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Patient Care Manager

Location:
Antioch, TN
Salary:
Open
Posted:
February 23, 2024

Contact this candidate

Resume:

Mary Robinson

*** ******* ***** *****

Antioch, TN 37013

ad3vgq@r.postjobfree.com

615-***-****

Certifications

•BLS

•ACLS

Work Experience

Travel Nursing

**/**-*******

Nashville General Hospital-Forensic Med Surgery 10/21-1/22

HCA Skyline Medical -Cardiac/Neuro/Nephrology 1/22-4/22

Trust point Hospital 4/22-8/22-Psyche Mental Health/Rehab

HCA Southern Hills 8/22-9/22

Monogram Healthcare

Nephrology Care Manager

November 2020-October 2021

Schedule regular meetings with all caregivers, doctors and specialists involved in a patient's care

Identify conflicts in patient care and make judgement calls as to the best path forward

Ensure all involved are up to date on the latest tests results and information

Maintain an information data stream on multiple patients

Oversee the implementation of a patient's medical plan

Identify problems ahead of time and initiate appropriate actions

Keep up to date and detailed records on all patients

Coordinate with other Care Manager to best fall inline with budget

Bethany Healthcare

Registered Nurse (PRN)

June 2020-Present

Assessing, planning, implementing, and evaluating patient care plans in consultation with healthcare professionals.

Evaluating medical information, as well as providing direct and individualized bedside nursing care to pre-and post-surgery patients.

Preparing, administering, and recording prescribed medications.

Allied Healthcare

Adjunct Faculty (Part-time)

March 2021-10/2021

They provide satisfactory education and nursing instructions to aspiring students.

Teach students modern concepts and techniques in the field of nurses.

Its main task is to lead and manage the students and making direct learning activities in the classroom, laboratory, and other field of learning.

They must also maintain the level of professionalism in all times.

Monitor the student’s attendance, grades and discipline some issues if necessary.

They must do the required forms such as: attendance, mid-term reports, grade reports, and student advising forms.

LPN instructors may provide students with academic support, tutoring and skills enhancement as necessary.

They should also prepare and organize lesson materials, equipment, and training area to have a teaching proficient.

South College University

Adjunct Faculty

October 2019-March 2021

•Develop appropriate academic lectures, labs, and other learning experiences that allow all students to achieve course objectives

•Submit an official grade sheet at the end of each quarter for each course taught.

•Monitor educational and professional literature for the best practices in areas related t

•courses taught.

•Assist with the development of curricular and policy changes as requested by .

•the Dean/Department Chair or Executive Vice President/Provost.

•Assist with the development of curricular and policy changes as requested by the Dean/Department Chair or Executive Vice President/Provost.

Cumberland Healthcare

Charge Nurse (PRN)

July 2019-May 2021

•Responsible and accountable for the nursing care function, activities and, development of the Certified Nursing Assistants in the unit.

•Assessed resident's condition upon admission and daily thereafter. Participated in the development, implementation, and evaluation of the plan of care.

•Communicated patient's condition to the physician. Noted and carried out physician orders.

•Administered medications and treatments as ordered by the physician following facility protocol...

•Responsible for maintaining documentation, which reflects health care needs of every patient, care and treatment provided, patient's response to care and treatment, and patient disposition.

True core Behavioral Solutions - Nashville, TN

Health Services Administrator

July 2018 to July 2019

•Developed and maintained electronic record management systems to analyze and process data. • Reviewed requests for expenditures and determined if such applications were justified and within budget.

•Monitored status of individuals with chronic health concerns.

•Consulted with healthcare professionals on business decisions.

•Assisted with regulatory issues such as compliance.

•Recruited, oriented and trained healthcare staff members.

•Created and implemented organizational policies and procedures.

•Provided in-depth support to the executive staff regarding healthcare programs and administration.

•Tracked and evaluated statistical data on healthcare activities to make effective program decisions.

LTC, Nashville Center for Rehab and Healing

Nurse Supervisor

January 2018 to August 2018

•Accomplishes nursing human resource objectives by selecting, orienting, training, assigning, scheduling, coaching, counseling, and disciplining employees, communicating job expectations. •

•Establishes a compassionate environment by providing emotional, psychological, and spiritual support port to patients, friends, and families.

•Maintains patient confidence and protect operations by monitoring confidential information.

Maintains documentation of patient and departmental records.

