Sarah Fuentes RN

510-***-****

ad0lit@r.postjobfree.com

Martinez, CA

Certifications:

RN License-Active

AHA BLS CPR-Active

Education:

Associate Degree in Nursing-College of Marin graduate in 2007

Work Experience

Health Link Home Health and Hospice: RN Clinical Manager-June 2023-October 2023

Responsibilities include overseeing, hiring, and training new staff with multiple skill levels and positions to include; intake coordinators, schedulers, professionally licensed clinicians; ST, PT, PTA, OT, RN, LVN, MSW and HHA. I interview, determine pay rate, employment status and geographical area needed. I analyze the employees' clinical or office value based on prospective employees projected value to the company to fulfill staffing and geographical needs of the company. I use a cost benefit analysis to project growth in census and generate a fully trained, functional quality clinical staff. I work with marketing to gain and retain new contracts as a choice provider. I maintain relationships with associated hospitals/facilities and participate in re-admission calls with hospital boards. The metric varies when attrition rates are caused by expected and unexpected gains and losses of staff overseen, currently I have 65 total employees I oversee and evaluate to cover a 200 plus patient census. I establish and implement new processes to develop innovative approaches to promote company growth and expansion while maintaining profitability without sacrificing clinical standard. I advise all therapies (approximately 30 plus) clinicians/office staff for which I am their immediate supervisor who evaluates, determines raises when applicable and conducts daily oversight, evaluations, and competency ratings. I monitor patient care and communication threads to ensure charts for compliance and that staffing needs are met. I work with marketing to promote growth at a sustainable rate for which I can hire, train and account for unexpected losses and gains. I maintain communication with suppliers and monitor equipment and supply cost. I streamline products by comparing and obtaining cost effective treatments as clinically appropriate. I work with the quality department to evaluate charts, orders, and staff development to meet Medicare guidelines. I evaluate referrals and determine acceptance based on insurance, location, and staff ability. I participate in manager bi-weekly meetings to collaborate with the San Francisco office.

21st Century Home Health RN Case Manager-August 2022-June 2023

I worked as an RN Case manager facilitating care for clients post hospitalization to prevent readmission and facilitate quality patient outcomes for the person to achieve their maximum level of independence following their most recent hospitalization and/or health decline. I coordinate care with the home health team to facilitate care. I then manage and evaluate the care team, (4) LVN’s, my concierge service, the home health aide (s). I evaluate the patient's need for additional therapies and request appropriate therapists to add onto the home health service team. I write a care plan to include necessary therapies and send staffing requests with written reasons for the need for care. Some of these are generated by the initial referral and some are based on initial nursing assessment of care needs and disease/illness management. All of which is reflected by my SBAR report given at every start of care for our clients to communicate to the staff the MD summary of client needs and reasons for care need, relevant orders for staff to complete or that have been completed, the POC for the duration of home health, therapists included within the initial referral from Kaiser and therapists added and why, the duration of care and why, costs for the patient, wound care, IV, DME needed if any. The summary includes the patient's PMH and most recent care needs. I then request the appropriate staff needed to complete the plan of care and the frequency, duration and start date of the therapist. I communicate and delegate nursing care with the LVN (s) for SN care, HHA for bathing needs, Concierge service for charting compliance. The PT manages the OT and PT care. I coordinate services. Monitor therapists notes in our charting system and communication system, dictate, and monitor order requests ensuring timely delivery to the MD for authorization and signing of orders, I monitor changes and authorizations as needed and generated by the concierge service. I evaluate the work of the LVN (s) daily through our virtual thread and their charting, weekly at our nursing meeting, and every 4 weeks with patient RN supervisory visits. I monitor the HHA in the same fashion, communicating recent orders and care needs as they arise, adapting the care plan and communicating care needs to facilitate MD authorization as needed, and I monitor the concierge’s compliance with dictated orders and directly evaluate their skills and work. I coordinate care with the MSW, PT, OT, and ST. I communicate patient care, dictate frequencies and care needed and ensure we are in compliance, up to date on orders, giving and recording quality care. I hold a weekly meeting with my concierge, my LVN’s and myself to discuss care needs. I communicate with the director of nursing, the director of PT, the office staff, our admitting department, and hospital discharge staff as needed to ensure exceptional nursing care while.

On My Care Home Health RN Case Manager-April 2022-August 2022

Home Health Case manager for nursing needs and coordination of care between medical providers. Communication between therapies manage patients' needs to achieve independence within the home or assisted living community setting. Management of wound care, urinary catheters, blood draws, Coagucheck for INR levels and reporting values, reporting to physicians as needed, communication with family as needed, communication with staff within the home as needed (caregivers, assisted living facility staff). Identification of social needs, medical needs, spiritual needs and personal needs to develop an attainable care plan particular to that patient and their social situation. Once needs are identified I provide all aspects of that patient's nursing care and communication. I manage their care and therapies to achieve their best level of independence that is attainable for their social, familial and medical needs to thrive as they age. Once this is achieved, I discharge the patient to their home setting and take on an additional patient to continue to maintain my desired caseload.

