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Manager ur and case management

Bethlehem, PA
October 29, 2018

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Contact: Shanna Ramirez Email: Tel: 407-***-**** ext. 126 Cell: 321-***-**** Kathleen McMahon

Professional Profile:

30+ years of clinical experience as a Registered Nurse in various settings

10+ years’ experience in Case Management and Utilization Management

10+ years’ experience with supervisory and leadership role with extensive practice in training, staff development, and education

Proficient in using computer applications such as Word, Excel, Outlook; familiar with InterQual; comfortable using medical chart format including Electronic Medical Records

20+ years’ Registered Nursing experience in the state of New Jersey

10+ years’ Registered Nursing experience in the state of Pennsylvania

Certified Case Manager

Work Experience:

Mar 2014 – Present Prime Healthcare Jersey City, NJ Senior Case Manager

Manage, analyze and coordinate the daily activities of the unit to ensure departmental productive goals are met with regards to quality timeliness, accuracy and consistency of medical decisions

Perform evaluation of workflows and pursues to improve processes that impact the department

Act as a subject matter expert for difficult and complex matters; represent the Plan with external customers, providers and agencies; represent the department on internal committees and participates in special projects

Perform utilization management for members from enrollment, pre-certification, utilization management to discharge addressing all transitions of care

Identify and implement cost saving/revenue generating opportunities

Assist the director in coordinating regulatory, quality, and accreditation activities

Lead the team of case managers and provide mentoring to staff members Mar 2013 – Mar 2014 Accolade Inc. Plymouth Meeting, PA Clinical Health Assistant

Triage telephone calls from patients in behavioral health and medical triage; use computerized database to facilitate access to necessary parties

Work closely with providers, nurses, insurance companies, patient families, and all other members of the organization by teaching, communicating therapeutically, and negotiating solutions

Responsible for staging care and directing patients to providers

Listen, demonstrate empathy, and utilize problem-solving techniques to resolve patient concerns

Conduct full behavioral health assessments, educate patients on their roles in their treatments, and aid them accessing healthcare solutions

Follow up on patients with chronic conditions and assist patients to get appropriate care in compliance with treatments

Negotiate billing, identify insurance processing errors, and arrange payment plans on behalf of patients Sep 2009 – Mar 2013 Temple University Hospital Philadelphia, PA Certified Nurse Case Manager

Contact: Shanna Ramirez Email: Tel: 407-***-**** ext. 126 Cell: 321-***-****

Facilitate progression of care for individual patients through the careful integration of family support, and community resources; utilization of additional services which has led to significant cost savings for the hospital through the shortening of average patient stay

Responsible for implementing accepted protocols in establishing venues of care for discharge planning, including home care, hospice, acute rehabilitation, and skilled nursing facilities for both long-term and short- term care

Work in close collaboration with patients and families, the medical team, interdisciplinary team members, outside agencies, and clinical liaisons to create the optimal discharge plans

Consistently propose a transition plan within 24 hours of admission

Review all documentation from specialists and consults with physicians and therapists to monitor patient progress

Serve as an active patient advocate for the patient and family throughout care process Feb 2004 – Feb 2009 Aria Health Philadelphia, PA

Charge Nurse/Catheterization Lab Nurse & Telemetry Nurse

Lead new staff in learning how to utilize tools, prioritize patients based on acuity, organize workload, and appropriately assess patients

Provide exemplary teaching and mentorship to new and existing nursing staff

Manage nursing care in alignment with industry best practices

Utilize computerized documentation systems to monitor, record, and communicate patient vital signs

Actively circulate during cardiac catheterization procedures, and develop advanced heart knowledge, including anatomy, physiology, diseases, medications, and treatments Jan 2001 – Dec 2003 Carrier Clinic Belle Mead, NJ

Psychiatric Nurse

Record and maintain patient information, such as vital signs, eating habits, behavior, progress notes, treatments, or discharge plans

Listen and provide emotional support and encouragement to psychiatric patients

Complete physical checks and monitor patients to detect unusual or harmful behavior and report observations to professional staff

Previous Positions Held:

JFK Medical Center – Neurological Surgery Unit

Trenton Psychiatric Hospital – Head Psychiatric Nurse Pinnacle Health Enterprises – Case Management Nurse Prudential – Workers Compensation Case Management/Manager of UM Visiting Nurse of Central Jersey – Supervisor of Clinical Reimbursement Prudential – Case Management Nurse

Palm Beach Gardens Hospital – Invasive Coronary Unit Nurse Education and Licenses:

Thomas Edison State College Trenton, NJ

Bachelor of Science in Nursing

Henry Ford Community College Dearborn, MI

Associate Degree in Nursing

Contact: Shanna Ramirez Email: Tel: 407-***-**** ext. 126 Cell: 321-***-**** Registered Nurse in the State of New Jersey

License Num. 26NR07940200

Registered Nurse in the State of Pennsylvania

License Num. RN548595

Contact this candidate