Case Manager Home Health
Resume:
Murline Hicks-Winfield, RN, BSN
*** ********** **., *****, ** 30809
**************@*****.***
PROFESSIONAL EXPERIENCE
Hospice triage Nurse
Intellatriage
• Provide after-hours nurse triage for hospice and home health provider
• Utilize client-customized protocols for patient-centered care
• Work a minimum of 1 week day shift and every other weekend
• Access EMRs for charting and utilize internal applications for job functions Complete shift prep and remaining charting within designated timeframes Registered Nurse Case Manager
ProMedica Senior Care 1/22 - 1/23
• Performs initial and ongoing assessments including admissions and inpatient evaluations; identifies problems and needs; plans, implements, and evaluates nursing care of patients.
• Provides care in accordance to the established plan of care and in compliance with law
& regulation.
• Obtains periodic pay or reauthorization and/or recertification as requested.
• Consults and collaborates with the IDT and others involved in the patients care.
• Coordinates and participates in interdisciplinary team conferences to assure that team efforts effectively complement one another and support the objectives outlined in the interdisciplinary plan of care.
• Acts as a case manager assuming the responsibility of coordinating care; teaches and demonstrates care to patient/family fostering independence in self-care and using patient/ daily goals as criteria for evaluating responses and modifying treatment plan. Coordinates care with the Social Worker, Volunteer Coordinator, Spiritual Care Coordinator, Bereavement Coordinator, and therapists assuring appropriate implementation and follow through with the plan of care.
• Completes all patient documentation according to professional standards, regulatory requirements, and ProMedica policies; obtains information and signatures as needed to complete necessary forms.
• Supports the patients and family's unique spiritual and cultural beliefs.
• Provides holistic, family-centered care across treatment settings to improve the quality of life.
• Anticipates, prevents, and treats undesirable and/or secondary symptoms.
• Communicates changes in patients status with attending physician, hospice medical director, hospice staff members, and other agencies as needed to coordinate optimal care for the patient/family.
• Responsible for the direct supervision of the home health aide and provides any teaching in-service in the home to the home health aide.
• Keeps management informed of issues/concerns which may affect Hospice and/or the delivery of care.
• Shares in providing coverage to patients/families 24 hours a day/seven days a week.
• Participates in orientation and in-service training programs for professional staff.
• Remains current and in compliance with associated state and federal regulations, clinical practice standards, accrediting regulatory bodies, and Hospice and ProMedica policies.
• Demonstrates commitment to customer service.
Responds in a timely and effective manner to patient/customer service needs and CHRONIC CASE MANAGER, RN- remote 2/2016-12/2/19
Navcare, Augusta Ga
• Responsible for the coordination of Medicare, Medicaid and private insurance beneficiaries’ care, assuring the required elements of CCM and TCM are met. Oversees the coordination and facilitation of care transitions. Supervises Medical Assistants which are responsible for receiving patient data and enrolling patients for the appropriate services.
• Provides clinical expertise and oversight for chronic care management of patients.
• Documents all communication and coordination of patient contact in electronic documentation system including aggregation and clinical summaries. Assures documentation includes tracking and time-stamping to support billing for CCM and TCM.
• Completes and answers patient calls related to CCM/TCM activities.
• Is proficient in the use of the electronic documentation. Provides consultative support and training to staff in required elements, documentation and coordination.
• Assures the electronic comprehensive care plan is created and maintained accurately per Medicare Regulations and organizational policies and procedures.
• Establishes and maintains positive relationships with all internal and external customers. Acts as a liaison for assigned patients with client (physician office, facility, etc.).
• Responds to customer requests and concerns. Documents all concerns and follow-up and escalates to Director when appropriate.
UTILIZATION MANAGER – INPATIENT 4/2016 – 6/2017
United Health Care – Georgia Remote
• Performs telephonic medical necessity reviews utilizing established and evidenced based criteria on all designated pre-certification requests, as well as targeted outpatient procedures, services and inpatient admissions.
• Essential duties include but not limited to prospective review of outpatient and inpatient admissions and/or services; concurrent review and discharge planning for all member’s admitted to acute, sub-acute and/or skilled nursing facilities; retrospective review for services not pre-certified and/or reconsiderations.
• In collaboration with physician and healthcare team, facilitate appropriate resource utilization within contracted and non-contracted facilities.
