Registered Nurse Case Manager Skills

• Applied concepts of infection control and standard precautions in coordinating/performing patient care activities to prevent contamination and transmission of disease.
• Reported family and patient information to the respective interdisciplinary team members to maintain continuity of patient care.
• Developed effective working plans for time management and organization to ensure accurate and appropriate patient care.
• Presented complex cases to patient care management and team members to facilitate collaboration and process efficiency.
• Collaborate with other multidisciplinary team members during patient care conference and modify care plans as appropriate.
• Supervised and provided direction to professional and auxiliary personnel who also provided direct patient care.
• Provided appropriate critical thinking skills and education needed for adequate and substantial patient care.
• Coordinated patient care/treatment, home modifications, travel and overall patient specific needs.
• Facilitate quality patient care by utilizing cost effective and outcome management criteria.
• Collaborate patient care with Interdisciplinary Team members to provide exceptional patient outcomes.
• Modified inpatient care through an interdisciplinary approach to ensure optimal patient outcomes.
• Developed and implemented systems for improved quality of documentation and patient care.
• Coordinated with scheduler availability of field staff to ensure appropriate patient care.
• Assume overall responsibility for organizing patient care from an Interdisciplinary Group approach.
• Audited and reviewed all documentation related to patient care and quality.
• Managed patient care per physicians' orders within an interdisciplinary system.
• Managed medications and formulated and implemented all patient care planning needs.
• Developed, implemented, and evaluated individualized patient care plans.
• Coordinated Available upon request /supervised all aspects of patient care
• Attend and participate in weekly interdisciplinary patient care conferences.

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• Functioned as a clinical resource and educator; identified opportunities for alternative care options and assisted members to achieve optimal health.
• Identified appropriate alternative and non-traditional resources and demonstrate creativity in managing each case to fully utilize all available resources.
• Compiled patient outcome statistics, resulting in a research study with ongoing presentations at numerous external medical conferences.
• Monitor patients treatments, procedures and medications frequently and communicate needed changes and concerns to appropriate physicians.
• Participated in care conferences and collaborated with internal and external resources as well as community agencies.
• Provided day to day patient education, provider relations and clinical monitoring RN Utilization Management Responsibilities.
• Maintain regular communication with the attending physician concerning patient/family care needs and response to interventions.
• Collaborate with Nurse Practitioner and external providers to coordinate care for medically complex patients.
• Served on point to establish coordinated efforts with government regulators and insurance companies.
• Trained extensively in Medicare and state regulations governing home care and hospice/palliative care.
• Collaborate with internal and external agencies and operate nursing activities in efficient manner.
• Communicated with physicians any changes in conditions, concerns of patient/family members.
• Performed relationship building with hospital organization and external customers to hospital.
• Refer patients to specialized health resources or community agencies furnishing assistance.
• Deliver advanced clinical care to patients returning home following hospitalization.
• Perform home health physical assessments and evaluate patient learning capabilities.
• Coordinated with alternative therapies to provide effective comfort measures.
• Facilitated medical treatment and return-to-work activities.
• Perform evening/weekend/on-call and PRN RN visits
• Charged with managing physical and mental health needs of population of persistently mentally ill adults in Alternative Families for Adults program.

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• Provided assessment and education regarding disease process, dietary requirements, and medication management to elderly patients in their home setting.
• Coordinated and oversaw team care using multidisciplinary approach to treat disease processes to assist patients return to maximum levels of independence.
• Provide and coordinate appropriate counseling concerning disease process, therapy regimen and precautions that may prevent complications and improve outcomes.
• Developed individualized patient care plans, based upon the identified disease process, severity of illness and anticipated outcome.
• Facilitated access to community resources and provided extensive education to patients on various disease processes for improve self care.
• Case management of Medicare patients, interdisciplinary communication, disease process education, medication education, POC development
• Utilized a multidisciplinary approach to educate patients/families about their disease process to foster independence and decrease re-hospitalization.
• Monitored closely for and promptly identified complications of disease processes which are reported immediately to the physicians.
• Monitored quality control of chronic clients and provided education to inmates regarding medications, disease process.
• Provide education to clients and family members about disease processes and provide emotional support and recommendations.
• Provided education to residents regarding disease and illness prevention, medications and disease process.
• Educate patient regarding disease process and management, pain management, and medication management.
• Developed care plans for patients specific disease process and implemented with physicians approval.
• Educate patients on their disease process, potential infections and medication administration.
• Provide ongoing education and emotional support related to disease process and progression.
• Provide education on medications, disease process, and nutrition/dietary information.
• Coached and educated members in managing disease processes and catastrophic injuries.
• Provide patient and family education regarding disease processes and end-of-life care.
• Educate patients and family on disease process and medications management.
• Provide patient and provider education about disease processes and safety.

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• Completed OASIS and other necessary documentation according to Medicare/Insurance guidelines while determining appropriate goals and outcomes to meet patient's needs.
• Monitored care through Medicare ACO data collection and analysis to maximize clinical, quality and fiscal outcomes for targeted population.
• Reduced financial burdens placed on hospital facility by ensuring patients were provided correct services based on Medicare and insurance guidelines.
• Participated in bi-weekly interdisciplinary team meetings giving input in regard to patient's eligibility for hospice benefits under Medicare.
• Direct care for home bound patients including assessment and documentation utilizing OASIS documentation following Medicare guidelines and AHCA regulations.
• Facilitated company audit of policy and procedures to prepare for survey to become Medicare certified to expand patient database.
• Coordinated with doctors and registered nurses to develop care plans while following Medicare regulations and licensing guidelines.
• Provided Case Management services to Medicare, Medicare Advantage and Commercial insured residents receiving skilled care services.
• Complete and compile documentation according to Medicare regulations, organizational policies and procedures, HIPPA standards.
• Manage reporting per Medicare requirements, ensuring diagnostic justifications for service levels, and service delivery.
• Demonstrated detailed charting reflecting compliance with Medicare guidelines and evidence of hospice criteria for care.
• Compile and complete documents to Medicare standards., organizational policies/procedures, and government regulations.
• Utilized Motivational Interviewing techniques to help Medicare patients make and achieve healthy outcomes.
• Involved and responsible for fiscal management with Medicare and Insurance companies authorizations.
• Complete documentation according to Medicare guidelines Perform home health aide supervisory visits.
• Individualized Care Plans and Re-Certifications bi-weekly to document changes within Medicare guidelines.
• Paper and computer documentation with McKesson system per Medicare and agency protocols.
• Assure regulatory compliance including achieving and maintaining Hospice/Home Health Medicare Certification.
• Provided admissions, re-certifications, and discharges per Medicare Oasis-C guidelines.
• Evaluate potential clients for eligibility of hospice services under Medicare guidelines.

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• Demonstrate OASIS documentation according to Medicare/Medicaid guidelines
• Provided case management services to the elderly, developmentally disabled, and mentally ill population in a Medicaid Managed Care organization.
• Provide Care Management and Assessment of health care needs for the WellCare- Medicaid insurance beneficiaries with Developmental Disability in the community.
• Developed and implemented Plan Of Care and Discharge planning under Medicare/Medicaid and Managed Care in accordance to federal regulations.
• Audit patient charts for completed documents necessary for billing and reimbursement of Medicare/Medicaid and other private insurance companies.
• Reviewed concurrent hospitalizations daily, audited physician's office visits and ancillary services for our 24,000 Medicaid members.
• Utilize Medicare/Medicaid guidelines to determine the nursing skills, visit frequency/duration of care required for each patient.
• Initiated a quality improvement program for Medicare and Medicaid to improve patient outcomes and hospital reimbursement.
• Coordinated multidisciplinary approach to patient care for Medicare, Medicaid, and private insurance patients.
• Maintained charts and updated patient information to meet State and Federal Medicare and Medicaid regulations.
• Reviewed charts of patients admitted to the hospital for insurance and Medicare/Medicaid admission criteria compliance.
• Ensured compliance with and continuously updated knowledge of Medicare and Medicaid practices and reimbursement requirements.
• Prepared and coordinated Medicare and Medicaid submissions in accordance with organization policy and government regulations.
• Performed regular patient chart reviews to ensure compliance with agency and Medicaid regulations.
• Performed and submitted comprehensive in-home assessments and coordinated Star Plus Waiver Medicaid benefits
• Report data collected to superiors and case managers to reduce Medicaid/Medicare costs.
• Inquired about prior authorizations, Medicaid and other patient related assistance programs.
• Documented clearly under Maternity Case Management requirements for medicaid funded program.
• Reviewed weekly skilled nursing documentation to ensure compliance with Medicare/Medicaid regulations.
• Outreached to Medicaid members to identify needs thorough comprehensive health assessment.

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• Assisted with the development, implementation and evaluation of facility philosophy/mission statement, objectives and goals, guidelines and methods.
• Developed and implemented comprehensive, cost-effective plans of care while continuously conducting assessments/reassessments as needed or required for all members
• Supported patient transitions through effective communication and interventions by arranging non-complex home health set-up with patient/family members preferred agencies.
• Volunteered initiative and trained for Case Management position during corporate restructuring due to unexpected loss of acting case manager.
• Demonstrated effective and empathetic communication with patients and their family members and between other members of Interdisciplinary Team.
• Created case management plans based on assessments with measurable, time-oriented goals and objectives utilizing evidenced-based criteria.
• Make evaluations and decisions based on measurable criteria, excellent communication skills and maintaining privacy and confidentiality.
• Participated in all the clinical outcomes of monitoring, agency performance and follow-up for improvement initiative.
• Work independently after office hours to provide individualized nursing care to hospice patients in different settings.
• Conducted initial assessment of patients and families and generated patient specific and individualized plans of care.
• Provided information and assessed for any in home safety equipment deemed necessary for each individual patient.
• Provided palliative care in outpatient/inpatient settings ranging from assessment to development and implementation of care plans.
• Provided emotional support and caregiver validation during difficult time in life of patient and families.
• Provided holistic care for terminal individuals including necessary nursing procedures and care in their homes.
• Collaborated effectively with integrated care team to establish an individualized plan of care for patients.
• Identified to participate in clinical outcomes monitoring, follow-up, and agency performance improvement initiatives.
• Facilitated patient assessments and devised effective treatment methods/care plans to reduce pain and discomfort.
• Educated patients/caregivers regarding infection control, medication regimen and importance of treatment adherence.
• Delivered patient support including assessment, counseling, education regarding medications and treatment.
• Provide comprehensive case management designed to improve individuals and/or family quality of life.

