Telephonic personal health nurse

JOHANNE MUNOZ, BSN,RN,CCM

Email: ********@***.***

Cell: 631-***-****

Professional Summary

Dedicated, Motivated, Skilled Nurse with experience in ensuring high standards of culturally competent care for a variety of patients with diverse needs within the community, hospital and telephonic/Outpatient settings.

Core Qualifications

• Strong Medical ethics

• Patient evaluation/interventions

• Strong clinical judgement

• Computerized charting experience-EPIC

• Compassionate

• Goal oriented

• Patient focused care

• Team player

• Organized

• Able to prioritize and work under stress

• Able to work independently

• Excellent time management skills

• Oasis knowledge

• Knowledge of Evidence based medicine

• Compliant with CMSA standards of care

• Knowledge of Milliman Care Guideline

• Experience with Utilization review/Denials/Appeals

• 30 years of Nursing experience in a variety of settings

Experience

Senior Personal Health Nurse

Conifer Health Solutions-Medical management services

3/7/15-Present

• Completes a Personal Health Nurse assessment incorporating analysis of clinical claim chart, discussions with the patient and the physician’s assessment and treatment plan

• Determines and Documents patient’s goals, engages the patient in personal health management process. Develops an ongoing individualized plan of care with timeframes reasonable and appropriate expected outcomes, specified interventions and patient goals

• Participants in account meetings. Reports any account issues or questions to Manager

• Sends daily high cost status reports to Account Client

• Communicates with Account client with issues regarding plan coverage, services and patient issues.

• Assists Manager in increasing team performance to meet company standards

• Assists team in completing QA criteria

• Collaborates with Insurance plan in resolving Claim issues

• Distributes New assignments to Team members for acute management

• Enroll members in Transition of care program to avoid readmissions

• Collaborates with Utilization management review to resolve claim issues

• Facilitate effective communication and coordinates resources to ensure seamless care

• Utilizes clinical expertise to address the unique needs of patients with acute and chronic illnesses

Clinical Care Transitions Coach/Home Care Nurse

Dominican Sisters/Suffolk County Care Transitions Program

10/13-6/2015

• Collaborated with hospitalists, medical interns and other key members to manage transition of care activities and communicate vital information

• Collaborated with acute care team to follow patient through care continuum

• Coordinated patient access to necessary services, including community resources and longterm care

• Multidisciplinary team based effort for monitoring achievement of patient goals, family engagement, and education

People management and Development

• Coached for self-management of health conditions

• Provided discharge/transition of care education

• Established and maintained a positive working relationship with interdisciplinary team and patient

• Improve adults to manage their own care and effectively use health services

• Increase patient knowledge about red flags that indicate worsening conditions

• Educate on follow-up appointments

Operations Management and Administration

• Identified High risk patients using a standardized process

• Reviewed completed medication reconciliation

• Oasis trained

• Partnership with University of Stony Brook Hospital

Clinical care Coordinator

Cogent Medical Group/Brookhaven Memorial Hospital

01/07-09/13

• Collaborated with the Hospitalist team to coordinate and manage process of patient care from admission to discharge with handoff to community care providers.

• Consulted with Social Workers, Physical therapists, Families, and doctors to provide quality care for patients and discharge planning.

• Made post discharge follow up appointments, obtained prior authorization for medications and obtained medical records.

• Documented Core measures of CHF,DVT and Advanced Directives

• Attended length of stay rounds to address barriers to discharge

Endoscopy Nurse-Endoscopy Unit

St. Catherine’s of Sienna Hospital

01/09-01/10

• Provided admitting, procedural and recovery care to inpatients and outpatients who required gastrointestinal procedures and pain management injections.

• Worked alongside MD and Anesthesiologist in performing biopsies, cauterizations, polypectomies, Peg Placements, ERCPs and epidural injections.

• Reviewed discharge instructions with patients and performed follow up calls.

Registered Nurse-Telemetry/Stroke/Medical-surgical unit

John T. Mather Hospital

11/02-3/06

• Provided physical, mental and social health care to patients

• Recognized normal and abnormal rhythms in correlation with health history.

• Provided accurate treatment for specified diagnoses

• Preceptor for new staff

• Preformed clinical assessments of patients

• Medication administration

Home care Coordinator

Visiting Nurse Service of New York

07/96-10/02

• Conducted initial assessments, implemented and evaluated via patient care on a consistent and systematic basis-Oaisis

• Collaborated with interdisciplinary team to maintain patient optimal care.

• Provided orientation and supervision to home health aides

• Effectively identified needs of patients/families and made appropriate referrals and utilized community resources.

Registered Nurse-Telemetry Unit

North shore University Hospital

06/91-7/96

• Provided nursing care to cardiac patients

• Recognized and assisted in treatment of abnormal rhythms

• Administered medications

• Preformed clinical assessment

• Collaborated with physicians in providing quality care

Education

State University of NY at Stony Brook

School of Nursing

RN, BSN-May 1991

Legal Nurse Consultant Center

Legal Nurse Consultant-Training Program

RNLC-November 2005

Certifications/Licenses

CCM

BSN

Certified Care Transitions Coach

New York RN license

Nevada RN License

References: Upon Request.

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