• Evaluates eligibility and benefit information and educates member and/or family, physician and interdisciplinary healthcare team as to meet the health needs of the member and minimize out of pocket costs.
• Identify and refer appropriate members to case management, disease management, risk management and quality improvement.
• Establish relationships and communicate with members, family, inpatient and outpatient providers and case managers, community resources, skilled nursing staff, member’s service, claims, contracts, benefits, appeals, risk and quality management.
CASE COORDINATOR RN 6/2015 – 2/2016
University Extended Care, Augusta, Ga
• Responsible for assisting in coordinating the placement of patients.
• Develops and maintains effective communication and working relationships with members of the UEC community, UHS, and other referral services.
• Assist in arranging and facilitating post hospital service.
• Makes referrals and connects patients with supportive internal or community services as appropriate.
• Communicates in an appropriate, effective, and a timely manner.
• Participates in assigned committees to help maintain patients in the UEC community. PATIENT CARE COORDINATOR (remote position)
Universal American, Mechanicsburg, PA 8/19/2013-6/2015
• Perform ongoing assessments and facilitate follow up care in conjunction with the assigned patient’s primary care physician.
• Care coordination activities also includes reconciling medication and monitoring compliance, assessing home safety, mobility and assistance with activities of daily living, educating patients and caregivers on the disease process, and scheduling follow up appointments and coordinating transportation needs. Perform home visits, with verbal permission from patient and/or caregiver, for patient support, when appropriate.
• Prepare for and attend ACO committee meetings as assigned.
• Take calls from patients and providers and give them appropriate information to help coordinate services.
• Document all contacts in the care coordination documentation system. NURSE AUDITOR (remote position)
inVentiv Medical Management, Augusta, GA 5/2012-7/2013
• Reviewing medical records for accuracy of payment by verifying coding and billing.
• Applying medical necessity guidelines based on appropriate criteria using Milliman and Interqual while maintaining standards set for medical records review. (RAC nurse) PATIENT CARE COORDINATOR
Humana Military Healthcare Services, Augusta, GA 8/2011-5/2012
• Coordinated care for prime beneficiaries receiving care outside of the MTF.
• Monitored quality of care, identified, and documented any potential quality issues. Coordinated patient transfers and documents appropriately in MSR.
• Reviewed inpatient and outpatient cases, ensured appropriate and timely discharge planning, and referred to Tier III care management as needed.
HOME HEALTH NURSE/TRIAGE RN
Sta-Home Health and Hospice, Jackson, MS 10/2008-7/2011
• Home health nurse that administered skilled care to patient’s requiring intermittent professional services, and taught the family and other members of the health care team.
• My duty as a triage nurse was taking and processing after hours and weekend calls for Sta-home.
• I was responsible for taking calls from the answering service as well as HCHB support calls from visiting on call staff.
UTILIZATION REVIEW NURSE
Health Systems of Mississippi, Jackson, MS 7/2005-10/2008
• Determined what level of care was necessary and appropriate for patients within my direct area of responsibility.
• Performed utilization and concurrent reviews using Interqual criteria and approving bed days for inpatient stays.
PACU RN
Rankin Medical, Brandon, MS 7/2004-7/2005
• Monitored patients when they were still under the effects of anesthesia.
• This required being extensively trained in critical care and being certified in ACLS and BLS.
• Charge Nurse in the recovery room.
PACU RN (PRN)
River Oaks Medical Center, Flowood, MS 4/2003
• Monitored patients when they were still under the effects of anesthesia.
• This required being extensively trained in critical care and being certified in ACLS and BLS. SURGERY/PACU/ADMISSION RN
University Medical Center (Wiser), Jackson, MS 7/1/2003 -4/2003
• Monitored patients when they were still under the effects of anesthesia.
• This required being extensively trained in critical care and being certified in ACLS and BLS.
• As a surgical Nurse I had specialized training in surgical care.
• I worked within the context of the surgical team to provide care to individuals before, during, and after a surgical procedure.
EDUCATION AND TRAINING
Mississippi College, Clinton, MS
Bachelor of Science in Nursing, December 2001
Hinds Community College, Jackson, MS
Associates in Art, May 1993
LICENSURE
Registered Nurse in the state of Georgia Compact License, License number RN217376
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