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• Facilitate communication between patients, their physicians and caregivers to clarify treatment plans, medication regimens or other urgent issues.
• Identified and coordinated treatment of high complexity, high cost patients providing continuity and individualized treatment plans and interventions.
• Coordinated interdisciplinary team in development and implementation of treatment plans to best facilitate clinical outcomes and maximize reimbursement.
• Developed individualized patient treatment plans and delegated care tasks to ancillary staff and care providers as appropriate.
• Documented case management assessments, activity, treatment plans and resolutions; prepares narrative and statistical reports.
• Ensured efficacy of prescribed treatment plans through monitoring of treatment outcomes and advocated for needed interventions.
• Performed daily utilization reviews and submitted clinical documentation for payer approval of LOS and treatment plans.
• Evaluated injuries and disabilities in Workers Compensation claims to determine severity and appropriateness of treatment plans.
• Collaborate with multidisciplinary team to develop, monitor, and refine individual treatment plans.
• Developed in conjunction with client and team individualized treatment plans that were recovery focused.
• Facilitated communication and coordinate treatment plans with claimant, physicians, facilities and technicians.
• Collaborate with medical directors and inter-disciplinary team to develop care management treatment plans.
• Assisted in the development of treatment plans using established and acceptable medical criteria/guidelines.
• Developed individualized treatment plans and administered medications via subcutaneous and intravenous infusion.
• Collaborated with health care team to effectively communicate desired patient treatment plans.
• Performed skilled nursing assessments and developed treatment plans based on initial evaluation.
• Reviewed and negotiated medical treatment plans submitted by physician of record.
• Developed treatment plans for management of diseases working alongside medical directors.
• Verified medications and treatment plans/changes with other medical professionals.
• Communicated directly with physicians to discuss treatment plans.

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• Communicated with medical insurance providers to verify patient eligibility, medical benefits, and obtained authorization for admission when appropriate.
• Collaborated with the Medical Directors on referrals to outside providers and formal denials requiring Medical Director's expertise.
• Collaborate with community health education/outreach organizations and providers to provide for the overall health promotion of TCHP members.
• Coordinated care with providers/patients/caregivers using best nursing practice to ensure optimal health status of patients in their residences.
• Communicate directly with providers and injured workers; assist with settlement negotiations and projection of future medical needs.
• Initiated and facilitated referrals to community based providers for lower level of care support and outpatient services.
• Communicated with medical providers and patients to assist the approval and application for prior authorizations for payment.
• Communicated effectively with health care providers and family members regarding patient status and updates.
• Collaborated and consulted with physicians and other providers to develop individualized plan of care.
• Reviewed medical record to assist providers with decision to admit for observation or inpatient.
• Coordinated care with family/caregivers/providers using best care practice working with patients in their residences.
• Assist Clinical Supervisor in identifying providers with documentation deficiencies and staff development processes.
• Provide feedback to Preferred Provider Network regarding provider nominations and experience with providers.
• Participate in weekly conference with Medical Director & Providers to develop plan of treatment
• Worked closely with insurance providers to obtain authorizations and timely payments for services.
• Skilled with negotiating modified duty positions/restrictions, and obtaining MMI status with providers.
• Assisted clinicians with coordination of services when multiple ancillary providers are necessary.
• Negotiate reimbursement amounts with out-of-network providers when in-network providers are not available.
• Communicate with various Insurance Providers to assure coverage and reimbursement as indicated.
• Perform utilization management, collaborate with care providers and team members.

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• Performed supervisory visits with LPN/CNA to ensure adherence to policy and patient satisfaction.
• Supervised LPN and CNA staff-completed supervisory visits and yearly evaluations
• Conducted supervisory LPN and CNA visits per regulatory requirements.
• Provide LPN supervisory visits and CNA supervisory visits
• Documented necessary supervisory LPN and HHA visits.
• Advised LPNs if health/welfare/safety issue arose, directed the nurse in proper course of care in a wide variety of situations.
• Home Health Case Management - admissions, clinical assessment, documentation, OASIS forms, supervision of LPN and CNA staff
• Provided case management of case load coordinating Doctor, CNA, LPN, Social Work, and Bereavement visits.
• Case managed 16-19 patients and supervised the home health aids and LPN staff that also worked with these patients.
• Train and supervise Health Coaches and LPNs in Community Health for high risk patients in and around Camden NJ.
• Coordinated patient care within all disciplines, supervised LPN and CNA staff, preceptor for new staff and student nurses
• Work in collaborative practice with the LPN on patient visit assignments to promote quality patient care and outcomes.
• Worked alongside hospice team in coordinating care for the patients, overseeing the LPN, and CNA cares.
• Direct care and Supervisory visits with LPN and home health aide and family assessing quality of care given.
• Supervised LPN's and CNA's and ensured safe care was provided and medical orders were followed.
• Counseled RN Case Managers and field LPNs regarding documentation and the importance of following policies and procedures.
• Case managed caseload of 10-20 hospice patients and supervision and assignment of duties to CNA and LPNs.
• Assisted in training of new LPN which included instruction of proper documentation and orientation to home visits.
• Provide routine visits per order, LPN and Home Health Aide supervisory visits within mandated time frames.
• Delegate appropriate nursing functions to LPN's and CNA's according to MN Board of Nursing guidelines.

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• Coordinated care with a multidisciplinary team which included nursing, physical therapy, occupational therapy, and speech therapy.
• Monitor and recommend treatment following the county panels including appointments, diagnostic testing, physical therapy and medications.
• Case management of care including communication with physical therapy, occupational therapy, physicians, and physician assistants.
• Refer patient to necessary services upon discharge: physical therapy, occupational therapy and speech therapy.
• Case Manage all medical appointments including physician appointments, physical therapy and occupational therapy visits.
• Monitored Aides, collaborated with Doctors, Physical Therapy Occupational Therapy and Assisted Living staff.
• Coordinated care with other disciplines such as physical therapy, occupational therapy and speech therapy.
• Coordinated patient care with various services including Physical Therapy, Occupational Therapy and Social Services.
• Collaborated with physicians, occupational therapy, and physical therapy for additional patient interventions.
• Determined medical appropriateness and necessity of outpatient physical therapy and alternate care services.
• Collaborate with physical therapy and physicians to ensure providing optimal level of care.
• Collaborated care with physical therapy, occupational therapy and social work.
• Coordinated care with physical therapy, occupational therapy and speech therapy.
• Managed 30-50 patients including physical therapy, occupational therapy and aides.
• Reviewed all physical therapy and chiropractic claims.
• Consulted with the physician regarding physical therapy, nutrition, speech therapy, respiratory therapy and other ancillary services as needed.
• Coordinated discharge orders, such as: ordering medical equipment, setting up physical therapy up for Home Health and Outpatient.
• Introduced the other disciplines as needed such as physical therapy, occupational therapy, social work and home health aid care.
• Assess client needs and implements a plan of care by coordinating with other disciplines such as physical therapy and occupational therapy.
• Home visits, physical assessment, interdisciplinary treatment planning with physician, therapist, physical therapy and all other disciplines daily.

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• Participated in Quality Improvement/Utilization Review activities.
• Maintained compliance with established utilization review process performance expectations and standards assuring participants received the highest level of professional medical accuracy.
• Provided utilization review to ensure patients receiving the appropriate level of care and appropriate communication with insurance providers for timely reimbursement.
• Combine clinical/quality considerations with regulatory/financial/utilization review demands to assure patients are receiving care in the appropriate setting and level of care.
• Provided education to nurses and physicians regarding benefits and purpose of case management services for utilization review and care coordination.
• Identified potential barriers to discharge and facilitated resolution of issues through communication with physicians, staff members and utilization review.
• Provided case management and utilization review on a 31-bed unit, utilizing Inter-Qual criteria to determine Inpatient or Observation status.
• Performed utilization reviews for each patient on a daily basis to ensure patients were meeting inpatient criteria and medical necessity.
• Case management and utilization review in an acute care setting with increasing emphasis on re-admission prevention and improved health outcomes.
• Performed utilization reviews ensuring admissions met criteria for appropriateness of care and medical necessity on a medical surgical unit.
• Performed utilization review ensuring admissions meet criteria for appropriateness of care, medical necessity, and level of care.
• Conducted initial utilization reviews to identify medical necessity criteria met for in-patient or 23 hour admission status.
• Recommended referral for utilization review for medical necessity as related to standard treatment guidelines and regulatory requirements.
• Performed daily utilization review of residents on Medicare/Managed care skilled services to determine qualification for skilled stay.
• Launched Great Beginnings program specializing in utilization review and care management working with multiple operating systems.
• Experience in the medical insurance industry by obtaining Prior Authorizations and complete Concurrent and Utilization Reviews.
• Performed care coordination, utilization review and case management for mentally ill and chemically dependent population.
• Assigned additional responsibilities as a performance improvement case manager, handling utilization review and discharge planning.
• Performed utilization reviews on all new patients, commercial, Medicaid and Medicare ensuring criteria guidelines.
• Included staff education, in-services, utilization review, and Patient Satisfaction Improvement Committee membership.

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• Monitor the appropriate completion of documentation by home health aides/personal care workers as part of the supervisory/leadership responsibility.
• Supervised/educated company assigned Home Health Aides in patient care and collaborated with interdisciplinary medical team on weekly basis.
• Provided supervision of home health aides and coordinated services of other disciplines including physical and occupational therapists.
• Supervised Home Health Aides, Performed physical examinations and mental health evaluations.
• Supervised LPNs, Home Health Aides and paraprofessionals according to regulatory guidelines.
• Supervised LPN/Home Health Aides according to regulatory protocol.
• Supervised Home Health Aides/Certified Nurses Aides and Homemakers.
• Collaborated and coordinated the patients care between physicians, nurses, physical therapy, occupational therapy, and home health aides.
• Coordinated and prioritized daily schedule with Home Health Aides and LPNs to ensure patients' and families' needs were met.
• Facilitated referrals to physicians, physical and occupational therapists, chaplains, social workers and home health aides based on need.
• Support members with condition education, medication reviews and connections to resources such as Home Health Aides or Behavioral Health Facilities.
• Case Manager for skilled home care patients*Used nursing process, assessed, planned & implemented patient care*Supervised Home Health Aides on team
• Assess need for durable medical equipment and arrange for delivery/pick up of equipment as necessary -Supervision of home health aides WORK HISTORY
• Coordinated the care of the client between multiple service providers; supervise home health aides; maintain record of client status.
• Supervised home health aides, assessed patients; instruction, wound care/dressing changes, lab, IV's, administered injections.
• Prepared detailed and accurate patient charts; managed patient care plans for the Home Health Aides and Licensed Practical Nurses.
• Case Manage total care of patients by coordinating with IDT members, supervising Home Health Aides and communicating with IDT.
• Collaborated with physicians, therapists and home health aides, to ensure each patient meets care plan objectives and goals.
• Collaborated with MD and NP, following through with orders received; delegated duties to LPN and Home Health Aides.
• Provided home care and hospice services, including admissions, discharges, assessments, and supervision of home health aides.

