Case Management Registered Nurse
Resume:
Summary of Qualifications
Accomplished and results oriented Registered Nurse with 29 years of diverse clinical and operations experience, including 20 years of management experience. Solid foundation of qualifications in clinical health care management, customer relations, excellent time management, administrative skills and technology literate.
Professional Experience
Sheakley- CINCINNATI, OH May 2016 - Current
Case Management Team Leader
Oversees day to day case management procedures and acts a resource for Case Managers.
Oversees development, coordination and implementation of orientation and in-services for the case management staff.
Designated Compliance officer responsible for overseeing compliance program.
Oversees clinical, policy and procedural training for all clinical and non-clinical staff for case management services provided.
Responsible for oversight of clinical decision-making aspects of the case management program
Development of clinical guidelines and incorporated process into the CM role.
Ensured that case managers assess, plan and deliver appropriate communication to all points of contact.
Audis claims to ensure procedures are followed to ensure URAC standards and BWC guidelines are met.
Co-Chair for Bureau of Workers Comp Quality Control Committee.
Achievements:
Improved patient progression of claims as evidenced by increased MoD score.
Implemented work queues and developed reports to improve Case Manager efficiency.
Ensured clinical standards were being met for URAC accreditation.
UC Medical Center- CINCINNATI, OH November 2011- April 2016
Manager of Bed Board & Transfer Center
Utilization Review
Case Management PACU
Clinical Documentation Specialist
Standardize Bed Board and Transfer center process.
Review of patient procedures in PACU for fiscal management of admissions.
Review of patient charts throughout hospital to ensure complete documentation for correct coding and maximum
reimbursement.
Education of physicians and residents regarding documentation improvement.
Achievements:
Improved patient progression by decreasing bed turnaround time and increased patient transfer time to facility.
Implemented reports to improve reporting of Surgenet.
Department increased hospital reimbursement by 1.7 Million in first fiscal year.
ViaQuest Home Health- CINCINNATI, OH March 2011- October 2011
Director of Nursing
Responsible for all clinical aspects of startup home health agency.
Collaborated with Regional Director to coordinate services in providing quality care.
Coordinated operational clinical systems.
Assisted Regional Director with overall operations of the Home Health Agency. This included marketing
to physician offices and hospitals.
Achievements:
Accreditation by CHAP (Community Health Accreditation Program).
Recruited patients and staff for start up company.
National Healing Corporation- CINCINNATI, OH September 2009- February 2011
Clinical Nurse Manager of The Christ Hospital Wound Care Center
Responsible for all clinical aspects of the Wound Healing Center.
Collaborated with Program Director and Medical Director to coordinate services in providing quality care.
Coordinated operational clinical systems.
Assisted Program Director with overall operations of the Wound Healing Center. This included marketing
to physician offices and making presentations to local insurance companies.
Trained in HBO.
Achievements:
Increased patient visits by 58% and HBO Units by 167%.
Instituted Double Clinics to accommodate increased volume of patients.
Increased LOC with each patient visits thru education of staff and physicians.
Instituted cost saving measures with product use.
Awarded research project of the year. Served as clinical proctor for research study.
Awarded front runner status for meeting the total patient visits and HBO units for the year during the third
quarter, as well as exceeding our projected revenue.
Select Medical Corporation: April 2007- August 2009
Select Specialty Hospital- CINCINNATI, OH
Director of Case Management
Daily monitoring of patient length of stay in regard to DRG reimbursement.
Direct and manage the Case Management Department of the hospital.
As the Director of Case Management I was in a senior leadership position responsible for the following:
Monitor patient care from admission thru discharge, facilitate interdisciplinary meetings, fiscal management,
utilization review, charge audit, marketing, patient length of stay, insurance pre-authorization and meeting
quarterly/annual goals for the hospital’s total net revenue.
Maxim Staffing- CINCINNATI, OH August 2006- April 2007
Registered Nurse:
RN in local hospitals on a PRN basis.
Worked in specialty areas: Adult and Neonatal ICU, ER, Telemetry, Orthopedics and Med Surg.
Anthem BCBS- CINCINNATI, OH August 2006- April 2007
Case Manager Utilization Review:
Coordinated all aspects of the patient services and made determinations for requested services.
Provided educational resources and information to: local communities, patients and physicians.
Coordinated with Medical Directors to facilitate patient services.
CHILDREN’S HOSPITAL MEDICAL CENTER- CINCINNATI, OH July 2004- August 2006
Registered Nurse Supervisor
Post Anesthesia and Neonatal Intensive Care Units.
Delivered full range of clinical interventions as they related to the pediatric population to include an extensive
variety of pediatric ventilators to include high frequency oscillatory ventilation as well delivery of specialty
medical gases.
Education of staff as a super user for incorporation of the Epic system at the hospital.
The University Hospital – CINCINNATI, OH August 1998 – December 2004
Registered Nurse Charge Nurse
Delivered full range of clinical interventions in the Neonatal Intensive Care Unit as well as emergency situations in the delivery room and emergency room.
Developed and Facilitated the Unit Based Design Team. This interdisciplinary team evaluated CQI monthly and developed and implemented quality improvement plans.
Chosen to oversee the collection of QA data for department.
Responsible for monthly education of new Residents and Interns on appropriate and acceptable “Orders”, medications & dosage, contraindications, therapies and equipment. Including policy and procedure for code management.
Developed and implemented department protocols to focus on patient and infant contact which increased customer satisfaction scores by 200%.
Accompanied physicians in patient rounds in which they relied on my clinical expertise to address patients’ needs.
Vitas Innovative Hospice – CINCINNATI, OH May 1998 –August 1998
Registered Nurse
Directed and managed the opening of the Vitas Hospice Inpatient Unit at Deaconess Hospital.
Ensured all policy and procedures were in place for JCAHO compliance.
GranCare Home Health & Hospice – GREENSBURG, IN February 1997 –April 1998
Registered Nurse Case Manager
Managed care of terminally ill patients, providing pain management and symptom control.
Education and supervision of staff.
Coordination of care with interdisciplinary team.
Home Health visits as needed.
Heritage House – GREENSBURG, IN September 1995 –February 1997
Registered Nurse Charge Nurse
Supervised care of acute and chronically ill patients on a skilled nursing unit.
Orientation of new staff.
Completion of MDS 2.0 and care plans for all residents.
Geriatric Nursing Care – CINCINNATI, OH July 1995 –September 1995
Registered Nurse
Private duty home health care.
Education
Eastern Kentucky University 1995
Associate of Science; Nursing
License & Certifications
Current Indiana RN Compact License
Current California, Michigan, Minnesota and New York, RN Single State License
Certified Case Manager
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