Home Health Care

Deborah S. Wilson

PH: 859-***-**** EM: *************@*****.***

Professional Summary:

OH Professional License, RN (Active/Unencumbered)

● MBA and BSN-prepared Registered Nurse with 20 years’ experience

● 14 years of experience in home health, Managed 25+ cases daily with Personal Touch Home Health Care

• Committed to compliance with strong leadership skills: held responsibility for front line direction of accurate, complete, and timely provision of quality patient care services in compliance with regulatory, operational and financial requirements with St. Elizabeth Health Care/DBA CHI Health

• Supervised staff of Registered Nurses, Physical Therapist, Occupational Therapist, PTA, OTA, Social Workers, and Home Health Aides; 15-20 direct reports with St. Elizabeth Health Care/DBA CHI Health

● Proficient in Oasis and Medicare guidelines

Professional Experience:

Tri Health Rehabilitation Hospital/DBA Select Medical 10/2017 – Present

Nurse Clinical Liaison-Payor Relations Specialist

•• Manages the pre-certification and prior authorization of referrals scheduled for admission to TriHealth Rehabilitation Hospital/Select Medical

•● Initiates and completes patient authorizations, ensuring each referral follows the process, from taking the initial referral until final disposition, acceptance, or denial

•● Obtains timely authorization of all patients requiring pre-certification and is accountable for conversion percentage and results

•● Ensures all policies governing commercial pre-certification and authorization are followed to minimize financial risk

•● Develops relationships that increase and stabilize conversion as well as generates referrals both locally and regionally

•● Serves as a member of the Business Development Team educating the team on payor preference to avoid backtracking, rework and increase customer service through an effective and efficient process

•● Evaluates Commercial benefits as verified by the Central Business Office and reviews benefits with Admissions Coordinator for possible risk and applies/completes written guidelines as necessary to reduce or manage risk

•● Completes billing and reimbursement and shares it with the Admissions Coordinator and Case Management

St. Elizabeth Health Care/DBA CHI Health 10/2016 – 10/2017 Manager Clinical Services

Held responsibility for front line direction of accurate, complete, and timely provision of quality patient care services in compliance with regulatory, operational and financial requirements

•• Supervised staff of Registered Nurses, Physical Therapist, Occupational Therapist, PTA, OTA, Social Workers and Home Health Aides; 15-20 direct reports

•• Monitored daily visits, approving of new MD orders, training and education

•• Completed compliance per Medicare guidelines for home health care

•Measured health outcomes against patient care goals

•• Made and recommended necessary adjustments

•• Documented patient care services

•• Provided patient assessment and coordinated plan of care to family members, friends and caregivers

•• Reviewed therapy notes

•• Audited plans to ensure diagnosis were appropriate

•• Charting: Charting episode included Discharge planning, Discharge set for

•• Case Manage for: history, diagnosis, hospitalization

•• Coordinate care and maintained communication with physician

Interim Home Health Care and IV Infusion 11/2002 – 02/2014

RN Transitional Care Manager & Case Manager – Skilled Nursing Facility

•• Field based case manager – performing visits to homes, clinics, nursing homes for Humana Senior Bridge

•• Coordinated admissions with Physician’s orders

•• Implemented all Plans of Care, decortications, and discharges

•• Reviewed medical records to ensure what was charted relates to diagnosis

•• Case Management for Chronic and Acute conditions including Cardiac, Diabetes and Dialysis

•• Chart auditing and Review to ensure medical necessity and appropriate level of care

•• Participated in Quality Assurance initiatives to ensure quality of care and to ensure patient is receiving the appropriate level of care

•• Provided patient assessment and coordinated plan of care to family members, friends, and caregivers

•• Created and implemented discharge plans for cardiac and geriatric with conditions like COPD, CHF, diabetes, and amputees

•• Provided complete and accurate documentation of patient’s condition and any changes in care of plans

•• Utilized EMR: OASIS, Microsoft Word, Excel, PowerPoint, outlook for all patient documentation

Education/Licensure:

MBA Health Care Management, Indiana Wesleyan University

Bachelor of Science Nursing, Indiana Wesleyan University

Register Nurse, The Christ Hospital College of Nursing

OH Professional License, RN (Active/Unencumbered)

Ky Professional License, RN (Active/Unencumbered)

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