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• Maintain professional management of each patient and act as primary liaison between physician, patient/family and hospice interdisciplinary group.
• Supervised and documented hospice aide/homemaker and licensed practical nurse care plans and provided ongoing education to said support staff.
• Performed initial nursing assessments and ongoing weekly assessments to ensure effective delivery of palliative care within the hospice philosophy.
• Worked with family/caregiver and hospice interdisciplinary team members to meet the emotional needs of the patient and family/caregiver.
• Established strong business relationships with facility staff contributing to increased hospice census for the organization.
• Assessed for appropriateness for admission to Hospice Care based on Federal Guidelines and Company policy.
• Managed and facilitate direction of a hospice caseload, supervision of ancillary and facility staff.
• Performed review of patient's medical history and diagnosis to determine hospice admission appropriateness.
• Conducted admissions of newly referred patients as needed, including determining appropriateness for hospice.
• Managed hospice patients throughout Mercy Medical Corporation including Mobile and Baldwin Counties of Alabama.
• Conducted physical assessments, re-certifications, hospice admissions, discharges and revocations.
• Evaluated, admitted, and appropriately documented patient eligibility of Hospice needs.
• Perform assessments, evaluate and reevaluate hospice treatments and medications for efficacy.
• Participate in community awareness programs to promote understanding of hospice concepts.
• Provided system management for discomfort, and hospice-specific specialized nursing duties.
• Evaluated patients for hospice eligibility and discussed with physician if appropriate.
• Coordinate interdisciplinary team approached care for Hospice patients and their families.
• Assessed patients under specific guidelines for appropriateness for hospice care.
• Applied specific criteria for admission and re-certification to hospice care.
• Evaluated patients for hospice eligibility and admitted them to service.

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• Direct patient care in home/SNF setting* Patient/caregiver education* Proper documentation* CNA Supervision* Medication reconciliation* Implement and maintain plan of care
• Supervised ancillary personnel (CNA and Licensed Practical Nurses) and delegated responsibilities when required.
• Conduct monthly multidisciplinary case conferences and monthly LPN and CNA supervisory visits.
• Provided palliative nursing care to terminally ill patients, established individual care plans, and supervised LPN and CNA staff.
• Assist CNA with bathing, dressing, grooming for bed bound patients, skin assessment with wound care as needed.
• Managed the complete needs of the Home Health Client and their interdisciplinary team members...i.e, CNA, LPN
• Direct and supervise home health CNA and personal care assistant to ensure patient activities of daily living are met.
• Supervised and directed assigned LPN's, CNA's and home health aides per federal and state regulations.
• Educated and supervised all CNA's on team, ensuring care is appropriate and within scope of practice.
• Participated in the interdisciplinary team consisting of : Physician, Pharmacist, CNA, Social worker and chaplain.
• Managed CNA Team on a daily basis and served as Lead Nurse during call shifts every 3rd weekend.
• Case management includes coordination of care with physician, social work, chaplain services and CNA's.
• Provide Supervision to another RN, LPN, and CNA Provide assistance for families and doctors ICD-9 Coding
• Ensured proper patient care, Established monitoring system, supervised LPN, CNA perform prescribed care plans.
• Provided oversight to CNA staff, ordered medications, and provided medication education to families and patients.
• Worked closely with my team of CNA, Physical Therapist, Occupational Therapist and Social Worker.
• Performed monthly supervisory visits on LPN s and CNA s. Performed peer review chart audits monthly.
• Manage CNA's assignment, get reports from licensed nurses and find replacement for call-ins.
• Supervised CNA'S in the home, LTF or ALF providing direct patient care.
• Case manager for the Waiver/VA/UMWA Special Programs for patient in need of CNA assistance.

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• Directed certified nursing assistants in quality patient hospice care and coordinated with social workers to present additional public resources when applicable.
• Coordinate care among interdisciplinary team including physicians, physical and occupational therapists, social workers, and home health aids
• Work collaboratively with case managers and social workers that assist patient population with housing voucher programs.
• Collaborate effectively with interdisciplinary team to include physicians, social workers, and other support staff.
• Communicated effectively with caregivers, physicians, social workers and the insurance representatives.
• Scheduled and managed external medical consultations with social workers and other necessary personnel.
• Performed disease management coordination of care with therapists and social workers.
• Participate on team of patient/family/physicians/pharmacists/behavioral health and social workers.
• Collaborate with Social Workers to facilitate discharge process.
• Teamed extensively with Social Workers.
• Interacted with Dr's, social workers, chaplain, equipment suppliers, nursing homes, and patients' family members.
• Coordinated care with medical doctors, psychiatrists, psychologist and social workers as part of a multidisciplinary team approach to care.
• Provided ongoing physical, emotional, and spiritual support utilizing the hospice team of aides, chaplains, and social workers.
• Developed goal oriented plans with interdisciplinary teams including primary care physicians, case managers, caregivers, social workers and patients.
• Direct supervision of all patient care, case management of patients, and supervision of therapists, Social Workers and Aides.
• Collaborate with all members of the hospice team including social workers, chaplains, and nursing assistants pertinent to primary patients.
• Collaborate with providers, social workers, Utilization management, behavioral health, medical director to meet the member's needs.
• Work with team which included:Primary MD, Hospice Medical Director, Social workers, Chaplains, and Bereavement Counselor.
• Collaborate with hospice team which consists of physicians, medical directors, nurse managers, social workers, volunteers and chaplains.
• Collaborate with physicians, social workers, chaplains, and home health aides in order to coordinate optimal care for patient.

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• Performed medication management and/or medication administration.
• Perform assessment, develop care plan, medication managements and highlight medical conditions that require physician's attention post hospitalization.
• Serviced adult psychiatric population who required assistance with medication management, diabetic/ wound/ respiratory care and placement of HHA services.
• Provided education and training to Patients and Family members regarding disease management; medication management; and infection control/disease prevention.
• Assess and manage palliative care needs for terminally ill patients Emotional support for patients and families Medication management Pain management
• Perform comprehensive quality management audits of medication management, pain management, care plans and assessments to ensure compliance.
• Educated both participants and their families on individual diagnoses, disease process, medication management and over-all safety.
• Assumed responsibility for medication management and collaborated with physicians, facilities, and families to achieve this.
• Referred to community/military resources, disease management education, medication management, and transitioning through medical board.
• Provided medication management and set-up for patients who could not take their medications properly without assistance.
• Provided medical treatments, medication management, health education, and individual counseling and crisis intervention.
• Performed assessments, disease instruction and review, medication management for adults and elderly population.
• Provided patient and caregiver education which included safe medication management, symptom and pain management.
• Provided individualized patient education on medication management, disease processes, therapeutic diets and treatments.
• Completed physical assessments and medication management of clients and communicated with their physicians as necessary.
• Case management, client advocate, medication management and education, medical equipment management.
• Supervised over medication practices, medication management/set up and provided hands on resident care.
• Provide symptom management through medication management, non-pharmacological interventions, and increased support systems.
• Ensured members received follow up care for medication management by coordinating transportation when necessary.
• Focused on promoting patient independence by instructing on disease process and medication management.

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• Coordinated services, treatment, consultations, medication orders and delivery of Durable Medical Equipment through collaborative services with physicians.
• Performed provider searches, durable medical equipment and transportation coordination, behavioral health referrals and Hospice services.
• Facilitate benefit overrides for medically necessary medications, treatments, transportation services and durable medical equipment.
• Obtained orders for durable medical equipment and facilitated patient attainment of needed equipment.
• Educated patients regarding procedures, diagnosis, new medications and durable medical equipment.
• Implement ordering of new medications and durable medical equipment.
• Make referrals for durable medical equipment and transportation.
• Coordinate ordering durable medical equipment and supplies.
• Managed pharmaceutical and durable medical equipment costs.
• Coordinated care of complex pediatric cases including home care, durable medical equipment, specialty service providers and primary care.
• Synchronized home health care services and durable medical equipment, and provided compassionate care and understanding for distressed members.
• Provided Coordination of Care between Physicians, Nurses, Durable Medical Equipment companies, Therapy, Hospitals, etc.
• Discharge planning to include obtaining home health, durable medical equipment, home IV antibiotics, oxygen, etc.
• Evaluated patient needs for services, durable medical equipment, extension of or concurrent treatment and appropriate discharge.
• Conduct discharge planning screens completed on patients with appropriate home health and durable medical equipment set-up as needed.
• Arranged discharge needs for NICU patients including follow-up appointments, home nursing care services and durable medical equipment.
• Process request for home health care services, durable medical equipment and home infusion using CMS criteria.
• Coordinated resources according to benefit structure, home care and durable medical equipment for safety as needed.
• Assessed patient for durable medical equipment needs prior to discharge, secure order and delivery of items.
• Arranged home health care, transfers to skilled nursing facilities, and delivery of durable medical equipment.

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• Functioned as clinic RN drawing blood, administering immunizations, performing STD exams, and patient education.
• Perform required medical services including drawing blood, insert and remove catheters, and execute tracheostomies and gastrostomies.
• Experienced with the pediatric population especially with calculation of medication and fluid resuscitation, drawing blood and initiating IV access.
• Administer oral, intramuscular, intravenous and subcutaneous medications, Setting up IV infusion and withdrawing blood for investigations.
• Administered medications, managed intravenous lines, drawing blood, communicate with physician and observed patient conditions.
• Used various nursing skills including wound care, medication administration, drawing blood, inserting intravenous catheters, and administering blood.

