SylviaCarlsonRN,CCM

***** ******** ****, ************, ** 615-***-**** ad10sh@r.postjobfree.com

Objective

To utilize nursing processes to care for patients, assess their needs, develop appropriate care plans, implement and evaluate outcomes and promote autonomy. To continue my case manager role so that patients receive the right care at the right time.

Experience

MEDICAL RN CASE MANAGER ANTHEM-BCBSM 2021- 2022

• Identify gaps in care or barriers in treatment plans.

• Coordinate care for members by navigating transitions of care.

• Provide education to members on disease processes and how to self- manage.

• Encourage members to make healthy lifestyle changes.

• Document and track findings.

• Coordinate services (home health, DME, etc.) throughout continuum of care.

• Collaborate among physicians, nurses, case managers, social workers, pharmacists, and allied health professionals.

• Incorporate adherence guidelines and other standardized practice tools, MEDICAL RN CASE MANAGER OPTUM: UHG 2017- 2021

• Coordinate care for members.

• Develop, monitor, and revise the member’s service plan to meet their needs

• Identify gaps or barriers in treatment plans.

• Provide patient education to assist with self-management.

• Make referrals to outside in network or Par-vendors.

• Coordinate services as needed (i.e., home health, DME, etc.)

• Provide education and promote disease processes and how to self-manage.

• Document and track findings.

• Present cases as needed.

CARE COORDINATOR POPULUS GROUP ANTHEM March 2017- October 2017

• Develop, monitor, and revise the members service plan to meet the members’needs, with the goal of optimizing member health care across the care continuum.

• Responsible for performing telephonic or face-to-face non-clinical assessments using a tool with pre-defined response options for the identification, evaluation, coordination and management of members non-clinical long- term service and support needs.

• Identify members with potential clinical health care needs (including, but not limited to, potential for high-risk complications) and refer those member’s cases to the clinical healthcare management team.

• Manage non-clinical needs of members with chronic illnesses, co-morbidities, and/or disabilities, to ensure cost effective and efficient utilization of long-term services and supports.

• Obtain a thorough and accurate member history to develop an individual service plan. Sylvia Carlson

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• Establish short- and long-term service and support goals in collaboration with the member, caregivers, family, natural supports, physicians.

• Identify members that would benefit from an alternative level of service or other waiver programs. CASE MANAGER BLUECROSS BLUESHIELD: 2005- 2016

• Worked in collaboration with patients and providers to assess needs, review policy, develop care plan, implement goals and objectives, evaluate outcomes and promote patient autonomy.

• Adherence to NCQA and URAC standards.

• Dealt with critical and medically complex cases to meet criteria for LTAC.

• Provided education regarding benefits and understanding policies.

• Identify barriers so they can be solved with available resources.

• Apply knowledge for discharge planning and of ICD 09/10. STAFF NURSE NHC PRN 2007-2008

• Provided nursing care to rehabilitative patients, s/p acute settings.

• Implementeddoctors’orders.

• Document outcomes.

• Provide education for discharge orders.

• Administered medications.

STAFF NURSE STATE OF TENNESSEE: DEPARTMENT OF HEALTH 2002- 2005

• Provided nursing care to patients seeing the medical doctor.

• Implemented protocol for immunizations to STD testing and treatment.

• Prioritized care for all ages according to acuity.

• Knowledge of CMS 671 form for Long Term Care.

STAFF NURSE SOUTHERN HILLS MEDICAL CENTER 2001- 2002

• Providedprioritizednursingcaretolaboringpatientsbyinterventionanddeterminingpatient’sconditionand needs, implementing appropriate care plans and monitoring process of stages of labor.

• Monitored and documented vital signs of patients and communicated progress as indicated.

• Carriedoutphysician’sordersincludingmedicationsandtreatmentsasprescribedandevaluatedprogress.

• Assessed learning needs of patient and family to educate based on age, culture, and willingness to learn. STAFF NURSE MAURY REGIONAL MEDICAL 2000- 2001

• Provided nursing care to gynecological patients and their families, mainly newly delivered mothers on the obstetrical unit.

• Utilize my bilingual skills with a large non-English-speaking, Hispanic community for continuity of care.

• Discharge planning and instructions with patients and their families prior to discharge. Licensures

Georgia: 263569 Texas: 1048270

Alaska: 151945 Massachusetts: RN2346191 Nevada: RN988680 Ohio: 456549 Rhode Island: RN67285 Minnesota: 2464297 California: 95160644 Michigan: 407******** Connecticut: 148819 Washington: RN60836721 Illinois: 041.505441 New York: 831705 Oregon:202000342RN All COMPACT STATES

Sylvia Carlson

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Certifications and Qualities

• Certified Case Manager by CCMC number; 130647 exp. 05/31/2024

• Certification for HCBS Assessor by State of TN

• Bilingual in Spanish and English

Professional Memberships

CMSA CCMC

Education

• COLUMBIA STATE COMMUNITY COLLEGE

Degree: Associate of Applied Science; Nursing- May 2000

• RICHARD KING HIGH SCHOOL

High School Diploma-June 1985

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