Case Management Emergency Department
Resume:
RHONDA CAMPBELL
**** *********** **. ***. ****, Reno, NV. 89511
ad4ysj@r.postjobfree.com
PROFILE
• SEASONED NURSE WITH OVER 40 YEARS OF ACUTE CARE CASE MANAGEMENT INCLUDING DISCHARGE PLANNING AND UTILIZATION REVIEW
• SKILLED IN UTILIZATION MANAGEMENT PROCESS INCLUDING APPEALS AND DENIALS
• EXPERIENCE IN COVERING FLOORS: EMERGENCY DEPARTMENT TELEMETRY, MED/SURG, OB/NICU, PEDIATRICS, CARDIAC, AND TRAUMA
• PROFICIENT IN SYSTEMS: INTERQUAL, MILLIMAN, MIDAS, MCG, EPIC, CERNER, MEDITECH, AND MCKESSON
• EXPERIENCE IN CORRECTIONS: SOUTH FLORIDA RECEPTION CENTER, DADE-COUNTY JAILS, BROWARD COUNTY JAILS, EVERGLADES CORRECTIONAL INSTITUTE, SAN QUENTIN CORRECTIONAL INSTITUTION
EXPERIENCE
02/2023 – PRESENT
CASE MANGER, RENOWN REGIONAL MEDICAL CENTER
Responsibilities:
• Patient Ally: Serve as the go-to person for patients, providing a friendly and supportive presence throughout their healthcare experience. Act as their ally, offering a listening ear and emotional support during challenging times.
2
• Care Navigator: Help patients navigate the labyrinth of the healthcare system, offering guidance on accessing services, finding healthcare providers, and understanding insurance coverage. Simplify complex medical jargon into clear, understandable language for patients and their families.
• Holistic Assessment: Conduct thorough assessments of patients' physical, emotional, and social needs to develop comprehensive care plans. Collaborate with healthcare professionals, including doctors, nurses, and therapists, to ensure all aspects of patient care are considered.
• Resource Guru: Connect patients with community resources, support groups, and educational materials to enhance their overall well-being. Identify financial assistance programs, transportation options, and other resources that can remove barriers to care.
• Treatment Coordinator: Facilitate communication and coordination among healthcare providers, ensuring a seamless flow of information. Schedule appointments, arrange consultations, and follow up on referrals to ensure patients receive timely and appropriate care.
• Problem Solver Extraordinaire: Address challenges that arise during the healthcare journey, such as insurance denials, scheduling conflicts, or medication issues. Advocate for patients' rights and find creative solutions to overcome obstacles.
• Empowerment Advocate: Educate and empower patients to actively participate in their healthcare decisions. Provide them with information about their conditions, treatment options, and self-care strategies to foster a sense of ownership and confidence.
• Applications used: EPIC
• 03 /2021– 02/2023
• CARE MANAGER, CENTENE CORPORATION
Responsibilities:
• Develop, assess, and adjust, as necessary, the care plan and promote desired outcome. 3
• Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short- and long-term goals, treatment and provider options
• Coordinate services between Primary Care Physician (PCP), specialists, medical providers, and non-medical staff as necessary to meet the complete medical socio - economic needs of clients,
• Develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs.
• Provide patient and provider education.
• Facilitate member access to community based services
• Monitor referrals made to community-based organizations, medical care and other services to support the members’ overall care management plan
• Actively participate in integrated team care management rounds
• Identify related risk management quality concerns and report these scenarios to the appropriate resources.
• Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems.
• Applications used: EPIC and Allscripts
• 1/11/2021 – 3/31/2021
• DISCHARGE PLANNER, TRAVELER (GREEN KEY SOLUTIONS) -U.C.I. MEDICAL CENTER
Responsibilities:
• Collaborate with the health care team to plan and coordinate safe and appropriate discharges. 4
• Arrange post discharge services such as home health, durable medical equipment, and medication management.
• Insure effective communication and handoff of information to the next level of care providers.
• Maintain accurate and up-to-date documentation of assessments, care plans and interventions.
• Enter data into electronic health records or case management systems as required.
• Generate reports, communicate patient progress and outcomes to the health care team and stakeholders.
• Add here to regulatory and accreditation standards as well as organizational policies and procedures. Stay updated on industry trends, evidence based practices, and changes in health care regulations.
• Conduct comprehensive assessment of patients medical, psychosocial and functional needs.
• Collaborate with the interdisciplinary team to develop individualized care plans based on the assessment findings.
• Establish goals, interventions, and timelines to facilitate the patient's recovery and ensure continuity of care.
• Coordinate and facilitate appropriate health care services, including medical treatments, therapies and consultations.
• Advocate for patients’ needs and ensure timely access to necessary resources and interventions.
• Monitor and evaluate the effectiveness of the care plan and make adjustments as needed.
• Promote patient engagement and empowerment by encouraging active participation in the care process.
