Resume

Registered Nurse Care Manager

Location:

Stroudsburg, PA

Posted:

March 03, 2024

Contact this candidate

Resume:

EVIARNA TOUSSAINT, BA, RN, BSN, CCM

ad3233@r.postjobfree.com

929-***-**** Cell

EDUCATION:

Long Island University

Bachelor of Science - Nursing May 2004

Hunter College of the City of New York

Bachelor of Arts Human Movement Studies January 1995

Objective: Dedicated Registered Nurse with an impressive and consistent record of exceeding patient satisfaction and professional skills, looking to expand my career and knowledge with a reputable company. Experience in the areas of Med-Surgery, ER, MLTC, LHCSA, FIDA, Psychiatry, LTC Intake, and Home-Care inpatient and outpatient facilities.

Skills:

Excellent Patient Advocate. Critical Thinker. Able to work indecently with limited supervision

Assist with new hire training. Wound care.GT-Tracheostomy. Ventilation. Computer Skills; Proficient in Microsoft Word 2000, Microsoft Excel 2000, Microsoft WordPerfect 2000, Lotus 1, 2, 3, Access 97, PowerPoint 2000, McKesson, LICHEE, Case Trakker Dynamo, CITRIX, Outlook. Lenavi PRO Assessment Analyzer, Qualcode Assessment Analyzer, Point Click Care, Sigma, CCM Certified, and Guiding Care.

EXPERIENCE:

09/2022 - Present

VillageCare Max, Nurse Care Manager

Reviews all new admissions to identify patients where utilization review, discharge planning, and/or case management will be needed using standardized criteria to achieve optimal patient outcomes and appropriate reimbursement for the organization. Provide a comprehensive network of behavioral, psychiatric, educational, & community services to adolescents and older adults. Assure a comprehensive member care approach using the nursing process, as well as, psychiatric nursing practice theory & assisting in planning, implementing & evaluating of member services.

Collaborates with Physicians and other clinicians to expedite diagnostic testing, treatment, and consultations. Documents all clinical reviews. Assessment of the patient’s clinical, psychosocial, and functional status in collaboration with the interdisciplinary team. Implementation and coordination of specific activities, strategies, and interventions to move the patient through the continuum of care. Documentation of outcomes achieved and identified internal and external barriers.

Interacts with patient/family to discuss plan of care and coordination of services based on clinical needs and available resources.

05/2019 - 07/2022

Riverspring Health, Nurse Care Manager

Assessed, planned, and provided continuous care management across all venues of care, including hospital, sub-acute, long-term, and home settings. Assessed regularly, members for ongoing eligibility for services based on the specific plan’s eligibility criteria. Provided a comprehensive network of behavioral, psychiatric, educational, & community services to adolescents and older adults. Assured a comprehensive member care approach using the nursing process, as well as, psychiatric nursing practice theory & assisted in planning, implementing & evaluating member services.

Performed home visits as required every 6 months and as needed for MLTC, to assess members’ living situations, cultural influences, and functional and cognitive needs. Collaborated with the primary care physician and Interdisciplinary Team (IDT) to develop the Patient-Centered Services Plan (PCSP) for the member. Assessed members for services and provides authorizations according to the PCSP. Identified and presented members with complex care management needs or in difficult-to-manage situations at Intensive Care Management Meetings (ICM).

Documents any grievance according to plan policy. Responded to members’ requests in the designated timeframes and completed Initial Adverse Determinations (IAD) as indicated. Identified members requiring Care Management Review (CMR), evaluated documentation provided by the IDT including hospital or nursing home discharge planners, and formulated appropriate plans of care.

Responsible for providing care coordination including in-home assessment, planning, facilitation, advocacy, and authorization of covered plan services to meet the member’s health needs while promoting quality cost-effective outcomes.

11/2018 - 05/2019

Premier Home Care, UAS RN Assessment Nurse

Assessed consumer’s eligibility for long-term care services. Addressed members’ issues and provided teaching and direction. Provided a comprehensive network of behavioral, psychiatric, educational, & community services to adolescents and older adults. Assured a comprehensive member care approach using the nursing process, as well as, psychiatric nursing practice theory & assisting in planning, implementing & evaluating of member’s services.

Provided health teaching to the consumers and family to achieve optimum potential. Communicated effectively with a very diverse group of individuals. Able to work independently within a team environment. Provided referrals to other available programs, such as CDPAP, Social Day Center, and social work interventions. Educated consumers and families to promote self-care and self-advocacy. Identifies positive outcomes in terms of the quality, safety, and cost-effectiveness of health care needs.

