nurse
METHODIST HOSPITAL
08.2007 - 01.2010
Assessed and monitored members in the community for effectiveness and compliance with prescribed Plan of Care.
Provided intensive and continuous care management across acute, home, hospital and long term settings.
Identified members needs to develop a safe comprehensive plan with sensitivity to cultural diversities.
Communicated and collaborated with Primary Care Physicians and other disciplines related to members needs.
Consult and educate patient, families and caregivers on disease processes, self care techniques and prevention strategies
Provide nursing services and authorizations within a capitated managed care system.
Proficient with UAS, OASIS and SAAM assessment tools.
Education
BACHELORS OF SCIENCE - NURSING
University Of Phoenix -Online
Salt Lake City, UT
10.2024
Skills
Critical Thinking
Effective customer communication
Public Safety and Security
Proficient evaluation and intervention
Patient assistance and service
Patient care
Patient engagement
Patient and family advocate
Electronic health records
Clinical assessment
Chronic disease management
Procedure implementation
Certification
9-12-2007 Registered Professional Nursing 591890 BLS and ACLS certified through AHA.