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• Administered/instructed caregiver on the administration of IV medications via peripheral IV or PICC as ordered.
• Administered intravenous medications and blood products via PICC line and peripherally inserted lines.
• Access IVAD/PICC line for administration of medications/nutrition.
• Performed assessment and evaluation of all systems, medication reconciliation, wound care, and PICC line infusion/Foley catheter management.
• Experienced in complicated Wound Care management, including wound vac and IV therapy through a PICC line delivery system.
• Provide teaching to patients/caregivers prior to going home on IV antibiotics and tube feedings, CVL and PICC care.
• Maintain PICC lines, Central Lines, and Ports and administer IV fluids and infusion therapies per MD orders.
• Have wound care specialist, available for PICC line or Port care and use, medication evaluation and instruction.
• Accessed PICC lines, SQ PORTS for med administration, lab and performed peripheral and central line dressing changes.
• Registered Nurse responsible for admission assessments, PIV and port access, maintaining PICC lines and drawing labs.
• Maintained all types of IVs including peripheral, PICC, Ports, double ports and central lines.
• PORT and PICC line care that requires specialized skills and assuming full responsibility for each of patient.
• Provide IV infusion care, access and maintenance of central lines (PICC lines, Ports)
• Completed referrals and orders for DME, home health, PICC lines and/or wound vac therapies.
• Maintained and managed peripheral IV's, PICC Lines, Central Lines, and Port-a-Cath's.
• Collected lab tests per MD order via peripheral stick, PICC line, and central line.
• Care of PICC lines, Wound-vacs, lab draws medication education and set up.
• Maintained PICC lines along with infusions along with patient and family teachings of infusions.
• Administer IV medications via central lines, PICC lines and peripheral lines per protocol.
• Decrease number of premature births and /PICC admissions for potentially high risk prenatal population.

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• Assessed member and clinical information, collaborated with medical team and community resources to develop comprehensive Care Plans, utilizing CareAdvance.
• Collaborate and facilitate care with other medical management staff, providers, community resources and care-givers to provide additional support.
• Delivered high-quality and compassionate case management to indigent and low-income patient population, providing community resources and collaboration as needed.
• Educated members/families, providers, medical staff and/members/families regarding benefits, disease process, appeals process and community resources.
• Provided referrals to various community resources to include mental health counselors, diabetic education facilities and pharmaceutical assistance programs.
• Provide members with coordination of benefits, community resources, and referral/authorizations to the appropriate medical physician and/or facility.
• Conduct telephonic interviews and assessments to engage members in coordination of services and provide education regarding community resources.
• Direct patient care Wound care Help patient with community resources Communication with physician regarding patient health Oasis C documentation
• Monitor patients' clinical progress and identify potential discharge needs and community resources early in the hospitalization.
• Collaborated with a variety of home care and community resources in initiating and coordinating patient discharge planning.
• Worked collaboratively with physicians and other medical professionals to coordinate patient care utilizing community resources as needed.
• Provided referrals to the appropriate community resources; facilitated access and communication when multiple services are involved.
• Demonstrate expertise in the utilization of all interdisciplinary team members, including volunteers and community resources.
• Informed families and primary caregivers and disease management and recommended community resources for chronically -ill patients.
• Perform discharge planning evaluations to determine continuing care needs and make appropriate referrals to community resources.
• Provide counseling as needed for primary caregivers, finding community resources and support as necessary.
• Prepared and implemented client teaching regarding prevention, disease process management, and community resources.
• Coordinated community resources and programs to provide assistance to patient and family members as applicable.
• Coordinated follow-up care with in network specialists and assessed need for additional community resources.
• Facilitated in finding community resources for members when benefits were non covered or exhausted.

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• Work closely with Pharmacy Consulting Group and Medical Director in managing complicated pain control regimens and other symptom management.
• Utilize basic nursing skills, including nursing assessment, symptom management, patient/caregiver education and documentation.
• Utilized expertise in palliative care and symptom management to assist patients in experiencing a peaceful transition.
• Coordinated medication and dosage changes for immediate symptom management issues with medical director and appropriate pharmacies.
• Managed communication between physicians and families and monitored symptom management to assure patient comfort and dignity.
• Reviewed patient medications for most cost effective while maintaining proper symptom management for each individual patient.
• Collaborated with physician and staff regarding patients status, symptom management and treatment interventions.
• Provided pain and symptom management to assigned clients in collaboration with interdisciplinary team.
• Provided quality end-of-life care for terminally ill patients, including superior symptom management.
• Worked weekends as required for on-call visits to patients/families experiencing symptom management issues.
• Collaborate with the Medical Director and attending physician on pain/symptom management.
• Individualized pain and symptom management customized to individuals needs and preferences.
• Provide individualized symptom management for patients with various diagnoses and symptoms.
• Provided hands-on care including pain and symptom management and education.
• Developed plan of care and performed interventions for symptom management.
• Provide professional pain management and symptom management for hospice patients.
• Facilitate hospital admission when acute symptom management is necessary.
• Initiate appropriate symptom management in collaboration with physicians.
• Anticipate disease progression and implications for symptom management.
• Specialized in pain and symptom management during end-of-life.

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• Assisted 50 clients with managing their medications, including obtaining necessary prescriptions, medication administration, and monitoring side effects.
• Performed initial comprehensive assessment, determined DME requirements, documented medication administration record and obtained admission orders from attending physicians.
• Reviewed medication administration records to ensure that all medication is administered, signed off and documented correctly for assigned participants.
• Possess excellent clinical skills, including intravenous therapy, medication administration, wound care and infusions of multiple medications.
• Educated families and patients on Hospice philosophy, while assessing my patients and overseeing medication administration and/or narcotic needs
• Initiate appropriate preventative and rehabilitative nursing procedures and medication administration as prescribed by the primary care physician.
• Review physician's orders and medication administration records to ascertain that medications/treatments are administered as ordered.
• Performed medication administration, set up and teaching and monitoring of client self-administration of medication.
• Review and edit monthly medication administration records for accuracy and ensure all orders are current.
• Led Resident Assistant medication training program, conducted classes for prospective medication administration delegation.
• Completed daily assessments, medication administration, and maintained safety compliant with state regulations.
• Case Management on site at assisted living facility to include medication administration to patients.
• Monitored vital signs, ensured safety and supported and coordinated medication administration with physicians.
• Manage, and monitor psychotropic medication administration under the supervision of the psychiatrist.
• Provided direct nursing care, medication administration and teaching related to disease process/management.
• Authorized orders, medication administration, coordination of ancillary services and equipment deliveries.
• Provided education to patients and families including end-of-life care and medication administration.
• Performed monitoring, intravenous insertion, dressing changes, and medication administration.
• Trained non-licensed staff in the process of medication administration under He-M1201 regulations.
• Instructed board approved Medication Administration Training Program for qualified Assisted Living staff.

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• Supervised/managed care provided per LPN/HHA per protocol.
• Nurse case manager, educate, train, and supervise PCA / HHAT in accordance with the Department oh Health guidelines.
• Provided wound care, medication set ups, blood draws for labs, and completed supervision visits for the PCA/HHA's.
• Coordinated, oversaw and supervised HHA's to ensure plan of care was followed and quality care was being provided.
• Provide hands on nursing care, supervision of HHA in home, coordination of services with MD and IDG team.
• Home Care RN, responsible for pt care, admissions, all areas of case management and supervisor of HHA staff
• Mobilize and coordinate services of therapists, DME vendors, labs, infusion services and arrange for HHA staff.
• Coordinate patient's care with physical, occupational and speech therapy, HHA, MD, family, etc.
• Conducted monthly supervisory pediatric home care visits, developed relationships with parents and RN/HHA staff for 22-28 cases.
• Improved management skills with HHA care, daily scheduling as warranted, and handling problems as they arise.
• Update HHA plan of care to ensure what the care plan says is actually what the patient needs.
• Develop, implement and supervise the patients plan of care involving nursing, rehab services and HHA services.
• Coordinated with community health nurses (CHN's) and HHA's to improve quality patient care.
• Establish HHA plan of care as well as indirectly and directly supervising the plan of care per regulations
• Supervised HHA's, LPN's and prepared the written instructions for care provided by HHA's.
• Conduct and document supervisory CHHA and LPN every 14 days and complete frequency change forms as needed.
• Assigned and oversaw LPNS and HHAS to each one of my clients as well as doing HHA inspections
• Direct patient care in CHHA including OASIS assessment, skilled interventions, procedures and tests as ordered.
• Direct and indirect of paraprofessionals/ HHA every 60 days to ensure proper completion of delegated tasks.
• Set priorities, manage time efficiently, teach medication and disease process, and supervise CHHA.

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• Educated patients on disease process, disease management, medications, and facilitated optimal level of functioning within disease limitations.
• Facilitated referrals to other health programs available such as Disease Management, Behavioral Health, Pharmacists and Lifestyle Management Programs.
• Advised and educated members on health maintenance and disease management; introduced and integrated process improvement and productivity enhancement strategies.
• Assume primary responsibility for case management, disease management, and utilization management using managed care guidelines and principles.
• Redirected patient to their Primary Medical Home, engaging physicians through collaboration and accountability towards chronic disease management improvement.
• Provide care to patients to facilitate achievement of goal oriented objectives for disease management and prevention of future hospitalization.
• Developed clinical content for the disease management staff to use for educating patients based on national clinical guidelines.
• Develop care plan including disease management teaching, planning, and implementation of plan and evaluating effectiveness.
• Delivered optimal patient/member health care through clinical and behavioral health assessment, triage and chronic disease management.
• Perform telephonic education to patient and patient's family on disease management and provide resources for intervention.
• Provide coordination of services and disease management education to Medicare Advantage members, families and caregivers.
• Examine clinical program eligibility, and disease management programs to assist members to achieve life-long well-being.
• Educated members and families on disease management and prevention and assisted with self-management or lifestyle changes.
• Utilized adaptive communication and teaching methods to educate patients and family members on medication and disease management
• Provided education to clients and caregivers on necessary treatments, medications, and disease management.
• Interacted with patients and their families to effectively provide disease management information and instructions.
• Educate patients and families on medication and disease management to reduce hospital re-admission rates.
• Focused on chronic and acute disease management, promoting patients' independence and self-management.
• Performed telephonic case management from home, including disease management and cost containment.
• Provide education and disease management, medication oversight and management for senior population.

