Registered Nurse Case Manager
Resume:
Geraldine Bacon
*********@*****.***
Education
Registered Nurse- completed.
Maricopa Community College
Bachelor of Science in Business Management - completed.
Saint Columban College
Experience
RN Care Coordinator/Case Manager
Centene Corporation
October 2023- present
Remote
Resolve issues involving grievance/appeals, claims, authorization, and single case agreements.
Resolve any escalated complaints from various departments, denied authorizations and appeal rights.
Resolves pharmacy and medication issues.
Interacting with facilities that requires placement.
Resolve concerns about clinical coordination needs such as DME, explanation of benefits, and other clinical needs.
Coordinate between Primary care physicians, specialist, and other health care providers to meet member’s needs.
Outreach members for post hospital discharge needs.
Assist with unresolve complaints of members.
Assess member’s healthcare status, resource utilization, treatment, and provider options.
Assess past and present treatment plan, and short- and long-term goals.
Develop the plan of care design to meet member’s needs.
Provide member’s education.
Assist and provide community-based services available for members.
Support the member’s overall care management.
Participate in team care management rounds.
Enter clinical data, assessments, and other clinical information into appropriate medical system.
Assistant Director of Nursing
Brookdale Senior Living
September 2018 – October 2023
Apache Junction AZ
Responsible for assessing and coordinating face to face or telephonically to evaluate care needs for intake and routine assessment.
Completes initial care plan by utilizing interviewing/assessment skills to determine appropriate care needs.
Audits the medical chart information and audits documentation for accuracy.
Responsible for individualized care planning, revising care plan and data review for each patient for appropriate billing.
Conducts evaluation and collaborate with team members to develop interventions to address issues to facilitate patient’s medical needs.
Communicate with patients and their families about a patient’s health condition.
Responsible for completing admission process.
Coordination and participation in Quality Improvement and Risk Management programs, Collaborative Care Meetings and Family Care Conferences.
Communicates information to the appropriate agency regarding changes in patient’s health including health care providers, home health, hospice, and any other healthcare agency.
Implements timely problem solving, clinical judgment and ability to multitask in a fast-paced environment.
Oversee medication training, pharmacy management and medication supervision.
Provides training and education on an ongoing basis enhancing clinical experience, member engagement, and communication skills.
Health Service Manager
Heritage Village Senior Living
September 2017 - September 2018
Mesa AZ
Manage health service department and supervises care associates.
Work with health care providers and other health professionals to provide safe medication management program and care.
Provide staff training and supervision for proper care and medication administration to the residents in the community.
Staff hiring
Assess residents and validate that level of care is adequate.
Supervise and coordinate admissions, assessments, and care plans.
Implement quality improvement program for the community.
Communicate with resident's family members regarding resident’s needed health care services.
Conduct assessments for initial move-in and on-going of current residents.
Develop and maintain care service plan for each resident and review medical charts.
Med Surgical Nurse
Apache Junction Health Center
February 2017 - September 2017
Apache Junction AZ
Accurately administer prescribed medications as per physician's order, supervise the continuity of nursing care, and respond to changes in medical condition.
Participate in the admission of new patients, medical procedures & patient's discharge.
Respond to residents’ call lights promptly and courteously.
Assure that all resident records are accurate.
Enter physician's orders into electronic medical record.
Administer professional services and care of patients receiving specialized treatment administered.
Assist with the rehabilitation of patients according to the medical care plan.
Accounting Supervisor
Body and Brain Headquarters
January 2014-February 2017
Mesa AZ
Monthly & quarterly filing of sales and used tax for different states.
Creating monthly sales tax reconciliation and entering in the computer.
Communicate with agencies related to the company's income and tax matters.
Monthly auditing, keyboarding of income transactions and expenses for multiple locations
Monitoring bank balances and monthly bank reconciliations.
Computer skills in creating deposit checking file for several accounts.
Monthly reconciliation for regional debit expenses.
Creating multiple accounting related reports (workshop statement report, pending
income report, force sale report, income management report and complete penalty report) entering in the computer.
Providing back up support to accomplish work deadlines (urgent support).
Accomplishes accounting objectives by training, planning, scheduling, and monitoring center support.
Identifying system improvements and resolving problems.
Contact this candidate