Case Management Manager
Resume:
Jennifer L. Francis, ARN, MSN, ANP
Somerset, MA 02726
ad362f@r.postjobfree.com
OBJECTIVE
EDUCATION
Boston College, Connell School of Nursing
Chestnut Hill, MA
• M.S.N. Pediatric Nurse Practitioner May, 2004
• P.N.C.B. Certification October, 2004 to present
• *Magna Cum Laude* G.P.A.= 3.84
University of Rhode Island
Kingston, RI
• B.S.N. University of Rhode Island January, 2000
• Highest Distinction G.P.A.= 3.87
Case Management Recognition
• Boston Globe 2021 Award for Best Case Manager
WORK EXPERIENCE
07/2022 –Current Director of Nursing Case Management and Care Coordination
• Oversee CM and SW to ensure safe discharges
• Ensure Quality and Policy Regulations are followed for the Department. Develop or update policies
• Responsible for the regulatory agencies for my Department during their audits
• Responsible for Utilization Reviews to ensure proper reimbursement
• Follow all patients clinical course and discuss discharge planning with an Interdisciplinary Team, weekly and as needed.
• Run meetings related to my department and participate in other meetings, as requested.
• Patient and/or family advocate
• Work with Legal on Conservatorship and Guardianship needs To obtain a position as a Director of Case Manager and Utilization Review New England Sinai
• Report directly to the President of the Hospital and work closely with the CFO
• Lead my direct reports and counsel when needed. Provide Mid/Annual Reviews.
09/2017-08/2018 Maxim Healthcare Staffing Solutions: Nursing Travel Agency Maxim Healthcare Staffing Solutions: Travel Case Management Boston Medical Center 01/18-08/2018
Boston Medical Center 08/2018-1/2021 Case Management (permanent)
• Using my clinical knowledge base to accurately assess patients’ history and medical records, to appropriately identify and use Interqual Criteria in the setting of multiple complex and diverse diagnosis’
• Actively participating in clinical disposition/discharge rounds in a collaborative fashion to obtain proper treatment goals and ultimately carry out the most appropriate individualized treatment plan
• Continued work on complex discharge/dispositions for the various patient populations that BMC cares for on a daily basis, in order to reach the most favorable outcome for each patient, while trying to maintain the most cost effective route for the hospital. This intention exists as a goal, so the hospital can continue to provide free care to those who have no other options and who have great medical needs
• Expertise regarding the ability to understand how payer systems work, thereby understanding how hospital reimbursement occurs
• Providing respectful and consistent patient and family contact when determining treatment plans and discharge planning
• Excellent organizational skills related to working in a dynamic environment
• Knowledge of Medicare rules and regulations involving patient hospital stays and services that are covered out in the community
• Overall knowledge of Federal and Mass regulations in reference to the admission and discharge process during hospital stays
• Continued extensive experience with computer skills including: Word, Excel, Microsoft Outlook, Power Point, Interqual, Epic, Allscript, and data gathering on a regular basis. Super User for Qventus and Epic.
• Able to move large volumes of patients who require rehab placement or home services
• Continued expertise in discharge planning, providing proper resources as appropriate, and utilization review, as it relates to case management
• Able to connect with referral resources as treatment plans are developed for patients
• Assigned to be part of specialized projects in an effort to improve work flow and safely decrease length of stay.
• Chosen to be part of the on-boarding process by interviewing potential case managers, which was followed by a discussion with senior leadership.
• Precepting and mentoring-as requested. Team player.
• Ability to provide exceptional work, in an autonomous atmosphere, using my many years of clinical experience to guide me. However, I can work in a collaborative environment on difficult cases, when appropriate. Maxim Healthcare Staffing Solutions:
Rhode Island Hospital 09/17-12/18/17 Utilization Review Position
• Responsible for coordinating continuum of care for assigned patients and ensuring utilization of resources, service delivery, and compliance with the medical team
• Document patient information in Interqual (very versed in the use of Interqual)
• Collaboration with the multidisciplinary teams and patients, along with their family’s to ensure the safest discharge.
• Ensures that patient’s medical needs are addressed and advocating for patient when necessary.
• Participates in Quality Assurance, as need
• Participate in insurance reviews and at the appropriate times, as for Pear to Pear Reviews
• Adept in EPIC, Allscripts, and many other programs
• Maintain accurate and timely patient information, which is readily acceptable for review and meets all requirements; assists in data collection for reporting/and funding sources.
• Follows State/Country mandated guidelines for the nurse care management programs
• Fosters intra-facility and inter-facility working relationships to help accomplish goals; act as a liaison between primary care providers, specialist, and/or patient
• Much experience in both utilization review and case management. 05/16-9/17
TRANSITIONAL WORK EXPERIENCE: Employee Health and Occupational Services
• Perform Pre-Employment Screening
• Draw blood work and give appropriate immunizations
• Physical Assessments as needed depending on Pre-Employment screening
• Blood and Body Fluid Protocol
• Allow injured employees to return to work following proper protocol
• Implement different projects to keep employees up to date on TB and immunization rules and regulations
03/15-09/17
Beth Israel Deaconess Medical Center Case Management: Emergency Department
• Investigated patient history, symptoms, clinical status, and treatment using Interqual ISD criteria as a tool to determine the severity of a patient’s illness and intensity of service
• Utilization Review experience and efficiency
• Worked with the multidisciplinary team when developing treatment plans, including contingency plans
• Collaboration with physicians when determining the best discharge course
• Providing the necessary information to appropriate organizations, such as DME companies and rehabilitation facilities.
• Referral to social work, patient advocacy, financial services, and quality management as needed.