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• Provided primary care services for infants and children in an acute care unit specializing in airway/pulmonary complications.
• Deliver continuity-based primary care services low-income patients.
• Invited by the Department of Veterans Affairs to present a lecture regarding best practices for contracting for primary care services.
• Provide primary care services to patients in an ambulatory health care setting.
• Collaborate with volunteer Physicians, Pharmacists, and Nurse Practitioners to deliver primary care services to underserved Adults and Pediatrics
• Head Nurse Medical / Surgical Hemodialysis RN Outpatient Case Manager Administrative Director for Primary care Services

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• Educated patients/caregivers on disease process management to include self-care techniques, prevention strategies, medications, nutrition and pain management.
• Manage several quality management projects such as wound management/prevention and pain management in order to increase overall quality of care.
• Included symptom and pain management, patient/family education, management/triage of sick calls, coordination of diagnostic tests/procedures.
• Provided assessments and education to patients and family members regarding pain management, disease progression and management.
• Collaborate with Medical Director to provide expertise in pain management of symptoms associated with disease progression.
• Developed Admission Care Plan, administered pain management assessment, and maintained case management records.
• Documented all pertinent information in patient record, including medication dosage and pain management.
• Completed review of medications; assessed pain management and need for health care equipment/technology.
• Provided comprehensive pain management and administered medications in compliance with physician's orders.
• Administered medications and educated patients and families on medications and pain management techniques.
• Experienced in pain management, evaluation and assessment of various medical/surgical issues.
• Developed and implemented pain management care; provided emotional and spiritual support.
• Performed prescribed medical treatments, including pain management and symptom control.
• Advanced knowledge in palliative care: Pain Management and Respiratory/anxiety management.
• Staff education regarding PRN medications and pain management were provided.
• Completed Certification in Advanced Pain Management therapy techniques.
• Recognized as specialist in pain management case management.
• Administered medications and pain management interventions.
• Conducted bereavement counseling, and pain management
• Pain management and comfort/palliative care given.

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• Complete initial and concurrent reviews for commercial and government insurance using appropriate computer integrated software programs and InterQual criteria.
• Perform chart reviews to assess appropriate status for observation or inpatient criteria using InterQual criteria and Medicare Coverage guidelines.
• Utilized McKesson InterQual system for daily utilization review to provide evidence-based clinical decision support.
• Perform utilization management based on applicable patient care protocols based on InterQual criteria.
• Communicated with physicians regarding proper admissions criteria, using InterQual.
• Review patient records using InterQual criteria for appropriateness of admissions.
• Performed utilization management and discharge management according to InterQual criteria.
• Utilized MIDAS and InterQual for electronic documentation and hospital utilization.
• Educated physicians on InterQual Criteria and its application to patient care
• Authorized inpatient and/or outpatient treatment based on InterQual criteria.
• Utilize InterQual Criteria for observation and in-patient admission status.
• Conduct concurrent and retrospective reviews utilizing InterQual criteria.
• Used InterQual criteria to screen patients for appropriate status and met standard of care in accordance with CMS guidelines.
• Based on InterQual Criteria, medical history, and current illness, wrote an appeal or accepted current status.
• Assess and monitor patient's appropriateness for care setting according to LiveSafe and InterQual criteria to be approved.
• Used evidence based decision making and InterQual to improved quality of care and optimum patient outcomes.
• Utilize clinical skills, chart review, physician communication, and InterQual standards for approvals.
• Coordinated discharge, referrals, transfers and inpatient stay in accordance with InterQual criteria.
• Performed InterQual reviews for MediCal patients each day patient was admitted to the hospital.
• Use of InterQual Criteria for Severity of Illness and Intensity of Service.

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• Served in increasing responsible positions for this hospice services company providing home-based, end-of-life care to patients with terminal medical conditions.
• Collaborated with other members of Interdisciplinary Team to develop and implement individualized, comfort-focused plans for end-of-life care.
• Developed individualized plan of care and coordinated optimal end-of-life care for patients.
• Provided collaborative quality end of life care to individuals and families
• Provided patient/family education re: end-of-life care.
• Collaborate with facility, family and hospice team to assist with providing optimal level of comfort during end of life care.
• Educate clients and families on the differences between curative and palliative care, insurance coverage, and medications for end-of-life care.
• Assist patient and family in preparing for end of life, teaching family how to provide proper end of life care.
• Assisted with orientation of new employees and participated in continuous improvement and educational programs about hospice and end of life care.
• Provide End of Life care including home visits to provide emotional support to family and instruct in use of comfort kit.
• Provided skilled nursing care in the patient's home and nursing care facilities with direct regard to end of life care.
• Performed individual and community presentations and education regarding terminal illness, end of life care, and resources or services available.
• Worked in conjunction with hospice care for multiple individuals providing end of life care ensuring full comfort provided with dignity intact.
• Organize and manage all disciplines necessary to provide quality end of life care for terminally ill patients and their families.
• Provide exceptional, quality care and serve as an educator for End of Life Care in patient's own home.
• Focus entirely on end-of-life care to provide hands-on nursing care around the clock in the patient's home or facilities.
• Provide nursing assessment of patient care needs, educate patient and families in end-of-life care and assist in care decisions.
• Manage discomfort and provides symptom relief, and apply specialized nursing skills related to palliative and end of life care.
• Received orders for patient medications, ordered medication refills, provided patient and family education on end of life care.
• Provided palliative/end of life care to patients in their homes, assisted living facilities, and/or long- term care facilities.

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• Performed on-site supervision of assigned staff and provided clinical directions to the LVN to ensure quality and continuity of service provided.
• Admit and discharge patients to services, supervise care delivered by LVN and HHA, and provide needed bedside nursing care.
• Performed case management tasks such as Case conferencing with LVN and home health aide in performing daily care of patients.
• Admitted patients, completed all required Medicare documentation time points, provided nursing care, supervised LVN and nurse aides.
• Coordinate with LVN's, PT/OT and aides to provide optimal patient care to patients in the home setting.
• Provide orientation to new RN, LVN, and HA, supervise and complete annual competency and skills evaluation.
• Provided supervisory visits of LVN on duty, assisted with corrections and maintaining of current plan of care.
• Home visits and supervisory oversight for LVN's and HHA's in home, Hospice and Home Health.
• Instruct, supervise and evaluate LVN and home health aide care as required by federal and/or state regulations.
• Nurse Supervisor, teach and assign other nurses RN's, LVN's and home health aide personnel.
• Case manager conducts supervisory visits of LPN/LVN and CNA/HHA every two weeks in compliance with Medicare Regulations.
• Supervised LVN's and Home Health Aide to ensure patient's plan of care had optimal outcomes.
• Provide oversight and guidance to LVN and other assigned staff in the delivery of quality care.
• Oversee and supervise all LVN's, CNA's, and providers providing care to patients.
• Managed 54 patients and coordinated and implemented care with 10 LVN's and home health aids.
• Supervised and provided clinical directions to the HHA/LVN to ensure quality and continuity of service provided.
• Scheduled activities of RN, LVN, Social Workers, Chaplain and Bereavement and Volunteer Coordinators.
• Supervised home health aids and LVN's providing support and training in related job duties.
• Supervised the care provided by the LVN and home health aids to their assigned patients.
• Participate in interviews for RN's and LVN's and provide input for hiring.

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• Managed an eleven-client caseload with complex medical problems and chronic illness, including diabetes, hypertension, and neurological disorders.
• Collaborated/coordinated with quality improvement and patient education committees to revise clinical management guidelines and program-related policies/procedures to improve Diabetes self-management.
• General assessment and care/case management of Medicare patients including wound care, diabetes, cardiac complications, respiratory treatments.
• Case manager for individuals recently discharged from the hospital as well as individuals having difficulty managing their diabetes.
• Provide clinical education and information for nursing staff related to diabetes patient management and quality of care.
• Developed Diabetes Case Management tracking tool to assist in monitoring progress of patient diabetes self-management.
• Provided ongoing identification and stratification of members with specific diseases such as Asthma and Diabetes.
• Coordinated/implemented patient education programs for Diabetes population exceeding 3,000 patients.
• Implemented and coordinated ongoing staff education program for diabetes.
• Skilled in providing care and education to patients with CHF, diabetes, wounds of various origins and post surgical care.
• Educated members on there medical diagnosis and ways to improve there health, better control there Asthma, CHF or Diabetes.
• Provided holistic nursing care to patients including mental health, wound care, diabetes management and management of multiple co-morbid conditions.
• Provided patient and family education on home infusion of antibiotics, wound cares, diabetes management, and heart failure management.
• Lead of pediatric case management team and assisted in design of disease management programs for diabetes, asthma and hemophilia.
• Provided skilled, intermittent home care services to adults including assessments, wound care, diabetes management and colostomy care.
• Developed community-based Diabetes Prevention, and Diabetes Class Series based on AADE 7, Implemented diabetes protocols for professional team.
• Developed multiples educational programs relating to first aid, CPR, Heart disease, Diabetes, and High blood pressure.
• Provide in home IV therapy, wound care, blood work, catheter changes, diabetes management, etc.
• Provide education to clients on disease management and progression, diabetes prevention and management, nutrition and treatments.
• Provide education to patients on a variety of subjects, including hypertension, diabetes, and cancer screenings.

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• Communicated effectively with facility directors, medical directors, interdisciplinary team, health care providers, insurance companies and vendors.
• Maintain communication with commercial insurance payers, managed Medicare and Medicaid sources and conduct daily clinical updates to insurance companies.
• Provided medical and personal information to insurance companies to obtain authorization for home health or physical and occupational therapy.
• Called insurance companies with mandatory information regarding client's medical criteria for inpatient as well as outpatient hospitalization.
• Participated in daily clinical review provided to various insurance companies and facilitation for peer to peer reviews.
• Communicated with insurance companies to relay pertinent clinical information in order to obtain reimbursements for care rendered.
• Educate physicians on the guidelines utilized by insurance companies regarding severity of illness and intensity of services.
• Complete daily utilization review reports and communicate this information to insurance companies and to hospital administration.
• Provide supervision in office evaluating and acceptance of new patients, obtaining authorization from insurance companies.
• Provided documentation for insurance authorization and communicated with various insurance companies for managed care patients.
• Communicated/coordinated pertinent information with primary care physician, pharmacies and insurance companies that assured payment.
• Worked with insurance companies for authorizations for appropriate discharges and for verification of concurrent stays.
• Performed Utilization Review and ensured payment for services for the facility from Medicare/Medicaid/Insurance companies.
• Provided utilization reviews and information to medical insurance companies, hospitals and other facilities.
• Interact with insurance companies to provide clinical information to obtain authorization for payment.
• Communicated with insurance companies to achieve certification and authorization for patients' stay.
• Remain educated on, and follow special instruction requirements for individual insurance companies.
• Submitted paperwork to regulatory agencies including Medicare, Medicaid and insurance companies.
• Obtained authorization as needed from commercial insurance companies for those patients affected.
• Provided clinical updates to insurance companies to negotiate and determine length-of-stay.

