MS. ADETOUN ADESHINA, RN; BS.

RN, CASE MANAGER

**** ****** ****, #***

Laurel, MD 20707 ad0g6p@r.postjobfree.com 240-***-****

•An experienced RN ‘available immediately’, for Case Management, Prior Authorization, Discharge Planning, Concurrent, Retrospective and Utilization Review, actively exploring learning & growth opportunities in a healthcare organization, a ‘Well trained and Goal-focused’ RN with proven record of reliability, responsibility, and accountability with the capacity to multitask and manage completing priorities without difficulty.

•Utilize standard guidelines and pathways for delivery of superior care to improve patient outcomes.

• Seeking to enhance my diverse professional skills, in health insurance & Case management, conducting Risk Assessments physically & telephonically, making recommendations and developing plans of care. LPN for 10 years (1997-2007)

•Extremely proficient with various software, including: EMR’s (EPIC, PCC, MatrixCare & MEDITECH),Milliman Care Guidelines (MCG), InterQual Criteria (Familiar), (HEDIS),(OASIS, CRADLE-Home Health App)

•MS Office & Windows, other smaller and “home-grown” applications. With a minimum typing speed

40-45 wpm.

•Authorized to work for any employer in the US Authorized to work in the US for any employer

WORK EXPERIENCE

Nursing Agency (s)Floater Nurse

PRN Nursing Agency(s) - MD

April 2022 to Present

●Administer patient medications and treatments as ordered.

●Interface with other providers-Doctors and Pharmacists to obtain and verify new orders, and transcribe them.

●Supervise and assign duties to Nursing Assistants, and other support staff.

●Participate in Care-planning meetings, patient assessments, appropriate planning, and documentation of nursing interventions.

RN-Case Manager

UMMC-Laurel Medical Ctr - Laurel, MD

December 2021 to April 2022

●Assess, identify and coordinate COVID patient’s needs, and implement plans of care, monitor and evaluate outcomes across the continuum of care;

●Works with the multidisciplinary team to determine potential and actual risks to recovery and formulates plan to determine appropriate level of care upon discharge from the acute care setting;

● Coordinating and monitoring the quality of care and treatment during the entire duration of their Hospital stay.

RN-COVID-19 Vaccination Mobile/Crisis Response Team

Aya Healthcare for CDC & FEMA-Crisis Response Team, State of MD

April 2021 to December 2021

●Provide patient care for screening, triaging, and obtaining informed consent;

●Reconstituting Vaccines per Manufacturer’s instructions;

●Administer IM Pfizer, Moderna & J&J vaccinations, to patients 5 years old and up;

●Assisting Pharmacists and other medical professionals with sorting, packing and shipping all COVID-19 vaccinations to medical facilities across the state of Maryland.

●Dispose of biohazardous waste.

●Provide patient teaching.

RN-Case Management Inpatient & Observation Units (Occasional Remote)

Doctors Community Hospital - Lanham, MD

June 2020 to April 2021

●Responsible for utilization review and conduct proactive discharge planning for every hospitalized patients.

●Managing inpatient and observation services in order to determine In or outpatient status.

●Interacting with Health Insurance Companies, and other health care providers to negotiate treatment plans and coverage per patient coverage.

RN-Case Manager (PRN)

High Quality Home Health - Laurel, MD

April 2019 to June 2020

●Implement medication, diet and other health care instructions as prescribed by the physician in the medical plan of treatments.

●Complete, maintain and submit accurate and complete clinical and progress notes

***EMPLOYMENT GAPS: ‘Caring for terminally ill parent who passed away-Aug 2015 till April 2019

RN-Utilization & Concurrent Review RN (Occasional Remote)

Johns Hopkins Healthcare - Hanover, MD

December 2019 to March 2020

●Responsible for utilization review and conduct proactive discharge planning for every hospitalized ‘Plan’ member.

●Actively monitors patient care in acute/sub-acute hospitals and acute rehabilitation facility.

