Case Manager Utilization Review
Resume:
Ellavese Rolle
Registered Nurse/Utilization Review/Case Manager.
*** ***** ** **** *** Florida.32909.
ad32b7@r.postjobfree.com
Objectives
A challenging position that utilizes my skills and experiences.
A highly motivated health professional with extensive clinical and management experiences.
Strong organizational skills with time management abilities.
Excellent Personal and communicational skills.
Ability to adjust priorities quickly based on facility needs.
Work Experiences.
RN -Case Manager/Utilization Review-Remote.
October 2020-present.
Sebastian River Medical Center.
Remote Utilization Review-Monitoring Observation patients.
Initial and continued stay review, utilizing InterQual criteria based on CMS guidelines.
Faxing clinicals to insurance companies post notification to payor.
Communicating with Physician Advisor regarding questionable status and continued stay.
Participating in interdisciplinary rounds twice daily regarding patient’s care plan.
Close monitoring of Observation patients, adjusting status as necessary based on changes in status.
Collaborating with registration regarding patient’s status change.
Ensuring appropriate status for planned outpatient procedures.
Adjusting status based on change in condition. Example: Outpatient in a bed converted to Observation or Inpatient.
Facilitate preceptorship program for new InterQual users.
RN-Case Manager
All nursing units.
December 2019-October 2020.
Initial assessment of new patients within 24 hours of admission thus determining possible discharge needs.
Participating in interdisciplinary rounds twice daily.
Constant communication with physicians, therapist,pharmacist and nurses regarding treatment plan as required.
Obtaining orders from physicians to adjust patients’ status based on change in condition.
Communicating with family members as required regarding plan of care.
Obtaining consent(s) from patients for home health companies, rehabilitation facilities, ALF and equipment based on insurance plan.
Referrals to Home Health companies, Assisted Living Facilities, acute and Sub acute rehabilitation facilities.
Facilitate transfers to high level of care,acute and subacute rehabilitation centers.
Hospice referrals as ordered.
Arranging intravenous home antibiotics.
Collaboration with CM Director and Hospitalist Director in identification of barriers associated with advancing plan of care and discharge to appropriate level of care.
RN Staff Nurse -Psychiatric Institution.
Cleveland Clinic Indian River Behavioral Health.
Vero Beach FL.
August 2017 to December 2019.Treatment as orders.
Admission assessment and documentation.
Administering treatment as orders.
Ensuring patient has no contrabands.
Referral to other specialties based on patient’s specific needs.
Participating in interdisciplinary rounds.
Adjusting care plans as ordered by attending.
Initial and continued stay reviews
Close monitoring of patient under suicide watch.
Close monitoring of patients who are in isolation.
RN Staff -Sub acute Care facility-PRN. All units.
Indian River Estates.
Melbourne FL.
February 2014- November 2019.
Physical assessment completion and documenting same in chart.
Transcribing orders.
Administering medication.
Assisting in personal hygienic needs.
Assisting therapy in ambulating patients.
Completing dressing change.
Transferring patients to acute care facility as needed.
Involving family members in changes in plan of care.
RN. Utilization Review Case Manager-Emergency Department/ICU/PCU.
Cleveland Clinic Indian River Medical Center.
Vero Beach FL.
February 2014-August 2017.
Initial and continued stay review, utilizing InterQual criteria.
Faxing clinicals to insurance companies.
Communicating with Physician Advisor regarding questionable status and continued stay.
Participating in interdisciplinary rounds twice daily regarding patient’s care plan.
Close monitoring of Observation patients, adjusting status as necessary based on changes in status.
Collaborating with registration regarding patient’s status change.
Ensuring appropriate status for planned outpatient procedures.
Adjusting status based on change in condition. Example: Outpatient in a bed converted to Observation.
Arranging air ambulance transport in the United States and Canada.
RN. Utilization Review Case Manger-Emergency Department
Osceola Regional Medical Center -Kissimmee FL.
Oncology department/Open Heart Center/Observation Unit.
May 2009 -December 2014.
Observation management in Emergency room.
Obtaining orders from attending to convert if necessary.
Completing initial and continued stay review based on InterQual criteria.
Fax clinicals to the insurance company.
Communicating with Physician Advisor regarding questionable status and continued stay.
Participating in interdisciplinary rounds twice daily regarding patient’s care plan.
Obtaining orders from physicians to adjust patients’ status based on change in condition.
Communicating with family members as required regarding plan of care.
Obtaining consent(s) from patients for home health companies, rehabilitation facilities, ALF and equipment based on insurance plan.
Referrals to Home Health companies, Assisted Living Facilities, acute and Sub acute rehabilitation facilities.
Facilitate transfers to higher level of care, acute and subacute rehabilitation centers.
Hospice referrals as ordered.
Arranging intravenous home antibiotics.
Ensuring follow up care is arranged prior to discharge.
RN- Home Health Nurse -Community Home health PRN.
2009-2010
Home Visit on assigned patient in a timely manner.
Evaluating home potential fall risk and advising patient of same.
Evaluating medication lists and ensuring compliance.
Ensuring medications are available.
Discussing disease process with patient and ensuring they have their scheduled appointment made.
Developed a teaching plan based on patient’s disease process.
Dressing changes as ordered.
Communicating with manager & attending with any changes in patient’s status especially if there is a potential for specialty referral or emergency room visit.
Calling 911 if necessary for emergency room evaluation with the manager and attending’s permission.
