Critical Care Case Managers
Resume:
WORK EXPERIENCE
Critical Care Nurse Liaison/Interim Payor Relations Specialist
Select Specialty Hospital - Cleveland, OH
May 2019 to Present
Remotely assess patients medical records to determine if healthcare needs meets critical care criteria required for critical care hospital. Educating Physicians and Nurse case managers on services provided at critical care recovery hospitals. Interact with patients and or primary family members in obtaining consent for treatment, answer questions and or educating on services provided at a Critical care hospital level of care, Implementation of marketing events for hospital account case managers. Service recovery with patients, and case managers as needed. Initiated precert authorization request with multiple major insurance companies. Completed billing and reimbursement forms for case managers to follow up with continue stay request.
Homecare Nurse
Just Like Family Homecare - Cleveland, OH
April 2008 to March 2019
• Provide skilled nursing assessments to Clients in their home setting • Arrange medical/non medical appt for clients as needed • Document services provided to MCR clients per Medicare rules and regulations • Implement healthcare referrals for current and potential clients • Implement weekly wellness clinics at Senior/Disability buildings • Assist interoffice staff with annual audits as requested • Communicate with Case managers of clients changes or concerns of clients as needed • Case manage clients needs holistically
Client Services Director
MedSource Home Health - Euclid, OH
February 2007 to April 2008
• Received/implement new admission intakes for home health services, and obtained Physician orders for services • Verify medical insurances, such as Medicare, Medicaid, Private Insurances, and HMO • Implement onsite clinical assessment on potential consumers at hospitals, skilled nursing centers, and in their private residents • Supervise Home health Aides (staff of 250), Staffing Care Coordinators, Human Resource Coordinator, Medical Records Clerk, and Payroll Clerk • Implement Employee Annual evaluations of those supervised • Obtain authorization for home health services from Medicaid HMO ANGELA T.
PETTIGREW-BELLE
Cleveland, OH 44120
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• Clinical Nurse Liaison • Case Manager • Admissions/Marketing Director • Utilization Review Nurse • Licensed Charge Nurse • Homecare Nurse
Authorized to work in the US for any employer
companies, Wellcare and Buckeye Community Health • Implement Passport, and Ohio Homecare waiver referrals for existing and potential clients as needed • Address consumer concerns/complaints • Implement skilled nurse visits as needed.
Passport Administrator, as of June 1, 2007 • Implemented supervisory visits per Western Area on Aging policy • Followed Clients care when admitted into hospital/ rehabilitation centers, communicating with DC Planners/LSW • Implemented and updated Client's Plan of Care • Communicate with Area on Aging Case managers any changes in client's condition or any significant changes • Implemented assessments on all new passports Clients in their setting • Supervised HHA/STNA providing services to passport Clients • Marketed Passport Case managers • Oversaw annual Passport audits with assistance from other Administrative staff
Wellness Director
Homewood Residence at Rockefeller Gardens
July 2006 to February 2007
• Supervised and managed Care Associates, staff of 40 • Audited Residents charts insuring annual history and physicals up to date in order to be in compliance with state regulations • Implemented personal service plans for new Residents, and updated plans for current Residents • Implemented incidents/exception reports on all Residents when applicable • Follow- up on Residents wellness appointments with PCP, and transcribed orders as needed • Addressed all concerns/issues with Residents and or responsible parties • Conducted weekly risk meeting with Key Associates • Collaborated with HR dept. administering mantoux test to all Associates and new Associates • Implemented bi-weekly shift schedule for all Care Associates within the Assisted Living building
Admissions/Marketing Director
HCR ManorCare of Mayfield Heights
February 2005 to July 2006
• Reviewed medical records of potential patients to determine if appropriate for admission into center • Verification of insurance benefits • Negotiated per diem rates with HMO/PPO case managers as needed • Provided tours of the facility • Ordered medical equipment prior to Patients admission into facility • Marketed facility throughout greater Cleveland, primary customer Physicians/Hosp. Discharge Planners • Trained key staff members on the admissions process, implemented quarterly • Held daily census meetings • Problem solved customer service issues with both Administrator and Director of Nursing • Physically assessed patients in home setting, and hospitals to determine if facility could meet needs • Implemented/developed Joint replacement program for the post acute ortho unit • Exceeded budgeted number of admissions/census within the region, and lead region census goals on several occasions Admissions/Marketing Director
Franklin Plaza Extended Care - Cleveland, OH
April 2000 to September 2001
• Completion of admissions paperwork • Physical assessment of patients at hospitals/healthcare settings for admission into center • Provided tours of the facility • Verified health insurance benefits • Negotiated per diem rates with insurance case managers • Held daily census meetings • Marketed facility throughout community • Introduced a formal sales and customer service training for key management personnel and front-line staff • Enhanced relationships with key healthcare professionals throughout Greater Cleveland area to create a regional referral base • Managed efforts of backup admission team to maintain 97% occupancy rate
Admissions/Marketing Director
Candlewood Park Health Care - East Cleveland, OH
November 1997 to April 2000
• Completion of Admissions paperwork • Physical assessment of patients at hospitals and other healthcare settings for admission into center • Provided tours of the facility • Verified health insurance benefits • Negotiated per diem rates with insurance case managers • Held daily census meeting • Held monthly marketing meeting • Enhanced relationships with key healthcare professionals throughout Greater Cleveland area to create a regional referral base Charge Nurse, Nurse Aide Program Instructor, Employee Health Clinic Nurse Grande Pointe Healthcare Community
September 1994 to November 1997
sister center to Candlewood Park Healthcare Center) Charge Nurse, Nurse Aide Program Instructor, Employee Health Clinic Nurse • Offered direct patient care to the geriatric population • Oversaw and administered patient medications/treatments • Monitored work performance of both state tested and non-state tested nurse aides • Provided training to non-state tested nurse aides to obtain state certification • Administered vaccinations to staff members and patients throughout the facility • Implemented health screens for the community bi-weekly
EDUCATION
RN degree
The College Network/Excelsior College
December 2003 to June 2007
Licensed Practical Nurse in Nursing
Cuyahoga Community College - Warrensville Heights, OH June 2007
None in Licensed Practical Nursing
Cuyahoga Community College/Jane Addams School of Practical Nursing August 1993 to August 1994
NURSING LICENSES
PN
Expires: August 2020
State: OH
SKILLS
Home Health
LPN
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Med Surg
Medical Surgical
Case Management
Nursing
Event Marketing
Critical Care Experience
CERTIFICATIONS AND LICENSES
LPN
ASSESSMENTS
Nursing Skills: Clinical Judgment — Familiar
February 2019
Measures a candidate’s ability to assess a patient's condition and implement the appropriate medical intervention. Full results: https://share.indeedassessments.com/share_assignment/fhov8daxnatttdcr Indeed Assessments provides skills tests that are not indicative of a license or certification, or continued development in any professional field.
ADDITIONAL INFORMATION
• Twenty-five years as a Licensed Practical Nurse
• Skilled with the Elderly in both a post-acute/rehabilitation, medical surgical, Dementia/Alzheimer's behaviors, long term care and home care settings
• Strong Interpersonal/communications skills with Patients/Residents, Colleagues, Hospital Discharge Planners, Social Workers, Nurse Case managers, and Physicians
• Experienced Train the Trainee
• Interim Clinical Manager for post acute unit
• Wellness Director
• 11 yrs experience in the homecare setting
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