Case Manager Rn
Resume:
Gracie N. Joseph, RN
RN Case Manager
*********@*****.*** • 347-***-****
Millerton, NY 12546, US
Experience and dedicated Registered Nurse with a proven track record of providing comprehensive care coordination and management for patients. Proficient in assessing patient needs, developing individualized care plans, and coordinating healthcare services to optimize outcomes. Skilled in collaborating with interdisciplinary teams, advocating for patients, and ensuring adherence to treatment plans. Committed to delivering high-quality, patient-centered care while promoting positive health outcomes. Strong communicator with a passion for delivering quality, patient-centered care in remote settings.
Areas of Expertise
● Case Management
● Patient Assessment
● Care Coordination
● Healthcare Management
● Patient Advocacy
● Utilization Review
● Patient Education
● Quality Improvement
● Regulatory Compliance
Professional Experience
Private Duty Nurse, New York, NY
Registered Nurse November 2023 Present
Conduct comprehensive assessments. Assist with in-home patient care by providing medication education, medication administration, monitor vital signs, take blood pressure readings, assess physical and emotional needs of the patient, document significant medical changes and communicate with the patient’s medical providers as necessary.
Improved safety of home environment.
Increased patient’s ability to adhere to medication regimen
Metroplus Health, New York, NY
Utilization Management Nurse
January 2021 — October 2023
Assess, plan, and implement healthcare services for members by leveraging clinical expertise and collaboration. Apply clinical criteria, guidelines, and judgment to determine coverage and make recommendations throughout the care process. Facilitate communication with providers and stakeholders to support seamless care delivery. Identify referral opportunities and integrate members with relevant products, services, and programs. Analyze medical service necessity to ensure adherence to established healthcare guidelines. Enhance patient care by optimizing authorization procedures. Evaluate patient records, treatment plans, and histories to ensure adherence to healthcare standards. Work closely with healthcare providers to improve patient care tactics and control expenses.
●Enhanced communication with physicians to facilitate effective care delivery and decision-making.
●Promoted quality effectiveness of healthcare services and consult on benefit utilization.
●Expedited critical reviews, meeting stringent timelines for patient service authorization.
Hospital for Special Surgery, New York
RN Case Manager/Utilization Review
January 2018 — March 2021
Conducted comprehensive clinical reviews by national guidelines, ensuring timely communication with third-party payers. Advocated effectively for clients, facilitating their safe and appropriate progression along care continuum. Secured prior authorizations for inpatient rehabilitation services and durable medical equipment, demonstrating a keen understanding of payer requirements. Educated clients, families, and caregivers on case management processes, verifying comprehension for safe transitions. Assessed client needs against current services and resources, connecting them with necessary support to achieve established goals.
●Acted as a Member of QA/PI Committee's processes, enhancing overall quality assurance and performance improvement efforts.
●Recognized for exceptional problem-solving skills, frequently called upon by management to handle complex patient cases.
Memorial Sloan Kettering Cancer Center, New York July 2016— November 2017
RN Case Manager
Completed comprehensive and complex care plans daily to direct interventions and desired outcomes for hospital stays. Ensured clients were transitioned to the next level as quickly as possible once they no longer met the clinical criteria for acute care. Proficient in assisting clients at end of life to transition to home hospice and inpatient hospice. Secured prior authorizations for inpatient rehabilitation services and durable medical equipment.
Served as an advocate for patients and family and ensured that the client’s movement along the continuum was safe and appropriate.
NYU- Lutheran Medical Center, Brooklyn NY
RN Case Manager/Utilization Review
August 2013 — July 2016
Developed comprehensive care plans daily to direct interventions and desired outcomes for hospital stays. Expedited patient transitions to subsequent care levels upon meeting clinical criteria. Conducted thorough reviews of patient records to verify accuracy and reflect actual care provided. Negotiated with third-party payers to secure necessary authorizations for inpatient rehabilitation and medical equipment. Addressed and resolved delays in patient care processes to maintain a steady flow within the healthcare system.
●Effectively managed patient complaints, enhancing satisfaction and care experience.
●Obtained prior authorizations efficiently, facilitating uninterrupted patient care and resource allocation.
●Assessed and planned healthcare needs meticulously, ensuring timely patient transitions and high-quality care continuity.
Lutheran Family Health Center, Brooklyn NY
Registered Nurse
May 2012 — November 2013
Led HIV Committee initiatives, streamlining pre-visit planning and patient outreach for optimized medication management. Coordinated patient triage and flow, ensuring efficient daily operations. Educated patients and parents on vaccination benefits and post-immunization care. Provided comprehensive prenatal and postpartum guidance, promoting safe maternal practices. Implemented motivational interviewing techniques to foster diabetic patient lifestyle improvements and self-management.
●Championed lead Nurse role within HIV committee, significantly improving patient care protocols and outcomes.
●Supervised medical assistants and LPNs, ensuring adherence to health center standards and quality patient care.
NYU-Lutheran, Brooklyn, NY
Registered Nurse (Medical- Surgical)
March 2009 — May 2012
Conducted comprehensive patient assessments to ensure high-quality care and patient safety in a Medical-Surgical environment. Administered a range of medications, including IM, Sub Q, IV, and PO, adhering to best practices and patient needs. Managed care for critical care patients, including those on cardiac monitors and ventilators. Performed specialized post-operative care, including Tracheostomy care using sterile techniques and drawing blood from arterial and central lines. Ensured accurate interpretation of six-minute ECG rhythm strips and demonstrated expertise in establishing intravenous lines.
●Nominated for Nurse of the Year in recognition of exceptional patient care and dedication to nursing excellence.
●Certified in post-operative patient care, contributing to the recovery and well-being of surgical patients.
Education
Bachelor of Science in Nursing, July 2008
Johns Hopkins University School of Nursing
Bachelor of Arts in Psychology, May 2006
Long Island University
Licenses & Certifications
PRI & SCREEN Certified
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