10/2016 - 10/2018

Integra MLTC, RN Case Manager

Served as the communication link between the physician, members, and staff by conveying and documenting problems, changes/observations, and other essential information for 150 to 175 members. Provided a comprehensive network of behavioral, psychiatric, educational, & community services to adolescents and older adults. Responsible for the implementation of the nursing process in all aspects of member care.

Educated members on disease processes and encouraged members to make healthy lifestyle changes. Conducted Utilization review of Medicaid services, such as DME supplies, an increase of PCA hours, and Long-term care placement. Used evidence-based criteria and guidelines to ensure members receive the highest quality of care in the most appropriate setting. Retroactive claims review of medical services and for outlier payments.

Reviewed and coordinated prospective, concurrent, and retrospective activities related to utilization. Organized and coordinated activities within the organization by standards of State and Federal regulations; and following accreditation and other guidelines. Performed medical necessity reviews for selected procedures and services. Assisted in training and orientation of new RN nurse care managers.

11/2012 - 04/2017

Premier Home Care, Field RN Supervisor (Per Diem)

Served as the communication link between the physician, members, and agency staff by conveying and documenting problems, changes/observations, and other essential information.

Served psychiatric population, as well as dual diagnoses. Provided a comprehensive network of behavioral, psychiatric, educational, & community services to adolescents and older adults. Responsible for the implementation of the nursing process in all aspects of member care. Assured a comprehensive member care approach using the nursing process, as well as, psychiatric nursing practice theory & assisting in planning, implementing & evaluating of member’s services.

Developed a complete plan of care based on the assessment of member’s needs. Initiated and monitored respective reimbursements within the agency, local, state, federal, and JCAHO standards and obtained required authorizations to ensure services. Supervised personal care aides, and field staff in the coordination of home care services to maintain JCAHO standards and state, federal, and Medicare guidelines.

11/2015 - 10/2016

Bayview Consulting, UAS RN Assessment Nurse

Assessed consumer’s eligibility for long-term care services. Addressed member’s issues and provided teaching and direction. Provided health teaching to the members and family to achieve optimum potential.

02/2015 - 08/2015

Preferred Home Care, Far Rockaway, NY

Lead Nurse Care Manager Supervisor, Psychiatric Adult Day Care Facility

Assessments implemented and determined and evaluated individualized member’s care plans for appropriateness of and acceptance of private home health services.

Provided a comprehensive network of behavioral, psychiatric, educational, & community services to adolescents and older adults. Responsible for the implementation of the nursing process in all aspects of member’s care. Assured a comprehensive member care approach using the nursing process, as well as, psychiatric nursing practice theory & assisting in planning, implementing & evaluating of member’s services.

Provided services requiring skilled nursing care services. Provided health teaching to the members and family to achieve optimum potential. Assured that progress reports are made to the physician, as well as reviewed plan of care in consultation with the physician. Responsible for supervising and teaching other nursing personnel HHA and PCA. Provides authorization of health care services, as well as DME supplies.

02/2015 - 08/2015

HouseCalls HomeCare, Queens, NY, Field Nurse Supervisor (Part-Time)

Served as the communication link between the physician, members, and agency staff by conveying and documenting problems, changes/observations, and other essential information. Served psychiatric population, as well as dual diagnoses. Provided a comprehensive network of behavioral, psychiatric, educational, & community services to adolescents and older adults. Assured a comprehensive member care approach using the nursing process, as well as, psychiatric nursing practice theory & assisting in planning, implementing & evaluating of member’s services.

Developed a complete plan of care based on an assessment of member’s needs. Initiated and monitored respective reimbursements within the agency, local, state, federal, and JCAHO standards and obtained required authorizations to ensure services. Supervised personal care aides to ensure that care is being provided to the members. Supervised field staff in the coordination of home care services to maintain JCAHO standards and state, federal, and Medicare guidelines.

07/2014 - 01/2015

Parker Jewish, AgeWell New York, Lake Success, NY

Nurse Care Manager, Managed Long Term Care Plan (MLTC)

Advocated for member's well-being, and served as a liaison between patients, their families, and healthcare providers. Coordination of home care services, case finding, screening, eligibility, and determination. Provided a comprehensive network of behavioral, psychiatric, educational, & community services to adolescents and older adults. Assured a comprehensive member care approach using the nursing process, as well as, psychiatric nursing practice theory & assisting in planning, implementing & evaluating of member’s services.