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• Performed frequent patient evaluations including monitoring and tracking vital signs.
• Monitor vital signs and administer medications.
• Complete medication reviews, bi-annual nursing assessments, assess vital signs and provide education to members regarding their medical conditions.
• Assessed vital signs and educated patients on diagnosis, and any problems with medications, diets and, or treatment.
• Perform procedures such as; vital signs, lab work, catheter placement/removal, and wound care per protocol.
• Perform evaluation tasks, including vital signs and medication review Administer medication as prescribed by the patient's Physician.
• Monitored vital signs, recent laboratory value, and administered medication through different routes abiding by the 5 rights.
• Checked/monitored vital signs, mental status, and lab values ensured any changes were reported to physicians as appropriate.
• Home visits conducted with head to toe assessments, vital signs, medication reviews and patient and family teaching.
• Administer medications, injections, blood draws, vital signs, health assessments and hospital discharge planning follow up.
• Make skilled nursing observation of patient status by monitoring and documenting vital signs, blood and urine laboratory values.
• Obtain and verify all consent forms, monitoring vital signs, daily weight, input-output, dietary intake.
• Formulated dialysis plan for ultra filtration, initiated dialysis via various accesses, and monitored patient vital signs.
• Take vital signs, give injections, fill pill boxes, syringes, and perform wound care.
• Performed initial intake, physical assessments, obtained vital signs, past medical histories, and consents.
• Performed head to toe assessments, obtained vital signs, vaccinations, IVs, and wound treatments.
• Administer medication, obtaining vital signs, EKG, UDS, and any required laboratory testing.
• Help doctors administer medications, monitor vital signs and subtle changes in a patient's health.
• Monitored basic vital signs: BP, pulse, temp, O2 saturation and pain levels.
• Home visits to include checking vital signs, collecting labs, checking and caring for wounds.

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• Informed the director of clinical services or patient care coordinator of unusual or potentially problematic patient/family issues.
• Function as care coordinator of the interdisciplinary care team including communication between medical directors and attending physicians.
• Direct patient care-male/female clients ages 21-elderly* Serve as home health care coordinator
• Care Coordinator for BPCI (Bundled Payment for Care Improvement) pilot program contracted with Medicare and JMCGH and CHS hospitals.
• Served in a variety of roles that included, patient care coordinator, responsible for the management of 15-20 hospice patients.
• Worked closely with physicians, radiologists, referral care coordinators and CM at receiving facilities to coordinate appointments and care.
• Coordinated with Interdisciplinary Team (Social Worker, Chaplain, Volunteer Coordinator, Patient Care Coordinator, and others).
• Case manager for the Edmond branch, later Patient Care Coordinator for the Bethany branch until they closed the office.
• Maintained regular communication with the director of clinical services or patient care coordinator and physician to review patient care.
• Coordinate care with a multifaceted team, provider's home health agencies, and inpatient care coordinators.
• Worked with team- social work, nurse practitioner and care coordinators all collaborated for patient care.
• Functioned as a care coordinator, keeping the needs of the patient and organization in mind.
• Collaborated with managed care coordinators to obtain insurance coverage for patients & plan for discharge.
• See above description of Patient Care Coordinator for details as these roles are very similar.
• Oversee team of aide, social worker, spiritual care coordinator, and therapists.
• Lead case manager for special needs account and promote team growth with care coordinators.
• Registered Nurse Care Coordinator, managing the care of clients with disabilities.
• Served as the Care Coordinator of clients in a home environment.
• Communicate with PCP's and care coordinators for good patient outcome.
• Worked in Patient Care Coordinator role in the absence of DOCS.

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• Provided patient care for terminally ill patients including assessments, treatments, administration of medications, education and emotional support.
• Provide oversight and comprehensive care, education and emotional support coordination with interdisciplinary team for end-of-life patients and their families.
• Complete patient assessments, evaluate efficacy of medication regimen, provide education and emotional support to patients and families.
• Offer emotional support and education to patients and families regarding disease progression, medication and treatments available.
• Educated family and patient on end-of-life process and care, offered patient/family emotional support.
• Provide focused education and emotional support regarding identified risk factors on a regular basis.
• Provide family education, emotional support, community referrals, and medication support.
• Provide behavioral/emotional support to the member to encourage independence and healthy lifestyle choices.
• Provide emotional support to family members during expiration process and after patient expiration.
• Provided behavioral/emotional support and supervision for those with severe mental health disorders.
• Provide compassionate care, emotional support and education to patients and families
• Provided information, emotional support and reassurance to patients and relatives.
• Offered and provided emotional support to client/family and facilitated educational goals.
• Provided patients and families with continued education and emotional support.
• Provide spiritual and emotional support as needed to family/patients.
• Provided behavioral/emotional support for those with terminal diagnoses.
• Provided end-of-life nursing care and caregiver emotional support.
• Provided compassionate and emotional support to patients/families.
• Provide emotional support with compassion and understanding.
• Provide emotional support and provide medical advice.

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• Provide consultation/clinical direction regarding physical/primary care issues for integrated IDT clinical care management team.
• Communicate effectively with members of hospice IDT to promote team-centered approach to patient/family care.
• Participate in IDT meetings to certify/re-certify patients for continued care.
• Complete timely reports and communicate effectively with IDT members.
• Communicated with interdisciplinary team and attended IDT meetings.
• Keep in regular communication with members of the IDT ensuring that patient and family needs are met throughout the hospice experience.
• Provide direct care to patients as prescribed by the Interdisciplinary Team (IDT), assuming primary responsibility for case management.
• Work closely with members of IDT, including physicians and provide direct patient care in the home and in nursing facilities.
• Develop and update care plans following each plan of care change and identify any need for intervention of other IDT members.
• Collaborate with IDT to coordinate hospice care for patient and family to ensure appropriateness, continuity, and quality of care.
• Communicate with IDT, Medical Director and Attending Physician regarding measures to alleviate symptoms, and monitor response to measures implemented.
• Provided efficient updates and patient consultation reviews for IDT staff members and supervisory disciplines also assigned to specific patient care team.
• Assessed, monitored changes and conditions of clients, and provided communication between medical professionals, families, providers and IDT.
• Participate in IDT meetings and work with the team to assist in determining patient and family care plan and needs.
• Help patient and families, through end of life, by managing any uncomfortable symptoms in conjunction with the IDT.
• Attended IDT meetings every two weeks with the Interdisciplinary Team to discuss each patients case and make changes accordingly.
• Performed IDT meetings every 2 weeks and reputed changes in comfort, symptoms, goal attainment to Medical Director.
• Team approach with PT/OT/ST/Wound Care RN/PCP/Specialist as well as co-workers, management and Director/Medical Director and participated in IDT.
• Attend IDT meetings to discuss, plan and evaluate efficacy of current POC, medication regime and symptom management.
• Develop, coordinate and direct hospice nursing care according to the Interdisciplinary Team (IDT) plan of care.

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• Performed prospective, concurrent and retrospective review of inpatient medical records and outpatient authorization requests with application of approved criteria.
• Assessed federal employee members and reviewed medical records to determine eligibility for benefits as well as extension of benefits.
• Reviewed medical records for quality issues, assessed patient status for undocumented quality concerns, and tracked multiple re-admissions.
• Review medical records for authorization of inpatient hospital, skilled nursing facility or swing bed admissions.
• Detailed assessments, care planning, working together with interdisciplinary team, maintain electronic medical records.
• Reviewed medical records and completed comprehensive reports outlining recommendations and contingency plans on a case-by-case basis.
• Review Medical Records to identify potential unnecessary services or care delivery setting and recommend alternatives.
• Complete pa electronic medical records, member assessment documentation, and continuing member progress summaries.
• Generate quality analysis reports on a monthly basis and auditing nurse documentation for medical records.
• Reviewed medical records daily for medical necessity for both Medicare and managed care patients.
• Contributed substantially to medical records and QA/QI department with weekly review of nursing documentation.
• Review of medical records for proper utilization of military benefits and continuation of care.
• Conducted regular medical records review/audits to assure quality measures were being followed and maintained.
• Make decisions regarding approval/denial of claims based on medical records and Official Disability Guidelines.
• Complete and draft reports and entry of medical information into electronic medical records.
• Reviewed medical Records for quality improvement and developed plans based on findings.
• Analyzed, evaluated and interpreted medical records for disability and workers compensation.
• Maintained extensive documentation of patient medical records in accordance with Medicare regulations.
• Reviewed medical records for compliance with company policies and federal regulations.
• Audited medical records for compliance of medical integrity and Quality Improvement.

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• Presented in-service training on Diabetes/CHF/A-fib/COPD/ESRD management.
• Provided nursing care for patients with diagnosis including: Dementia/Alzheimer, Cancer (various), COPD, and many others.
• Helped patients rehabilitate from stroke or surgery; managed chronic conditions such as diabetes, heart disease, COPD and arthritis.
• Position required competency in verbalizing and demonstrated understanding of diabetes, asthma, COPD, CAD, and CHF disease processes.
• Cared for a variety of patients with skilled needs including wound care, CHF/COPD/Diabetic management, post-surgical and psychiatric conditions.
• Direct experience with patients dealing with the following clinical issues, COPD, Asthma, CAD, CHF and Diabetes.
• Managed clients with chronic illnesses such as Diabetes, CHF, COPD, Heart Disease, Kidney Disease and Arthritis.
• Direct care for patients suffering from CHF, COPD, Diabetes, and Orthopedic Medical conditions in their homes.
• Work with providers to institute educational programs for patients with chronic diseases such as diabetes, hypertension and COPD.
• Assisted patients with multiple chronic diagnosis including COPD, Asthma, CHF, CVA, and Renal failure.
• Provide assistance with medication set up, review of systems, anticoagulant therapy, COPD and other diagnosis.
• Coordinated care for patients with multiple chronic diagnoses, including COPD, Heart Failure, DM and CVA.
• Assist patients with multiple chronic diseases including COPD, CHF, Diabetes, cancer, and dementia.
• Experience with various medical conditions including Parkinson's, dementia, kidney failure, COPD and cancer.
• Provided education to clients and family in the home setting about their diseases, e.g.CHF, COPD.
• Educated patients and caregiver information related to their condition (diabetes, COPD, cardiac).
• Assisted patients with COPD, asthma, heart disease, stroke, hypertension and diabetes.
• Provide disease management education for special needs population (CHF, DM, COPD).
• Educated patients and families with multiple chronic diagnoses including COPD, Diabetes, and CHF.
• Assisted patient's with multiple chronic diagnoses, including COPD, CHF, etc.