RN-Utilization Review/Case Manager-ICU/PCU/Oncology/Orthopedic/Neurology/Emergency Room
Indian River Medical Center
Vero Beach FL.
October 2006 – May 2009.
Obtaining orders from attending to convert if necessary.
Completing initial and continued stay review based on InterQual criteria.
Fax clinicals to the insurance company.
Communicating with Physician Advisor regarding questionable status and continued stay.
Participating in interdisciplinary rounds twice daily regarding patient’s care plan.
Obtaining orders from physicians to adjust patients’ status based on change in condition.
Communicating with family members as required regarding plan of care.
Obtaining consent(s) from patients for home health companies, rehabilitation facilities, ALF and equipment based on insurance plan.
Referrals to Home Health companies, Assisted Living Facilities, acute and Sub acute rehabilitation facilities.
Facilitate transfers to high level of care,acute and subacute rehabilitation centers.
Hospice referrals as ordered.
RN Utilization Review /Case Manager -All Units including Emergency Room.
Jupiter Medical Center.
Jupiter FL.
August 2004-October 2006.
Obtaining orders from attending to convert if necessary.
Completing initial and continued stay review based on InterQual criteria.
Fax clinicals to the insurance company.
Communicating with Physician Advisor regarding questionable status and continued stay.
Participating in interdisciplinary rounds twice daily regarding patient’s care plan.
Obtaining orders from physicians to adjust patients’ status based on change in condition.
Communicating with family members as required regarding plan of care.
Obtaining consent(s) from patients for home health companies, rehabilitation facilities, ALF and equipment based on insurance plan.
Referrals to Home Health companies, Assisted Living Facilities, acute and Sub acute rehabilitation facilities.
Facilitate transfers to high level of care, acute and subacute rehabilitation centers.
Hospice referrals as ordered.
RN-Charge Nurse- Orthopedic floor
Good Samaritan Medical Center
West Palm Beach FL.
August-1996-0ctober 1999.
Obtaining report on all patients in the unit from off going charge nurse.
Assignments of other staff members to patient care.
Rounding with physicians and adjusting treatment plans based on orders from attending.
Ensuring appropriate staffing while lunch break is implemented.
Listening to all complaints from staff patients and family. Determining the most appropriate steps in resolution of situation once discussed with manager.
Contacting staff off duty if there is a call out of expected oncoming shift.
RN-Staff Nurse-All Units
Palm Garden/Noreen McKeen- Skilled Nursing facilities-PRN.
West Palm Beach FL.
June 1996-September 2003.
Directing other staff in continuity of care.
Physical assessment completion and documenting same in chart.
Transcribing orders.
Administering medication.
Assisting in personal hygienic needs.
Assisting therapy in ambulating patients.
Completing dressing change.
Transferring patients to acute care facility as needed.
Involving family members in changes in plan of care.
RN -Case Manager/Utilization Review-Emergency Department/Orthopedic/Medical Surgical/Neurology.
Good Samaritan Hospital/St Mary’s Hospital.
West Palm Beach FL.
June 1999-October 2004.
Obtaining orders from attending to convert if necessary.
Completing initial and continued stay review based on InterQual criteria.
Fax clinicals to the insurance company.
Communicating with Physician Advisor regarding questionable status and continued stay.
Participating in interdisciplinary rounds twice daily regarding patient’s care plan.
Obtaining orders from physicians to adjust patients’ status based on change in condition.
Communicating with family members as required regarding plan of care.
Obtaining consent(s) from patients for home health companies, rehabilitation facilities, ALF and equipment based on insurance plan.
Referrals to Home Health companies, Assisted Living Facilities, acute and Sub acute rehabilitation facilities.
Facilitate transfers to high level care,acute and subacute rehabilitation centers.
Hospice referrals as ordered.
RN-Charge nurse/Preceptor-Orthopedic/Neurology
Mt. Sani Medical Center.
Miami Beach FL.
December 1993-August 1996.
Preceptorship program for new nurses.
Rounding with attending physician
Transcribing orders as per physicians.
Contacting physician regarding changes in patient’s condition or abnormal laboratory or radiology testing.
Directing other staff in code procedures.
RN-Charge Nurse-Sandilands Psychiatric/Gerontology.
Nassau Bahamas.
December 1977- October 1990.
Admission assessment and documentation.
Administering treatment as orders.
Ensuring patient has no contrabands.
Participating in interdisciplinary rounds.
Adjusting care plans as ordered by attending.
Close monitoring of patient under suicide watch.
Close monitoring of patients who are in isolation.
RN- Charge Nurse-Medical Surgical Floor/Pediatric/Orthopedics
Princess Margaret Hospital
Nassau Bahamas.
October 1990-December 1993.
Physical assessment completion and documenting same in chart.
Transcribing orders.
Administering medication.
Assisting in personal hygienic needs.
Assisting therapy in ambulating patients.
Completing dressing change.
Transferring patients to acute care facility as needed.
Involving family members in changes in plan of care.
Directing care administered by other staff.
Education
RN Nursing Compact state License.
Associate Nursing Degree.
Nassau Bahamas
Expires: July 2024.
Bachelor of Nursing.
Grand Canyon University.
Actively pursuing Case Management Certification.
Skills
Microsoft programs.
Microsoft Excel.
Call center participation.
Collaborative Care.
Midas.
EMR.
ICD-10
Millman & Robertson.
InterQual.
Managed Care Insurance plans.
Remote Case management.
Appeal denials.
Meditech.
References
Available upon request.
Contact this candidate