Karen Ann Byrnes

RN CASE MANAGER

Professional, detail oriented, and courteous RN Case Manager, with 35+ years’ clinical expertise within various nursing contexts, including ICU, med/surge, prison service, community, and home settings. Serves as strategic adviser for physicians, patients, and health care providers to develop holistic plan of care within medical center and social service domains. Experienced with systems navigation across multiple systems. Consistent, self-motivated, and positive individual, with ability to work independently with minimal supervision. Offers well-developed management experience and decision making capability, with solid computer skills. Passionate about continued professional development, with ambition to undertake certification in case management. Member of Michigan Nurses Association and National Commission of Correctional Health Care. Possesses RN license in Montana, Florida, and Michigan.

Chassell, Michigan 499176 906-***-**** ad2693@r.postjobfree.com LinkedIn

SKILLS & COMPETENCIES

Medicare Knowledge – Home Health Nursing – Utilization Management

Cost Savings Decision-Making Care Management & Coordination Internal Systems Navigation

Acute Care Delivery Nursing Informatics HIPAA & Local Regulations Compliance

Chronic Care Support Treatment Plans Funding Knowledge

Clinical Support Policy Writing Problem Solving and Critical Thinking

Clinical Criteria Program development Negotiation

Cost-Effective Health Care Services Community Resources Delivery Mobile Applications & Phone Calls

Accountability & Self-Management Analytical Thinking Collaborative Communication

PROFESSIONAL EXPERIENCE AND ACHIEVEMENTS

CVS Aetna Case Management

Nurse Case Manage

3/2023-6/2023 (temporary contract position)

Completing Dual Enrollment Assessments and Establishing Case Management for Members enrolled in Medicare and Medicaid. Case Management of high risk members until a permanent case manager is appointed.

Pinnacle Home Care

Home Health Nurse

11/22-1/22

Completing home health care visits for a Medicare certified agency. Including OASIS experience for starts of care, ROC, discharge, etc. Utilization of KanTime charting system.

Portage Home Health Care

Home Health Nurse

06/2022 – 11/2022 Houghton, MI

Provided one-to-one home health nursing care as responsive point of contact in Medicare accredited environment. Offered care of primary adult patients in home settings, ensured documentation in accordance with Medicare guidelines and confidentiality regulations, and delivered Outcome and Assessment Information Set (OASIS) assessments to determine reimbursement and measure quality in accordance with LHC group. Assessed patient needs and developed care plans in collaboration with physicians. Monitored patient responses to care and oversaw accurate case management. Trusted to conduct reviews and refer patients for further testing as needed. Performed physical assessment, administered medication, and tended to additional needs of patients as required.

Core Competencies: Cost Savings Support, Data Collection, Data Mining, Quality Assurance (QA), Workflow Management

Streamlined processes to transform accuracy of care plans; identified and removed redundant and inappropriate interventions from online system to reduce time spent and improve resulting percentage of goals accomplished

Department of Veterans Affairs

ERANGE Nurse

03/2012 – 03/2022 Hancock, MI

Served as Mental Health Intensive Case Management (MHICM) nurse for ERANGE program. Supported Veterans in their homes to effect positive life changes, manage mental health symptoms, and avoid psychiatric hospitalizations. Educated Veterans to access and utilize services, and provided guidance to staff regarding importance of provision and accessibility for psychiatric patients. Diffused agitated patients through cooperative communication strategies to minimize risk of injury.

Core Competencies: Utilization Management, Program Development, Policy development, Clinical Nursing,

Healthcare Management, Patient Care Management, Writing Appeals for Veterans

Developed ERANGE program in upper peninsula within VA guidelines; created policies for nursing that comply with VA guidelines and CARF standards to ensure patient safety, quality of care, and CARF accreditation

Decreased hospitalizations of medically and psychiatrically frail patients to reduce cost to employer; developed relationships with vulnerable individuals; performed accurate case management services to ensure needs were met

Assisted reluctant Veteran to secure emergency surgery and save limb; educated patient on current health system functions; communicated with Veteran support network and hospital performing surgery; organized transportation

OTHER RELEVANT EXPERIENCE

Supplemental Health Care, Rochester MN Travel Nurse, Psychiatric 05/2010-06/2010

State of Minnesota, Rochester, MN Psychiatric Registered Nurse 10/2009-12/2009

Golden Living Center of Rochester, Rochester, MN Unit Manager 12/2008-04/2009

US Bureau of Prisons, Rochester, MN Prison Nurse 12/2008-12/2008

Michigan Department of Corrections, Marenisco, MI Prison Clinic Nurse 11/2004-11/2008

Superior Home Care, Ontonagon, MI Home Health Nurse Case Manager 08/2001-10/2004

Northeast Michigan Community Services Agency, Alpena, MI Waiver Program Nurse 01/1998-06/2001

First American Home Care, Petoskey, MI Administrator 06/1995-10/1999

Community Mental Health, Petoskey, MI Crisis Residential & Outpatient Nurse 05/1997-04/1999

Bortz Health Care of Petoskey, Petoskey, MI Rehabilitation Coordinator 05/1992-05/1995

Assistant Director of Nursing 11/1989-05/1990

EDUCATION

Federal Corrections Certification (Academic Honors)

Federal Law Enforcement Training Center, Glynco, GA

BSN, Bachelor of Science in Nursing (3.0 GPA)

University of Phoenix, Troy, MI

ADN, Associate Degree in Nursing (3.49 GPA, Graduated Cum Laude)

Finlandia University, Hancock, MI

Certifications: Registered Nurse Licensure – Minnesota, North Carolina, Wisconsin, and Michigan State Operated Services Core Curriculum (2009, State of Minnesota); Advanced Cardiovascular Life Support (ACLS) (2008, State of Minnesota); Basic Cardiac Life Support (BCLS) current until 2024

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