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Case Manager Registered Nurse

Location:
West Bend, Wisconsin, 53090, United States
Posted:
September 18, 2018

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Resume:

Lyn Backhaus

**** ***** *****, **** ****, WI ****0

Home: 262-***-**** – Cell: 414-***-**** ac63hy@r.postjobfree.com

Professional Summary

Positive professional Registered Nurse Manager with broad based experience through progressively responsible positions in home health, hospice and assisted living settings with a steadfast commitment to quality care and motivating team members. Recognized by managers as a team player who displays professionalism with excellent time management, organization and communication skills. Strong adherence to standards of practice within legal, ethical and regulatory framework.

Skills

Strong clinical judgment.

Hospice and Palliative Care experience.

Assisted Living and Home Healthcare experience.

Patient/family focused education and advocacy.

Knowledge of Medicare and Medicaid regulations.

Team player with positive attitude.

Adept at prioritizing/managing deadlines.

Independent judgment and decision making.

Personal and professional integrity.

Proven patience and self-discipline.

Staff management ability,

Staff training and development.

Work History

RN Manager-Assisted Living 2017-2018

Ovation Sarah Chudnow –Mequon, WI

Manage and coordinate the clinical services in the RCAC and Memory Care CPRF units including evaluation of staffing needs and scheduling of staff; nurses and direct care staff.

Actively maintain up-to-date knowledge of applicable state regulations.

Provide supervision for day-to-day operations of the units in accordance with set policies and guidelines.

Regularly evaluated employee performance, provided feedback and assisted, coached and disciplined staff as needed.

Establish and maintain positive relationships with residents, and families, other area health care providers, physicians and community.

Routinely evaluated the overall resident care within the facility and diligently enforced high standards.

Provide education and training for unlicensed staff to meet regulatory compliance.

Instructional Aide Nursing-Health Sciences 2015-2017

Moraine Park Technical College – West Bend, WI

Assist students in the practice of nursing skills and remediation activities under the guidance of nursing faculty.

Take inventory on the campuses for nursing and nursing assistant supplies.

Provide centralized purchasing for health care labs on the campuses.

Monitor, track and ensure compliance for require documentation of students health records.

Collaborate with instructors, community colleagues and vendor to maintain and update skills labs.

Care Manager 2015

Senior Bridge – Milwaukee, WI

Communicate with members to ascertain feelings or need for assistance or social and emotional support.

Counseled and educated members about health issues, medications, disease management and wellness to implement health improvement practices.

Liaised between members and physicians to ensure member comprehension of treatment plans.

Develop and implement nursing care plans; based upon member interviews/assessments into electronic medical record.

Clinical Services Manager 2014

St. Camillus Home Care and Hospice –Milwaukee, WI

Coordinate and supervise activities of unlicensed staff engaged in providing personal care to patients.

Contact prospective patients to explain available services and charges.

Maintain patients' medical records, utilizing electronic medical record system.

Direct, supervise and evaluate work activities of nursing and scheduling personnel.

Consult and coordinate with healthcare team members to assess, plan, implement or evaluate patients' plan of care.

Keep informed of Federal and State regulations affecting patient care to ensure plans adhere to regulations.

Director of Nursing 2013 to 2014

Preferred Home Health Services/Mid America Health Care –Milwaukee, WI

Actively direct and support clinical staff ensuring regulatory compliance.

Actively maintained up-to-date knowledge of applicable state and Federal laws and regulations.

Regularly evaluated employee performance, provided feedback and assisted, coached and disciplined staff as needed.

Reviewed clinical documentation to ensure accuracy and regulatory compliance.

Assigned staff to meet patient care needs, while adjusting for census, skill mix and sick calls.

Nurse Reviewer 2011 to 2012

National Government Services –Milwaukee, WI

Interpreted home health medical reports to render appropriate determination for billable services.

Evaluated the accuracy of provider documentation, including dates of service, level of care, diagnoses, patient identification and provider signature as required by Centers for Medicare/Medicaid.

Completed appeals and filed and submitted determinations into medical system.

Remained up-to-date with all Medicare/Medicaid and insurance requirements, including the details of patient financial responsibilities, fee-for-service and managed care plans.

Resident Services Director 2010 to 2011

Meadowmere Assisted Living –West Allis, WI

Administered, directed and coordinated the clinical services in 100 Apartment Residential Care Complex.

Provided thorough supervision for day-to-day operations of facility in accordance with set policies and guidelines.

Regularly evaluated employee performance, provided feedback and assisted, coached and disciplined staff as needed.

Established and maintained positive relationships with residents, and families, other area health care provider.

Routinely evaluated the overall resident care within the facility and diligently enforced high standards.

Facilitate and provide education and training for unlicensed staff to meet regulatory compliance.

Director of Clinical Services 2009

Touch Stone Senior Services –Madison, WI

Administered, directed and coordinated the clinical services in eight Assisted Living Facilities.

Actively maintained up-to-date knowledge of applicable state regulations.

Provided administrative and clinical leadership to the staff ensuring quality care.

Developed and updated required training materials, systems, policies and processes to meet regulatory compliance.

Monitored the ongoing implementation and effectiveness of each facility's systems to assure regulatory compliance.

Clinical Supervisor 2008 to 2009

Wheaton Franciscan Home Health & Hospice –Milwaukee, WI

Supervised and provided assignments for 6 RN Case Managers, 2 RN Visit Nurses and 1 LPN.

Evaluated nursing documentation to confirm accuracy and completely described care provided and patient responses to assure maximum reimbursement from payer source.

Assigned staff to meet patient care needs and address productivity standards, while adjusting for census, skill mix. Regularly evaluated employee performance, provided feedback and assisted, coached and disciplined staff as needed.

Conducted weekly meetings with Case Managers to ensure plan of care meets conditions of participation within State and Federal Regulations.

Clinical Advisor 2008

Humana Insurance –Oakbrook, IL

Counseled and educated members about healthcare insurance coverage based upon their plan.

Educated patients on available community resources and programs.

Served as a liaison between members and discharge planners to assist patients in understanding their treatment plans.

Evaluated health education needs of patients and provided necessary training and instruction via in person inpatient meetings.

Documented member information obtained from interviews; in person or telephonically for determination in case management services.

Director of Nursing 2005 to 2007

Heartridge Homes, Inc. –Madison, WI

Administered, directed and coordinated the clinical service in 6 assisted living facilities.

Actively maintained up-to-date knowledge of applicable state regulations.

Diligently monitored the Quality Assurance program to maintain high standards of care and ensure regulatory compliance.

Established and maintained positive relationships with government regulators, residents, and families, other area health care providers, physicians and community.

Co-organized and led monthly personnel meetings with Vice President of Operations.

Revised policies and procedures, trainings in accordance with changes in state regulations.

Provided training and instruction for unlicensed staff in the mandatory training areas identified in the State Regulations.

Education

Licensed Practical Nursing:

Sacred Heart School of Practical Nursing –Milwaukee, WI

Associates Degree Nursing:

Moraine Park Technical College –West Bend, WI

Bachelor of Science Nursing:

Concordia University Wisconsin – Mequon, WI

Affiliations

American Nurses Association

Sigma Theta Tau National Nurses Honor Society

Certifications

Registered Nurse in the State of Wisconsin, License number 90832-30

Basic Cardiac Life Support Certification

Clinical Experience

Home Health and Hospice Case Manager

Insurance Case Manager

Interests

Volunteer: St. John's Lutheran Church; Stephen Ministry Program Leader and Trainer



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