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Case Manager Management

Location:
Oklahoma City, OK, 73102
Posted:
October 30, 2023

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Resume:

LORI KEY, RN, BSN

**** *** *** **** *-Mail: ad0qf1@r.postjobfree.com

Kingwood Texas 77339

281-***-****

OBJECTIVE

I would like to obtain a full time RN oncology position.

SUMMARY OF QUALIFICATIONS

* 25 years of diversified nursing experience, 10 years of ER experience.

* Strong Case management and utilization review background. Knowledge of Medicare and Medicaid guidelines and Interqual criteria.

* Strong clinical skills and nursing knowledge in multiple specialty areas including: medical surgical nursing, cardiac intensive care, med-surg, intensive care, emergency room and recovery room.

* Results oriented, ability to multi-task effectively, and follow through with assignments to successful completion. Proven ability to work remotely. Proven ability to work telephonically.

* Excellent organization, communication, teaching skills, problem solving abilities, decision making skills and excellent negotiation skills.

* Worked with a large and diverse patient population.

* Team oriented, caring and compassionate.

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* Extensive knowledge of case management procedure and protocol involving all private insurances and Medicare and Medicaid

* Computer skills including Word, Microsoft office, and Windows environment, outlook, Cerner, and Interqual Trained.

* Thrive in a busy fast-paced working environment

Townsen Memorial hospital-

Employee health and education 2/22 to present. I am interim Case Manager. Townsen is a busy small surgical center with a 5 bed IP unit. I wear lots of hats here. I back up for house supervisor, PACU and the ER when needed.

Texas Emergency Hospital-

ER Charge Nurse and ER educator (June 2017 to 2/22)

United Surgical Partners Hospital at Kingwood: Kingwood Texas

RN Case Manager and Utilization review Nurse (June 2015 to May 2019) Discharge planner,

Coordinator of all DME, rehab, LTAC and home health. I was responsible for all Medicare/ Medicaid and Insurance audits and appeals and all Insurance clinicals for medical necessity. Proficient in Interqual, Cerner, Meditech, Outlook and some Excel. I was responsible for the Joint program ( education, preparation for home program).

United Healthcare Community Plan: Houston, Texas

RN Case Manager Service Coordinator (January 2011-June 2015): Performed state Medicaid assessments for Star Plus Waiver Program (field) and telephonic assessments, Home visits, Case Manager for 65- 80 Star Plus waiver members.

Encompass Home Health: Conroe, Texas

RN Case Manager (July 2009-January 2011): Responsible for 30 -35 patients, Admissions Oasis C, assessments, implementing plan of care, evaluating care and services, coordinating services, participated with the multidisciplinary care team, post hospital resumption of care, teaching and discharge planning. Home Health Case Management requires strong clinical skills, organization, team approach, leadership, and ability to work in a fast paced environment.

CLEVELAND REGIONAL HOSPITAL: Cleveland, Texas

RN Case Manager and PRN PACU (December 2006-July 2009): Responsible for data collection, distribution of information to ensure and control length of stay, provided data to insurance companies, Medicare and Medicaid to ensure proper reimbursement for patient hospital stay. Responsible for discharge planning and coordinating home health care, long term care, rehab, nursing home care, and community services. Hospital Case Management requires confidence and strong clinical skills due to the interaction with physicians in attempting to manage length of stay.

VITAS HOSPICE: Houston, Texas

RN Case Manager (May 2005-December 2006):

Responsible for complete plan of care for terminally ill patients who chose palliative care.

KINGWOOD MEDICAL CENTER: Kingwood, Texas

ICU (May 2004-May 2005)

CLEVELAND REGIONAL MEDICAL CENTER: Cleveland, Texas

Intensive care, Emergency room, House Supervisor, Recovery Room and IV team. (January 1994-May 2004)

SPRING BRANCH MEDICAL CENTER – RN - August 1990-January 1994

DENVER GENERAL – RN - August 1989 – August 1990

HILLCREST HOSPITAL – RN - November 1988 – August 1989

EDUCATION

REDLANDS COMMUNITY COLLEGE: El Reno, Oklahoma

BSN from University of Texas at Arlington 2019.

Professional references are available upon request



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