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• Applied Inter-Qual Criteria to perform initial, concurrent and retrospective chart reviews for clinical appropriateness, medical necessity and treatment.
• Evaluate new admissions for medical necessity using approved criteria for medical necessity determination and appropriateness of level of care.
• Follow observation patients daily to determine medical necessity and educate physicians using criteria that would warrant an inpatient status.
• Performed daily chart reviews to ensure medical necessity and compliance with governmental regulations and industry standards of performance.
• Review of Private Duty Nursing request for Medical Necessity, following company policy/procedure of approving or denying request.
• Contributed to the development of medical necessity guidelines by participating in both Commercial and Medicare clinical coverage committee.
• Evaluate Consult physician advisers to determine the medical necessity and appropriateness of treatment plan goals and objectives.
• Collaborated with physicians and made recommendation regarding medical necessity for admission, continue stay or alternative treatment.
• Managed daily caseload of request for coverage defined as clinically complex with the THP Medical Necessity Guidelines.
• Utilized MCG and InterQual criteria for determining medical necessity, and appealing denied decisions from insurance providers.
• Generate authorizations and Case management services while determining eligibility and medical necessity of requested health care services.
• Perform a comprehensive review of retrospective treatment and documentation to make an appropriate medical necessity decisions.
• Performed clinical data/ record review to support medical necessity for the above listed specific outpatient services.
• Assess for medical necessity & appropriateness of admissions/ treatments by utilizing InterQual criteria using a multidisciplinary approach
• Ascertain that admissions meet criteria for appropriateness of care and medical necessity through utilization review.
• Performed daily concurrent reviews UM assessed benefit eligibility, medical necessity and level of care.
• Worked consistently with nursing staff and medical director to determine medical necessity for inpatient care.
• Review for medical necessity/prior authorization with coding specifics based on clinical information from active providers.
• Prepare referrals not meeting medical necessity or plan language for Medical Director review as appropriate.
• Referred provider requests to Medical Director when medical necessity is not met based on criteria

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• Coordinated placement of discharged patients by interacting with top HMO and service provider officials to ensure continuation of quality medical care.
• Delegated assignments to and established good working relationships with two licensed practical nurses in order to coordinate quality medical care.
• Coordinate patient care with medical care provider, physical therapy, occupational therapy and medical social worker.
• Established medical care for clients with behavioral health and co-occurring disorders while working within an interdisciplinary team.
• Develop and implement cost savings strategies that maintain high-quality medical care while ensuring favorable treatment outcomes.
• Performed prospective, concurrent, and retrospective reviews to justify medical necessity for requested medical care.
• Case management responsibilities including coordination of medical care and other applicable services based on individual needs.
• Assisted patients with treatment and coordinated medical care with outside facilities, including rehabilitation centers.
• Coordinate the comprehensive medical care for approximately 300 patients with chronic hematological diseases.
• Provided insurance company adjusters with information on necessity of home medical care.
• Conducted investigations or reviews into complaints regarding the delivery of medical care.
• Utilized clinical expertise in direct medical care of terminally ill patients.
• Review medical treatment to prevent against unnecessary and inappropriate medical care.
• Coordinate and arrange medical care services for medically complex hospital patients.
• Manage medical care of approximately 60 people with developmental disabilities.
• Specialized in medical care coordination of catastrophic injured employees.
• Devised cost-effective and medically necessary strategies for medical care.
• Coordinated medical care and facilitated timely return to work.
• Coordinate medical care with physical and occupational therapists.
• Managed medical care for medically fragile individuals.

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• Obtained appropriate insurance authorization, physician orders and completed OASIS assessments and concurrent documentation in timely, complete and accurate manor.
• Collaborate care between physicians emphasizing continuity of care and communication by initiating physician orders correctly and timely.
• Complete prior authorizations, obtaining signed physician orders and accompanying paperwork necessary for PA approval.
• Reported findings to attending physician and admitted to hospice according to physician orders.
• Conduct client admission assessments and obtain physician orders for medications and medical treatments.
• Direct line of communication with patient physicians and implemented physician orders.
• Performed wound care and obtained laboratory specimens as per physician orders.
• Obtained and executed physician orders based on nursing assessment.
• Document electronically all physician orders and OASIS documentation.
• Received referrals and obtained physician orders as needed.
• Provide constant monitoring of physician orders and implementation.
• Administer medications according to Physician orders.
• Provided hands-on care, management and evaluation of the care plan, and educated the patient in accordance with physician orders.
• Admit patients and confer with the physician in developing the plan of care based on physician orders and initial nursing assessment.
• Provided direct nursing care per physician orders such as TPN, IV Therapy, injections, patient education, and documentation.
• Identified patient's home care needs, obtained and directed physician orders toward home care, and obtained Insurance authorizations.
• Devised individualized patient nursing plan of care that corresponded with patient health care needs, personal goals and physician orders.
• Follow up with members on a regular basis to insure appropriate follow up with appointments, testing, physician orders.
• Plan, provide, supervise and document competent hospice nursing care for patients in accordance with physician orders.
• Complete nursing assessments, creates plans of care, and carries out care to patients per physician orders.

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• Skilled Nursing Services: Wounds including wound VAC, Vital Signs, Management of CHF, DM, Liver disease.
• Served on the CHF committee at UVM@CVPH to provide outside community information to the hospital.
• Lead clinical staff for institution of CHF PROTOCOL, TAVR Protocol for San Antonio Cardiology.
• Provided wound care, CHF and cardiac monitoring, urinary catheter care, various drains.
• Developed order/goals for HCP computer documentation for CHF PROTOCOL, TAVR PROTOCOL AND PLEURIX DRAINS
• Discharge Planning; Utilization review; Quality Manager over CHF and AMI Core Measures.
• Performed Core Measures for PNA, AMI and CHF to assist with performance improvement.
• Collected data for MI, CHF, and Pneumonia core measures as needed.
• Provided services to patients with the following: Wound care, CHF education.
• Participated in Ethics Committee and CHF core Measure Committee for outcomes.
• Monitored patients after post discharge from hospital with diagnosis of CHF.
• Case Manager for CHF and Renal floors.
• Instructed staff re documentation of Chf, pain levels, and correct documentation of blood sugars and diabetic teaching.
• Interview CHF patients readmitted within 30 days in order to better manage future care and hopefully prevent/decrease readmissions.
• Provide patients with education of Diagnosis such as CHF and medication compliance to prevent readmissions to hospital.
• Cared for patients with CHF, cancer, Alzheimers, and a variety of other disease states
• Installed and monitored Telehealth System in conjunction with CHF program.
• Case managing patients with wounds, joint replacements, ostomies, post-CABG patients, CHF, PICC lines, etc.
• Keep level of stay down, insurances, Eqhealth, core measures for CHF, Ml, and Pneumonia
• Assisted in developing chf teleheAlth program.

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• Provided direction to licensed and non-licensed staff members in activities necessary to provide quality patient care and services.
• Identified potential risks for re-hospitalizations and facilitated resolution of issues through communication with physicians and senior staff members.
• Named by several facility staff members and family members for providing exceptional nursing care.
• Developed/maintained rapport with patients, families, interdisciplinary team and facility staff members.
• Supervised licensed and paraprofessional staff members and coordinated all care delivery.
• Participated in Interdisciplinary Team Meetings with other hospice staff members.
• Trained and provided preceptor interventions to staff members during orientation.
• Transitioned staff members from written to electronic medical documentation.
• Improved communication between staff members.
• Gained Leadership skills through supervision of approximately 25 staff members, including CNA's, LPN's, and RN's.
• Educated patients, families, and staff members to the special needs of the dying patients and provided support to all.
• Maintained up-to-date patient records, while communicating regularly with attending physicians, the hospice medical director, and hospice staff members.
• Conduct crisis intervention, problem solving and education of patient's families and facility staff members caring for dying patients.
• Coordinate & collaborate with physician and other staff members to ensure the highest quality outcomes through the care delivery process.
• Based upon the plans they develop coordinators then work with all staff members to ensure the plan is implemented correctly.
• Modify patient care when needed and collaborate with hospice medical director, attending physician and other pertinent staff members.
• Worked effectively with physicians and nursing staff and assisted in the training of student nurses and new staff members.
• Initiated communication with attending physicians, other hospice staff members and referring agencies as needed to coordinate optimal care.
• Communicate with vendors, veterans, doctors, Health Net and other staff members on a daily basis.
• Maintained up to date computerized records and communicated with physicians and other hospice staff members and other agencies.

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• Full final visits completed, pronounce death as needed and handle family coping and bereavement in conjunction with MSW and SC.
• Provide ongoing assessments and oversee PT, OT, HHA, Speech and MSW to assure individuals needs are being met.
• Assess home situation and environments and determine need for the necessary disciplines, i.e., MSW, HHA, Physical Therapy.
• Visit frequency and visit plotting, referral to disciplines including PT, OT, ST, MSW and Home Health Aid.
• Collaborate with M.D., Pharmacy, MSW, Chaplin, and Coroner during process of death and dying of hospice patients.
• Work on a team with a physician, MSW, chaplain and therapies to provide the best care for patients.
• Coordinated care with other members of the care team including Physical Therapy, Occupational Therapy, MD and MSW.
• Work in team setting to include LPN's, Physical/Occupation Health, MSW, Pastor and Home Health Aids.
• Refer patient to other interdisciplinary team such as MSW, PT, OT, Psych nurse, etc.
• Participated in the development and presentation at the Annual Convention of HPNA and AAHPM with Physicians and MSW.
• Conduct and collaborate with MSW home, hospital, SNF and health care center visits when needed.
• Case Management, including referral to PT, OT, ST, MSW and HHA as indicated.
• Request additional involvement of PT, OT, MSW, HHA, based on assessed needs.
• Collaborate with the primary care team of MD, MSW, chaplain, and clinic manager.
• Provide extended support to those families in need and direct them to MSW for further support.
• Worked closely with other disciplinary such as, MSW, PT, OT and speech therapies.
• Participated in discussion on patient's needs with MSW, hospice chaplain, CNA and volunteers.
• Worked with an inter-disciplinary team consisting of PT/OT/ST/MSW to improve quality of life of patients.
• Referred patient's requiring specialized skills to PT, ST, OT and MSW.
• Collaborate care of patients with physical, occupational therapist, MSW, and physicians.