Assessed member’s conditions and needs to develop and personalized an individualized care plan. Evaluated and updated care plan on an as-needed basis. Reviews and coordinates prospective, concurrent, and retrospective activities related to utilization. Monitors documentation for accuracy and clinical compliance. Identifies positive outcomes in terms of the quality, safety, and cost-effectiveness of health care needs. Excellent critical, listening, and thinking skills, as well as decision-making and problem-solving skills. FIDA and Medicare trained.

07/2012 - 09/2014 Healthfirst, NY, NY, UAS Reassessment Nurse

Conducted home/facility visit(s) for comprehensive health reassessments regarding clinical, behavioral, and home safety requirements on existing members. Assessed member’s safety in the home setting.

Conducted intake assessment as well of auto-enrolled cases, in conjunction with the PCP and member’s needs. Assessed short-term and long-term needs and established case management objectives. Interacted continuously with members, families, physician(s), and other providers utilizing clinical knowledge and expertise to determine medical history and current status. Acted as a liaison and member advocate between the members/families, physicians, and facilities/agencies. Coordinated community resources with emphasis on medical, behavioral, and social services.

8/2010 - 05/2012 Center Light Health Care, NY, Membership Development/Intake RN

Conducted home visits to educate applicants, families, and/or applicant’s caregivers on program benefits and design. Identified applicants’ health care needs and completed medical assessment of applicants. Responsible for assessing eligibility and safety of members in the home setting.

Provided a comprehensive network of behavioral, psychiatric, educational, & community services to adolescents and older adults. Assured a comprehensive member care approach using the nursing process, as well as, psychiatric nursing practice theory & assisted in planning, implementing & evaluating member services. Collaborated with other members of the Intake team in decision-making regarding members’ eligibility for the program and formulation of a plan of care. Utilized the company’s designated criteria along with clinical knowledge to develop a personalized plan of care. Conducted appropriate care plans based on health assessments with health care providers, members, and caregivers. Collected information concerning eligibility, provider status, benefit coverage, and coordination of benefits. Assisted in training new agency staff.

03/2007 – 08/2011 Remede Staffing, Inc. Queens, NY, Emergency Room – RN

Responsible for attending to, and monitoring patients in the Emergency room. Directly responsible for the delivery of medications, wound care, treatment, and education. Duties include assessment, evaluation, and monitoring in the Emergency Department. Provided care to Long-term care patients and Re-hap, as well as patients on ventilation

04/2007- 01/2008 Lincoln Hospital, Bronx, NY, Registered Professional Nurse

Provided professional registered nurse services to patients from admission to discharge. Duties include assessment, evaluation, and monitoring in the Emergency Department. Supervised and directed staff in the delivery of care. Provided individualized interdisciplinary care so that appropriate outcomes for patients are achieved promptly.

Planned nursing care for patients, based on identified problems, and needs as appropriate to the ages of patients served. Transcribed physician orders accurately. Evaluated patient response to achieve a therapeutic outcome. Recorded discharge summary of nursing intervention, teaching, and patient comprehension.

06/2006 - 01/2007

Americare, CSS CHHA, Brooklyn NY, Registered Nurse Case Manager

Served as the communication link between the physician, patient, and agency staff by conveying and documenting problems, changes/observations, and other essential information for 50 to 85 patients. Provided a comprehensive network of behavioral, psychiatric, educational, & community services to adolescents and older adults. Assured a comprehensive member care approach using the nursing process, as well as, psychiatric nursing practice theory & assisting in planning, implementing & evaluating of member’s services.

Developed a complete plan of care based on an assessment of the patient’s needs. Plan of care updated and verified as needed promptly. Initiated and monitored respective reimbursements within the agency, local, state, federal, and JCAHO standards and obtained required authorizations to ensure services.

Participated in case conferences with all disciplines to convey information to the interdisciplinary team. Supervised field staff in the coordination of home care services to maintain JCAHO standards and state, federal and Medicare guidelines.

01/2004-4/2006

On Time Agency, Queens, NY, Registered Nurse Coordinator

Provided assessment of new health care needs of referred patients and eligibility for home care services. Provided patients and families teaching from admission to discharge, as well as on an ongoing basis.

Certifications & Licensure:

Registered Professional Nurse- RN, NY and PA

NYS UAS certified, Basic Cardiac Life Support, ACLS, PALS, PRI Screening and Training. Milliman’s Care Guideline trained, CCM Certified and CPI Training.

Skills:

Bilingual in French, Creole, conversational in Spanish

Proficient in Microsoft Word97, Microsoft Excel 97, Microsoft WordPerfect 2000, Lotus 1, 2, 3, Access 97, Power Point, McKesson, LICHEE, CITRIX, Microsoft Outlook, Care Compass, Lenavi and Qualcode Analyzer.

Contact this candidate