LTCG and Life plans Local Care Coordinator (ICN)-December 2021-August-2022

RN Local Care Coordinator for multiple long term care insurance companies on a contracted basis through life plans and LTCG. I conduct health assessments and screenings in clients' homes for underwriting referrals, caregiver certifications and claims assessments. I conduct neurological evaluations, medication review, health screenings and care plans based on the client’s needs. I work within tight timelines once referrals are booked. I arrange appointments with the client once a referral is accepted, preparing them for the appointment. I conduct the in-home assessments requested and return it within 24 hours with their current medication list, current physicians, care providers, level of care for ADL/IADLs, alongside environmental factors and equipment used. Major medical events are also noted within my detailed report written to return to their long-term care insurance company after review from LTCG quality Care Coordinators.

Clipboard Health-November 2021-August 2022

Registry staff for skilled nursing facilities on a per diem basis.

Advice Nurse September- 2013-June 2019

I triaged calls for all specialties and ages for all of Northern California’s Kaiser Permanente members using EMR (EPIC/KPATHS) and protocol driven electronic appointment booking system for documentation and facilitation of care. I select the proper intervention for the member; emergent, appointment, home care advice or a combination of the above. As needed, I consult with fellow Doctors, Nurses, ancillary staff, management, or law enforcement when appropriate. I utilized company protocols, workflows, online documents, and critical thinking skills in a quick and efficient manner to guide my care. I properly documented using the company's EMR charting system. My focus was on adult primary care members through their lifespan. My secondary focus was a balanced combination of post operative, OBGYN and pediatric members for all of their self-care needs, medical or surgical. This job greatly expanded my clinical knowledge base and triage skills. I have also become skilled in computerized charting which has continued to evolve over my years spent at Kaiser.

Urology and Head and Neck Surgery RN-June 2010-September 2013

I assisted physicians in the surgical removal, closures and dressings of head and neck lesions (skin cancers, cysts, temporal artery biopsies and turbinate reductions). This also included patient pre and post operative care teaching. In addition, I was responsible for preparation of sterile fields. Other aspects of this job involved suture and staple removals utilizing plastic surgery techniques and staff teaching of such skills, ensuring competencies. Cerumen impaction assessment and removal was also performed. Additionally, I performed multiple medication administrations; bladder installations (BCG treatment/chemotherapeutic agents), intramuscular, nasal and oral administrations, preparation and proper disposal. I performed a variety of urological procedures (catheter removal and insertion for Supra public, Foley and straight catheterization and stent removal). This included teaching of self-catheterization. I was also responsible for

arranging VED and vasectomy classes. Managing and triaging referrals. Managing physician orders of laboratory and x-rays as necessary. Advice calls. My leadership skills evolved greatly as I earned my staff nurse level three by conducting collaborative nurse physician meetings, updating department protocols, managing staff sick calls (during my managers absence) and adjusting staffing as necessary. I assisted my direct manager in developing staff scripts for our local call center. I managed our prostate cancer tracking system for 1700 plus members. Notifying physicians and members of follow up care needed based on PSA results.

Telemetry and Stroke RN-March 2008-June 2010

I expanded my knowledge of cardiac and neurological patients. Received certification in management of members with acute CVA’s. Managed and recovered post cardiac catheterization patients. Floated to medical-surgical units based on staffing demands. Performed peritoneal dialysis, assisted physicians in central line insertions, thoracentesis, and lumbar punctures. Utilized telemetry to identify and treat patient rhythms, reporting to the physician as appropriate. Post operative teaching. CVA, MI, CHF teaching for members.

Step Down/TCU RN-July 2007-March 2008

Assimilated into the role of the critical care nurse. Administered, titrated and monitored various drips (including cardiovascular, chemotherapeutic, antibiotic and for comfort care measures). Managed multiple ventilation modalities. Trained in cardioversion and procedural sedation. Identified patients' rhythms via telemetry systems, consulting and intervening as necessary. Managed chest tube drainage systems. Used critical thinking and time management skills to function effectively in a fast-paced environment. Utilized the nursing process to provide quality care and exceptional service to a diverse patient population suffering from various acute and chronic disorders.

References

Dima Kirik-Executive Director-415-***-****

Glenda Ordonez RN-Kaiser Permanente Senior Manager-707-***-****

Mary Provines RN- 415-***-****

Nancy Yoones DON- 415-***-****

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