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• Intervene as necessary according to the developed POC and contact appropriate medical professionals in emergency situations.
• Develop and implement an individualized POC in collaboration with the physician and other disciplines.
• Prepared bimonthly patient care summaries/updates and participated in team conferences regarding patient's POC.
• Experienced with computer medical documentation in POC system.
• Managed patient plan of care (POC) including family/care giver instruction, patient assessments, evaluations, and safety issues.
• Perform nursing assessments, formulate POC for each patient, coordinate patient care, and carry out medical regimens ordered by physicians
• Develop and implement individual patient POC, acts as patient advocate while working in collaboration with all patient care team.
• Conducted and documented assessments, evaluations and other related forms, as well as verbal orders and changes in POC.
• Comply with POC and assessment and reassessment of patients' needs and continuity of services by appropriate health care personnel.
• Assess patient condition to identify additional services needed and prepare a plan of care (POC) form listing treatments.
• Develop a POC that corresponds with the physicians orders through assessment of patient's needs, condition, and environment.
• Participated in weekly case conferences, (IDG) with input into POC for all patient's on service.
• Collaborate with IDG to ensure that POC is appropriate for patients and that patients maintain optimal quality of life.
• Work closely with interdisciplinary team to develop, implement, and review the plan of care (POC).
• Manage the POC of terminally ill patients in assisted living, long term care facility, and home settings.
• Developed and updated care plans following each POC change and ensures updates are made from the psycho-social staff.
• Teach patient and family necessary treatments, procedure, medication regimen, and comfort measures according to POC.
• Direct supervision of LPN's as well as HHA's and homemakers that are part of the POC.
• Contributed to Palliative Care conferences, assisted in conducting groups meetings, and established individual and POC goals.
• Established POC's with family and physicians, monitoring, assessing, documenting changes in health status.

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• Provide clinical oversight for hospitalized patients to determine appropriate level of care and medical necessity of admissions and continued stays.
• Performed initial and concurrent reviews on medical and surgical inpatients to determine medical necessity and appropriate level of care.
• Conduct initial and concurrent review to assist in medical necessity determination and appropriate level of care.
• Determine appropriate level of care and utilization of services while ensuring quality cost effectiveness of services.
• Collaborate with Physicians in determining appropriate level of care for patients not meeting inpatient criteria.
• Obtained authorization for post-hospital care at appropriate level to ensure continuity and maximize patient outcomes.
• Perform utilization reviews to ensure appropriate levels of care appropriate reimbursement of services
• Develop Patient Specific Plan of Care-Determine Appropriate Level of Care-Coordinate/Consult Physicians and Clinicians
• Identified appropriate level of care utilizing clinical and personal expertise.
• Assess then identify their needs and provide information and assistance regarding the appropriate level and type of services for that need.
• Worked closely with physicians to determine appropriate level of care and services based on patient needs as well as financial impact.
• Apply specific criteria for admission and re-certification to hospice care to establish appropriate levels of care and the patient's eligibility.
• Collaborated with physician, family, and patient in planning care and ensuring safe discharge to appropriate level of care.
• Utilize InterQual criteria to ensure that patients meet the appropriate level of care for admission, stay, and discharge.
• Assist with the discharge planning process with hospital and/or other appropriate level of care staff by ensuring adequate and appropriate.
• Provided transition of patients to appropriate levels of care coordinating services in order to meet the needs of the member.
• Developed, initiate, and coordinate individual patient case management plans to ensure appropriate level of care across the continuum.
• Reviewed member's severity of illness vs intensity of services using InterQual criteria to determine the appropriate level of care.
• Collaborated with physicians and the care team to ensure patients were receiving the appropriate level and quality of care.
• Review patient status, educate patient on self management and ensure appropriate levels of post care education are provided.

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• Completed all required documentation according to VC policy, procedures and guidelines; participated in monthly chart audits and documentation review.
• Performed regular chart audits to determine appropriateness of care and staff compliance with documentation regulatory requirements, i.e.
• Performed chart audits for appropriateness of care and for compliance with Medicare/Medicaid and other third-party reimbursements.
• Participate in Quality Assurance Program, including chart audits and quarterly reporting to management team/corporate offices.
• Participated in Performance Improvement and Quality Assurance activities as required, including frequent chart audits.
• Maintain patient records and participate in chart audits and other quality improvement activities.
• Performed chart audits and collected/analyzed data to promote accurate patient education and assessment.
• Performed chart audits to ensure Medicare/Medicaid and other third-party reimbursement relativity and compliance.
• Conducted quality management chart audits for the quality management department.
• Chart audits for compliance with CMS/Medicare/Medicaid regulatory standards.
• Perform chart audits for appropriate and timely documentation.
• Conducted annual RN physical assessments/Chart audits
• Performed and participated in quarterly chart audits, monthly UM meetings, weekly complex care meetings and weekly physician meetings.
• Worked closely with the DON to perform chart audits and to implement processes that will help improve out comes.
• Assist In-Office with chart audits, supervisory roles, coding for billing, following-up with MD communication and orders.
• Perform chart audits and site reviews of providers and candidates requesting to be credentialed for the IBS panel.
• Chart audits, ensured proper coding and scoring of OASIS in order to be paid correctly by CMS.
• Conduct chart audits, make quarterly reports on patient diagnosis based criteria for cooperation in patient care.
• Performed daily chart audits for core measures, blood transfusions, and other various quality improvement areas.
• Performed all required chart audits for accuracy, performed, quarterly reviews for compliance and clinical quality.

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• Performed skills consistent with agency/procedure/protocol.
• Provide assistance to severely injured military members and veterans transitioning from Department of Defense to Department of Veterans Affairs medical facilities.
• Facilitate authorizations of care as appropriate within the members benefit structure, utilizing appropriate medical policy and MCG approval criteria.
• Maintain all required documentation in the appropriate electronic systems on a timely basis, per established policy and procedure.
• Provided education to physician and staff regarding the case management role and documentation requirements in accordance with regulatory agencies.
• Authorize medical treatment and associated diagnostic testing on assigned claims as allowed by state or policy jurisdictions.
• Collaborated and coordinated patient medical services with Primary Care Physicians, Behavioral Health, specialist and vendors.
• Manage large case-loads in a fast-paced consistently changing environment while utilizing clinical expertise and excellent nursing judgment.
• Worked independently and exhibited strong leadership qualities by producing excellent results efficiently without outside direction or management.
• Worked in a self-directed environment and demonstrated the ability to work with minimal supervision.
• Maintain appropriate documentation accordance to organization, state and federal compliance rules and regulation.
• Developed relationships with hospital staff to ensure appropriate management of the injured employee.
• Coordinated admissions and referrals for patients requiring long- term care and additional assistance.
• Develop strong community relations through networking and liaison representation with referral agencies.
• Administer medications, prepare equipment and assist during examinations and treatments.
• Sound ethical and independent decision making ability consistent with medical protocols.
• Coordinated episodic care to eliminate unnecessary cost and ensured optimal outcomes.
• Completed 24 hour post hospital discharge telephonic calls with medication reconciliation.
• Facilitated monthly staff meetings, communicating changes in protocol and procedures.
• Assisted clients to obtain discounted medications through participating drug companies.

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• Prepared regulatory MDS 2.0 and Developed comprehensive care plan with coordination of multidisciplinary team.
• Serve as educational resource for MDS eligibility and other administrative issues.
• Completed Comprehensive Fall assessment and Safety Risk Data Collection for MDS
• Completed MDS assessments/interviews, input patient information utilizing RCS programs.
• Assumed additional responsibilities as assigned by supervisor.MDS certified,
• Fulfilled the role of MDS Coordinator/Case Manager, with the responsibility of maximizing reimbursement, maintaining schedules and submissions.
• Complete MDS-HC and submit via the Virtual Gateway per department process to ensure appropriate rating category is achieved.
• Utilize MDS 3.0 process in conjunction with the RAI process to formulate care plan specific to resident.
• Schedule all MDS and review all Residents and records for changes and make recommendations for resident needs.
• Developed plan of care for residents based on assessments conducted and needs identified through the MDS process.
• Performed assessments using MDS 2.0 and developed care plans for skilled and intermediate patient population.
• Completed the MDS, led the care plan team, contact person for family members.
• Participated when needed with MDS audits and substituted for MDS Coordinator at PPS meetings.
• Maintained current MDS status of each resident per OBRA/Medicare PPS federal and state guidelines.
• Performed MDS Assessments for reimbursement purposes in a 113 bed Long Term Care facility.
• Coordinate completion of MDS sheet for swing bed patients, and submission to CMS.
• Conduct and coordinate the development and completion of the resident assessment (MDS).
• Examine and validate MDS data prior to transmission to US Federal regulators.
• Gather all pertinent information that was needed to complete the MDS process.
• Transmit MDS assessments through CMS to be transmitted to TMHP for approval.

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• Perform intake assessments on potential patients and coordinate admission with hospice medical director and primary care physicians as needed.
• Conducted intake assessments through interviews with patients and relatives to gather case history, plans and provides nursing care for patient.
• Provided weekly reports, assisted with Intake assessments, Hospice admissions, and weekly staff education and case conference meetings.
• Offer intake assessments for newly diagnosed, transferring care, post incarceration and those lost to care.
• Performed client intake assessments, developed plan of care including medical interventions and measurable goals or outcomes.
• Conduct in home intake assessments, reassessments for authorizations, post hospital assessments, and incidents.
• Served as the intake nurse as needed and performed intake assessments on prospective patients.
• Performed intake assessments, developed plans of care for individual clients.
• Complete HIV Intake Assessments, Acuity Scale and TART Assessments.
• Perform head to toe intake assessments and Oasis charting.
• Performed initial and ongoing client intake assessments.
• Complete initial comprehensive intake assessments, weekly assessments, and recertification documentation on an ongoing basis.
• Completed intake assessments with patients and drafted community re-entry plans following treatment.
• Reviewed and entered new admission intake assessments utilizing Interqual criteria.

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