• Facilitate referrals to community resources and support groups for ongoing support and self- management.
• Applications used: EPIC, Allscripts
5
9/14/ 2020 – 12/13/2020
DISCHARGE PLANNER, TRAVELER (AMERICAN MOBILE) -SARASOTA MEMORIAL HOSPITAL
Responsibilities:
• Collaborate with the health care team to plan and coordinate safe and appropriate discharges.
• Arrange post discharge services such as home health, durable medical equipment, and medication management.
• Insure effective communication and handoff of information to the next level of care providers.
• Maintain accurate and up-to-date documentation of assessments, care plans and interventions.
• Enter data into electronic health records or case management systems as required.
• Generate reports, communicate patient progress and outcomes to the health care team and stakeholders.
• Add here to regulatory and accreditation standards as well as organizational policies and procedures. Stay updated on industry trends, evidence based practices, and changes in health care regulations.
• Conduct comprehensive assessment of patients medical, psychosocial and functional needs.
• Collaborate with the interdisciplinary team to develop individualized care plans based on the assessment findings.
• Establish goals, interventions and timelines to facilitate the patient's recovery and ensure continuity of care.
• Coordinate and facilitate appropriate health care services, including medical treatments, therapies and consultations.
• Advocate for patients’ needs and ensure timely access to necessary resources and interventions.
• Monitor and evaluate the effectiveness of the care plan and make adjustments as needed. 6
• Promote patient engagement and empowerment by encouraging active participation in the care process.
• Facilitate referrals to community resources and support groups for ongoing support and self- management.
• Applications used: Allscripts, E.C.I.N., PULSE
01/2016-02/11/2019
Blended Case Manager - Utilization Review / Discharge Planner Temp Staffing Agency to Permanent Position- Jackson Memorial Hospital Responsibilities:
• Demonstrates behaviors of service excellence and CARE values (Compassion, Accountability, Respect and Expertise).
• Assess complex patient care needs/situation/acuity levels obtaining significant data from assessments (physical/functional, mental, psychosocial, environmental, family support, spiritual, cultural, financial, legal).
• Completes electronic documentation for case management activities such as discharge planning, patient throughput, appropriate level of care, communication with physician, nursing and patient / family member. Articulates information pertinent to clinical condition, LOS, discharge delays, outcomes, resource utilization, discharge planning, etc. at team meetings / presentations, patient care rounds, interdisciplinary rounds and to administration, medical director and physician advisors.
• Coordinates patient care throughout an episodic / continuous course of care for a specific DRG/diagnosis/procedure/population using InterQual, Milliman or other specific criteria and evidence-based guidelines.
• Follow and perform all related unit specific policies and procedures, as detailed on the unit specific competency checklist.
7
• Utilizes job and unit specific equipment as required.
• Performs all other related job duties as assigned. Applications used: Allscripts and EPIC, CERNER
08/2015 – 01/2016
Behavioral Health Case Manager
Aerotek/Magellan Health Plan Insurance- Temp. Assignment Participated in a pilot program that was launched by the state of Florida, a managed care plan that would manage medical and psychiatric care together. Responsibilities:
• Duties included utilization review for medical and psychiatric patients.
• Review electronic medical records for medical necessity using InterQual or Milliman’s tools.
• Issue denials for hospital stays that did not meet criteria for admission or continued
• hospitalization.
• Collaborate with Durable Medical Equipment vendors for discharge planning.
• Collaborate with the Medical Directors as needed for questionable hospitalizations.
• Collaborate with the hospital case managers to assist with discharge planning.
• Provides non-clinical support to workflows involving utilization management, case management, disease management, and health promotion.
• Troubleshoots when an appropriate provider, type of service, or appropriate level of care cannot be readily found.
• Has current knowledge or research availability of community resources and services and link members to appropriate services. May assist in transitions in care for hospitalized patients and makes appropriate placements, if needed.
• Assumes responsibility for self-development and career progression. 8
• Proactively seeks and participates in ongoing training (formal and informal) in all aspects of the Care Worker role.
• Assists in the mentoring and training of new Care Workers.
• Remains responsible for updating self on ever changing information to ensure accuracy when dealing with members and providers.
• Participates in operational activities, including data collection, tracking, and analysis.
•
• Applications used: EPIC, ALLSCRIPTS
EDUCATION
04/2022
MSN - GRAND CANYON UNIVERSITY
Sigma Theta Tau – National Nursing Honor Society
4.0 GPA
SUPERVISOR / LEADERSHIP ROLES / SKILLS
• Staff Education
• Nurse Manager – Med/Surg /Immunology Unit
• Night supervisor with Greenbriar Skilled Nursing Facility, Miami, Fl.
• House Supervisor for White Oak Skilled Nursing Facility, Columbus, S.C.
• Collaboration / Negotiations
• Cost containment
• Project Management
•
9
• Conflict resolution
• Creative thinking
Contact this candidate