LAUREN JAMES
Charlotte,NC
Summary
Qualified Nurse Administrator with robust background in community health nursing. Experienced leader with strong background in guiding teams, managing complex projects, and achieving strategic objectives. Excels in developing efficient processes, ensuring high standards, and aligning efforts with organizational goals. Known for collaborative approach and commitment to excellence.
Demonstrated expertise in administering patient care, health education, and advocacy, leading to improved community health outcomes. Consistently leveraged critical thinking and compassionate communication to deliver high-quality care and foster strong patient relationships.
Excellent knowledge base in Medicare and Medicaid Programs, Value based Purchasing, Hedis, Star Ratings, Quality and Compliance, and Managed Care. Knowledge of Medicare Conditions of Participation requirements for care and payment, clinical operations, quality measures, star ratings, OASIS, UAS, PDPM, PDGM, and customer satisfaction. Computer skilled, Microsoft Word, Excel. PowerPoint. Visio. Proficient in EMR Sigma Care, Allscripts, Netsmart, McKesson, and HCHB software programs.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Manager, Care Manager
Centene Corporation (CCH)
06.2023 - Current
- Instrumental in planning and implementing NC Medicaid Tailored Plan
- People Leader for a team of Care Navigators, LCMSW Social Workers, and RN Case Managers
- Monitor and audit documentation for quality and metrics
- Manage performance and coaching for success
- Partner with outside vendors and other entities for business needs and purpose
- Managed and motivated employees to be productive and engaged in work.
- Accomplished multiple tasks within established timeframes.
- Maintained professional, organized, and safe environment for employees and patrons.
Clinical Manager, RN
Centerwell Home Health
10.2023 - 06.2024
- Responsible for supervising Home Care RNs, PT/OT and Social Workers
- Educate and advise clinical staff about evidenced based care practices and treatment plans
- Provide performance management, feedback, and mentoring
- Ensure policy and procedure are adhered to as governed by Centers for Medicare and Medicaid
- Process PTO requests, payroll, scheduling, and performance review
Manager, Case Manager
Centene Corporation, CCH
10.2022 - 08.2023
- Managed and motivated employees to be productive and engaged in work.
- Accomplished multiple tasks within established timeframes.
- Maintained professional, organized, and safe environment for employees and patrons.
- Enhanced customer satisfaction by resolving disputes promptly, maintaining open lines of communication, and ensuring high-quality service delivery.
Clinical Manager, RN
Advanced Home Health
05.2021 - 11.2023
- Responsible for supervising Home Care RNs, PT/OT and Social Workers
- Educate and advise clinical staff about evidenced based care practices and treatment plans
- Provide performance management, feedback, and mentoring
- Ensure policy and procedure are adhered to as governed by Centers for Medicare and Medicaid
- Process PTO requests, payroll, scheduling, and performance review
Assistant Director of Nursing
NYC Health + Hospitals Corporation
05.2020 - 01.2021
- Responsible for administrative house supervision
- Maintain staffing and delegation of tasks
- Responsible for comprehensive care planning, maintaining resident safety, compliance and reporting
- Conduct quality improvement and assurance auditing, staff education and in-service
- Conduct and maintain COVID screening, testing, and health records of staff and patients
Clinical Manager, RN
VNS of New York
02.2020 - 06.2020
- Company Overview: (Furlough due to COVID)
- Responsible for supervising Home Care RNs, PT/OT and Social Workers
- Educate and advise clinical staff about evidenced based care practices and treatment plans
- Provide performance management, feedback, and mentoring
- Ensure policy and procedure are adhered to as governed by Centers for Medicare and Medicaid
- (Furlough due to COVID)
RN Unit Manager, Sub Acute/Telemetry Unit
Archcare at Terrence Cardinal Cooke
09.2019 - 01.2020
- Maintain staffing and delegation of tasks
- Responsible for comprehensive care planning, maintaining resident safety, compliance, and reporting
- Conduct quality improvement and assurance audits, scheduled staff education, and in-service
RN Case Manager II
Centene Corporation (Fidelis Care)
07.2018 - 09.2019
- Coordinate community services
- Telephonic assessments monthly
- Utilization Management of services in the community such as PCA services, DME, skilled services, SNF
- Managed a caseload of 150-175 members
RN Unit Manager
New Vanderbilt Rehabilitation Center
09.2017 - 09.2019
- Provide leadership to multidisciplinary clinical staff
- Responsible for ensuring guidelines, protocols, and policies are adhered to
- Responsible for staff development and education
- Performance management of all clinical staff
Clinical Manager, RN
Archcare at Home
06.2014 - 07.2018
- Responsible for supervising Home Care RNs, PT/OT and Social Workers
- Educate and advise clinical staff about evidence-based care practices and treatment plans
- Provide performance management, feedback, and mentoring
- Ensure policy and procedure are adhered to as governed by Centers for Medicare and Medicaid
Education
Bachelor of Science - Nursing
Chamberlain University
Chicago, IL07.2022
Associate of Applied Science - Nursing
St. Pauls’ School of Nursing
New York, NY12.2012
Skills
- Community education, Community health, Infection control
- Nursing management, Effective leadership
- Proficient in Word, Excel, PowerPoint, Visio
- Insurance plan expert, Healthcare regulations
- Policy adherence, Operations management, Resource utilization
- Budget planning, Compliance oversight, Strategic planning, Quality improvement
Certification
- NYS Board of Nursing, RN License 674258
- NC Board of Nursing, RN License/Compact 331455
- Basic Life Support Certification (BLS)
Timeline
Clinical Manager, RN
Centerwell Home Health
10.2023 - 06.2024
Manager, Care Manager
Centene Corporation (CCH)
06.2023 - Current
Manager, Case Manager
Centene Corporation, CCH
10.2022 - 08.2023
Clinical Manager, RN
Advanced Home Health
05.2021 - 11.2023
Assistant Director of Nursing
NYC Health + Hospitals Corporation
05.2020 - 01.2021
Clinical Manager, RN
VNS of New York
02.2020 - 06.2020
RN Unit Manager, Sub Acute/Telemetry Unit
Archcare at Terrence Cardinal Cooke
09.2019 - 01.2020
RN Case Manager II
Centene Corporation (Fidelis Care)
07.2018 - 09.2019
RN Unit Manager
New Vanderbilt Rehabilitation Center
09.2017 - 09.2019
Clinical Manager, RN
Archcare at Home
06.2014 - 07.2018
- NYS Board of Nursing, RN License 674258
- NC Board of Nursing, RN License/Compact 331455
- Basic Life Support Certification (BLS)
Bachelor of Science - Nursing
Chamberlain University
Associate of Applied Science - Nursing
St. Pauls’ School of Nursing
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