RN-Telephonic Case Manager

Cigna-Health - Houston, TX

September 2017 to February 2019

●Used clinical skills and knowledge of State and Federal mandates to provide care and disease Management services to high risk members with Complex/chronic illnesses.

●Create a comprehensive disease management plan of care for members, in collaboration with Physicians, other disciplines and Caregivers.

RN-Prior Authorization Nurse-Remote

United Healthcare - Houston, TX

April 2013 to August 2017

●Conducted review of requested services, per standards in the policies and procedures to ensure that the level of care, length of stay, or services requested are medically appropriate, and rendered timely manner as required by state regulations.

●Provided authorizations and/or denials based on clinical documentation and medical necessity for services, using established guidelines for inpatient admissions & rehabilitation services, skilled nursing/ home care, infusion services, elective surgery, and referrals to non-participating physicians;

●Collaborate closely with the Medical Director for Complex cases and denials to complete the prior authorization; and facilitated ‘peer-to-peer reviews as needed.

RN-Acute Care Clinical Staff Nurse

Texas Health Hospital - Dallas, TX

November 2010 to December 2015

●Worked as a ‘floater’ in a variety of Texas Health Hospital Locations providing direct patient care in facilitating changes to meet favorable patient outcomes.

●Provide state of the art care for patients in pre- & post-operative postoperative patients: assessments, pain management monitor hemodynamic status of patients, blood transfusions, post op orders, transfers.

RN-Complex Case Manager-Remote

Amerigroup Healthcare - Houston, TX

January 2011 to April 2013

●Conducted detailed telephonic Health Risk Assessments on Members; Identified and provided disease management to members, with Complex/chronic illnesses.

●Established collaborated member-focused Care plan, and short- & long-term goals documenting per CQA Standards.

●Coordinated appropriate member-focused treatment plan with other disciplines.

RN Charge Nurse

Ginger cove Nursing & Rehabilitation Center - Annapolis,MD

March 2005 to November 2010

●Rendered professional nursing care in accordance with physician’s treatment plans and evidence-based care.

●Provided back up to MDS Coordinator-by assisting with concurrent MDS review to ensure appropriate RUG category is achieved by integrating appropriate clinical information from in-house departments to ensure appropriate reimbursement.

●Provided ‘Case-Mix’ education to the interdisciplinary team as appropriate.

RN Medical-Surgical/Staff Nurse

University of Maryland, Medical Centers - MD

July 2007 to October 2010

●Rendered standard of practice in nursing care; utilizing evidence-based practice/care.

●Contributed to the achievement of unit objectives, by performing and delegating assignments/tasks with appropriate follow-up.

Specialty Pharmacy Telephonic Nursing Coordinator and Chronic Disease Manager

CVS/Caremark RX-TheraCom, Inc. - Rockville, MD

May 2003 to June 2007

● Telephonically trained Nurses, other clinicians & Patients in injection training across the US and coordinated home care injection training for patients receiving specialty Rx as needed. ● Provided counseling and direction to patients, to ensure proper disease management.

EDUCATION

ADN

Montgomery College

May 2005 to May 2007

Certificate

USDA Graduate School Computer Apps & Technical Writing

October 1994 to May 1996

BSC in Public Relations & Mgmt.

Bowie State University

September 1981 to May 1988

SKILLS:

•Possess over 20 years’ experience in a variety of HealthCare settings. Including but not limited to: Case Mgmt., Discharge planning, Prior Authorization.

•LTAC-Med-Surg. Staff Nurse, Acute patient care, Rehab & Geriatric Care.

•Long term patient care and HMO program regulations.

•Proficient with various software, including Microsoft Office, Milliman Care Guidelines (MCG), InterQual Criteria and Oasis Home Health software.

•Accurately document Member’s history per Medicare, Medicaid, NCQA, CHAP Standards.

•Conduct detailed telephonic Health Risk Assessments on Members with high risk, high cost, and Complex/chronic illnesses.

CERTIFICATIONS AND LICENSES

RN License

Maryland Compact State Nurse License RN R177444 (Exp) 09/28/2023

DC License RN1058406 (Exp) 06/2024

BLS/CPR Exp 04/2025

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