Nashville Metro Care and Rehabilitation

LTC Registered Nurse Supervisor

March 2017 to December 2017

•Provide direct nursing care to the residents and supervise the day-to-day nursing activities performed by nursing assistants.

•Perform administrative duties such as documenting nurses' notes, physicians' orders, discharge plans, dietary changes, reports, evaluations, and studies.

•Recognize and respond to changes in patients' conditions and document observations, outcomes.

•Order from pharmacy, prepare and administer medications as ordered by physician.

•Give and receive condition report from the on-coming and off-going shift.

•Monitor and update care plans each shift as appropriate.

•Maintain privacy and confidentiality of records, conditions and other information relating to patients, employees, and facility.

•Encourage an atmosphere of optimism, warmth, and interest in patients' personal and health care needs.

National College - Nashville, TN

Adjunct Instructor

May 2016 to December 2017

•Teaching undergraduate students in a specific field of expertise.

•Developing and managing the class syllabus and ensuring that the syllabus meets department and college standards.

•Planning and creating lectures, in-class discussions, and assignments.

•Grading assigned papers, quizzes, and exams.

•Assessing grades for students based on participation, performance in class, assignments, and examinations.

•Collaborating with colleagues on course curriculum.

•Advising students on how to be successful in class.

Staying updated on innovations and changes within their course field.

WellCare Health Plans, Inc

Case Manager

July 2016 to May 2017

•Provides authorization to facilities using standard clinical criteria guidelines in conjunction with clinical judgement to determine the needed care required within the patient's individualized created care plan.

•Initiates and continues direct communication with health care providers involved in the care of members.

•Interacts with treating physicians and health plan medical directors to evaluate medical treatment plan and assesses opportunities for optimizing clinical outcomes through referrals to specialty care programs or an alternate level of care.

•Documents clinical updates, authorizations and referrals in the health plan medical management system adhering to health plan documentation standards.

•Utilizing clinical judgment assesses and evaluates members at risk for complicated medical comorbidities, and/or repeat admissions potential and determines individualized care plan for communication and interventions to promote successful discharge and post-acute care treatment plan.

TriWest Healthcare Alliance - Nashville, TN

Care Coordinator

October 2015 to July 2016

•Coordinates discharge planning, completes necessary authorizations, and conducts post-service nursing calls.

•Conducts Utilization Management stay and inpatient reviews to assess medical necessity. • Researches and collaborates with appropriate community resources to support discharged beneficiaries.

•Prepares more complex cases for Medical Director and Peer Review.

•Collaborates with Medical.

•Director on decision-making.

•Utilizes clinical and analytical skills to identify and refers cases to Case Management or Disease Management as appropriate.

•Communicates with providers to develop plan of care.

•Conducts complex authorizations for beneficiaries in acute, residential treatment center, skilled nursing facilities, or long-term acute care hospitals.

Cumberland Health Care & Rehab

MDS Coordinator

July 2015 to October 2015

•MDS coordinators promote the physical and emotional well-being of nursing facility residents.

•I use a Resident Assessment Instrument (RAI) to gather information from residents and their families during initial and periodic interviews.

•Assures timely completion of accurate assessments and interdisciplinary care plans that meet Federal and State guidelines identifying resident acuity and needs, helping to determine specific care needs and communicating needs / expectations to families and responsible parties.

Nashville Community Care & Rehab

Quality Assurance Nurse

August 2014 to June 2015

Bordeaux

•Collaborate with the Nurse Director to develop an effective quality monitoring program.

•Provide QA training to all staff in order that quality actions are incorporated into their daily practice.

•Collect data related to assessments and assessments outcomes.

•Examine cases at random for completeness, accuracy, and consistency.

•Examines data for outliers and researches such cases.

•Analyze recommended scores in relation to Nurse Assessor determinations.

•Develops / completes reports that track and trend activities / outcome.

Blue Cross Blue Shield of South Carolina

Medical Reviewer III

December 2011 to August 2014

• Performs medical reviews using clinical/medical information provided by physicians/providers and established criteria/protocol sets or clinical guidelines using Medicare guidelines and ICD coding.

• Documents decisions using indicated protocol sets or clinical guidelines, utilization/medical review, quality assurance, utilize websites, teleconferences and focus groups.

• Provides support and review of medical claims and utilization practices.

Education

MSN in Clinical Nurse Specialist

Acute Care Liberty University

2010

Nursing

Chamberlain University - Downers Grove, IL

2008

Associate of Arts in Nursing

Deaconess College of Nursing - St. Louis, MO 2005



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