• Having an excellent understanding of many different adult illness’, from mild acuity to severe acuity, which directly correlates to working in the emergency department.
• Providing respectful and consistent patient and family contact when determining treatment plans and discharge planning
• Excellent organizational skills related to working in a dynamic environment
• Knowledge of Medicare rules and regulations involving patient hospital stays and services that are covered out in the community
• Overall knowledge of Federal and Mass regulations in reference to the admission and discharge process during hospital stay
• Continued extensive experience with computer skills including: Word, Excel, Microsoft Outlook, and data gathering on a regular basis.
• Able to move large volumes of patients who require rehab placement or home services
07/11-02/15
PSA Home Health Care Nurse Case Manager/Staff Educator
• Responsible for supervising/evaluating over 700 + Registered Nurses, LPN’s, and CHHA. This includes hiring, performance evaluations, and terminations. Overseeing in-office staff: including scheduling coordinators for patients/nurses and the billing department
• In charge of assessing patients (Adult & Pedi), for an initial evaluation/intake along with teaching staff how to complete this, as well. This determines the needs of the patients and/or caregivers and history of illnesses, which allows the Case Manger to implement the appropriate services.
• Supervising patient care and families/caregivers needs and concerns with a large case load of 80 + patients
• In charge of completing my own, in addition to teaching staff, how to complete 485’s/Plan of Care- signed by physicians, Oasis’, and assessing/advocating for hours needed for patients through insurance companies (Primarily Medicaid, Medicare, and Private Insurance/Third Party.)
• Overseeing physician orders are current and signed for both myself and staff, as patient’s needs change, and advocating for such needs via contact with appropriate physicians respectively
• In close contact with families/caregivers, as well as nursing, for each of my assigned cases
• In charge of handling my own discharge or recertification of patients and also the staff patients as needed, through teaching continued assessment of needs, and correlating discharges /recertification with appropriate physicians, when goals have been met or need to be continued.
• Teaching RN’s and LPN’s with hands on evaluation/testing of tracheostomy, IV/TPN, G-tubes, and Ventilators. The evaluation methods include: written testing and physical demonstration. The demonstration piece includes nurses working with a specialized “mannequin” made for trachs, central lines/IV and g- tube teaching. Emergent scenarios taught. Also, there is a ventilator to teach and have return demos on. Also, teaching how to complete written oasis’ and 485’s which were computerized. Proper nursing notation was taught as well.
• Experience and clinical skills remain updated with trach’s, vents, g/j-tubes, central lines, IV’s, and TPN. I also took on call triage for nurses regarding all patients under the care of PSA.
• Extensive experience with computer skills including Word, Excel, Microsoft Outlook, and data gathering on a regular basis.
• Knowledge of Federal and Mass State regulations as it pertains to home care compliance excellent organizational skills while working in a fast patient environment.
01/11-04/11 Clinical Faculty of Maternal Child Health University of Rhode Island
Kingston, Rhode Island
• Responsible for supervising and teaching applications of Maternal and Child Health Nursing to a clinical group of 6 or more undergraduate students at Charlton Memorial Hospital
11/04 – 11/10 Pediatric Nurse Practitioner, M.S.N
Women and Infants Hospital
Providence, Rhode Island
• Responsible for applying all aspects of neonatal health care to infants admitted to the unit. This includes, but not limited to, the diagnosis and day to day management of neonatal patients in the Intensive Care Unit.
• writing orders: lab, x-ray, other studies/consultation as needed
• procedures: umbilical, percutaneous, radial lines; lumbar punctures; chest tubes; bladder taps
• assessments/notes: assess patients daily and writing daily notes
• developing plans: development of plans for neonates on rounds with interdisciplinary team including doctors, RNs, nutritionists, social workers, and respiratory therapists
• update parents on day to day changes on their neonate’s plan of care
• Managed multiple pre-post op surgical patients, along with Surgical Service Team, including but not limited to: neurological; cardiac, genetic deformities, and GI.
09/07-12/07
University of Rhode Island
Kingston, Rhode Island
• Responsible for supervising and teaching applications of Maternal and Child Health Nursing to a clinical group of 6 or more undergraduate students at Women and Infants Hospital
01/05-04/06
University of Rhode Island Clinical Facility of Community Nursing Kingston, Rhode Island
• Responsible for supervising and teaching application of Community Nursing to a clinical group of 6 or more undergraduate students in the community setting.
01/00- 11/04 Neonatal Intensive Care Nurse, R.N.
Women and Infants Hospital
Providence, Rhode Island
• Responsible for timely report of current status to physician or nurse practitioner
• Respond to code emergencies as directed by Neonatologist
• Handle all duties as admission nurse for infants admitted onto the unit
• Administer care for infants in transport to or from hospital
• Coordinate responsibilities of charge nurse to include, but not limited to, scheduling of staff, direct individual assignments, assist staff with application of proper care, and incorporate incoming infants into unit as necessary
• Competent in use of current technology used to support efforts of health care in intensive care unit
• Provide family centered care
• Train new staff for unit as directed by hospital management 10/98-01/00 Neonatal Intensive Care Unit Secretary Women and Infants Hospital
Providence, Rhode Island
• Preparation of paperwork, charts, patient records, and the appropriate forms necessary to ensure medical orders are followed and recorded
• Communicate and interact with parents and visitors on a daily basis
• Answer and direct all phone calls
• Alert physicians of emergency situations
OTHER WORK EXPERIENCES AND CERTIFICATION
• RI Nurse Practitioner Licensee Current
• RI Registered Nurse; Ma Registered Nurse Current
• Certified Case Manager Goal August 2022
• Basic Life Support, CPR, Automated External Defibrillation Current
***REFERANCES AVAILABLE ON REQUEST***
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