Care Management Medical Director

Kawanda Reid-Hamilton LPN

Maryland Heights, MO **043 C: 314-***-**** perpetualhome01@gmail

PROFESSIONAL SUMMARY

I have experience in managed care serving Medicaid, Medicare, and the commercial insurance population. My leadership skills are strong as I have been in supervisory and management positions.

SKILLS

CareWeb QI, IDX, QNXT, Inter Qual (Care Enhanced by Provider Portal, Propat, Profax, Encoder Pro, Ionxy, RX

McKesson,) America, Cisco, Microsoft, UNK2, Amysis, phone and fax queues, Outlook, Teams, Excel, Word, VSeem Microsoft, WebX, Video Zoom, Covid Swabbing Machine, Teams, Duo, Infinity Infusion Pumps, Bivona Trachs, all ADL’s and personal care, Point Click Care, Team Link, PDPM, OBRA, Care Management Strategies, Weekly Care Management Meeting, AIMS, UDA’s

WORK HISTORY

Crystal Creek Nursing and Rehabilitation St. Louis, MO 4/26/2023-Current

MDS Coordinator

In this management position I am responsible for following the RAI process, assessing residents behavioral, psychological, clinical, nutritional, and physical strengths. Developing care plans, follow OBRA schedule, admission UDA, readmission entry MDS’s. I work closely with nursing, therapy, dietitian and the medical director. Attend CMI meetings, triple check, IDT meetings, care management strategy meetings, daily clinical and managing the restorative therapy department

Perpetual Health Development Career Center CNA School 2019-Current

CNA Clinical Supervisor

Manage and teach nurse assistants to become CNA in the state of MO. Teaching the appropriate and approved way to

perform all ADL’s to care for the elderly residents in LTC facilities.

Maxim Healthcare Staffing Agency 12/2022-Current

Private Duty Nurse

I go into patients’ home and provide total care, providing clinical documentation, g-tube care, trach care, perform all ADL’s, communicate effectively with the patients, families and physicians.

Utilization Review Nurse-In person and remote July 2014 to November 2022

Aetna Better Health of Missouri - St. Louis, MO and Phoenix AZ

Coordination of decisions for all services requiring medical necessity reviews. Communicate with medical directors, management, physicians, office staff and members to assist with providing the best care for members. Conducted daily review of authorization request for outpatient services, inpatient request, DME, medication management, and home health services. Additional duties include review the case management inbox, provider portal, review claim cases, assist with training new employees, and test/ trial of new systems, department policies, and programs. Educate providers on utilization and medical management processes

Provide clinical knowledge and act as a clinical resource to non-clinical team staff Enter and maintain pertinent clinical information in various medical management systems. Worked in phone and fax queues.

Molina Health Care of Missouri – St. Louis, MO 8/2008 to 3/2012

Utilization Review Nurse

Provided Coordination of decisions for all services requiring a medical necessity review including:

inpatient and outpatient hospital services, diagnostic imaging, out of network services, high cost medication and

injectable drugs, and the holistic care for all my members on the insurance side. Interact with the medical director for Molina Health Care and communicate with providers in a professional manner to ensure the delivery of high quality, cost effective healthcare. Utilize clinical skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations. Responsible and proficient in communication, leadership, keyboard skills, and the ability to navigate through multiple computer systems at once while operating on dual screens. Worked in phone and fax queues.

North Gate Park Nursing Center 09/2008 to 02/2009

Charge Nurse/Wound Care Nurse Supervisor

Responsible for the care of 40-50 patients through the direct supervision of 4-5 CNA's and 1 CMT, encompassing:

administering medications, vital signs, IV therapy administration, oxygen therapy, tracheotomy /colostomy care,

catheter insertion, caring for dialysis patients pre-post procedure, and g-tube care

Operates as the wound care nurse, changing dressings an applying wound vacs, taking preventive measures,

communicating with outside entities, complete weekly wound reports, continuously assess patients hydration status,

food consumption, medications, lab results, and healing process.

EDUCATION

High School Diploma: 1990

Arcadia Valley High School - Ironton, MO

Nursing, perquisites for the RN program

Mineral Area Community College - Farmington, MO

Nursing, 2004 IV Certified LPN

Applied Technology School of Nursing - St. Louis, MO

Nursing, perquisites for the RN program

Florissant Valley Community College - St. Louis, MO

ORGANIZATIONS

Aetna Better Health Missouri AAERG 2015-2021

Aetna Better Health Missouri Culture Club Committee 2015-2021

Aetna Better Health Missouri Aetna Toastmasters VP, Membership 2016-2021

Black Nurses Rock 2019-2021

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