Case Manager Management
Resume:
TIFFANY KAVANAUGH, RN BSN CCM
Spokane Valley, Washington
*************@**.***
PROFESSIONAL SUMMARY
Motivated team-player and health professional with 37 years of nursing experience across a broad range of nursing specialties including intensive care, cardiac acute care, cardiovascular nurse physician’s assistant, and clinical case management.
Dedicated leader and team builder with 17 years’ experience as a nurse consultant or nurse consultant supervisor.
Nurse Complex Case Manager with vast experience assisting members diagnosed with chronic kidney disease and end-stage renal failure, cardiovascular, neurological, oncological, and chronic conditions.
Compassionate caregiver who treats patients and their families with the upmost respect and personal attention to detail.
Effective communicator who easily builds rapport with patients, subordinate nurses, medical staffs, and insurance companies.
Exceptionally hard worker who stresses integrity, quality, and selflessness in all aspects of the job.
KEY COMPETENCIES
Recruits/trains/leads effective teams of geographically separated Nurse Case Managers.
Supervises, standardizes evaluates, and corrects Nurse Consultants’ performance
Identifies and communicates patient needs
Identifies and mobilizes necessary resources for client care
Advocates with medical providers on behalf of clients/account owners to ensure necessary/appropriate medical care at reasonable cost
Collaborates with providers, insurance/claims adjusters, clients, family and community resources
Negotiates effective cost-savings with providers and insurance companies
Identifies and mitigates barriers to successful medical treatment plans
Facilitates/coordinates communication among all players in a medical treatment plan
Assesses clinical status and medical treatment plans
Reviews and assesses case management and medical reports
Assists clients with application of insurance benefit plan documents
Facilitates patient participation in medical treatment plans and community resources
Researches and applies clinical protocols and standards of care
Maintains strict Client/Account confidentiality.
EXPERIENCE
Nurse Case Manager Dec 2021 to Present
Molina Healthcare Services, Eastern Washington, 1330 N Washington St Ste 4000, Spokane, WA 99201
Nurse Complex Case Manager Molina Healthcare /Apple Care Medicaid primarily focusing on members diagnosed with chronic kidney disease and end-stage renal failure, cardiovascular, neurological, oncological, and chronic conditions. Works closely with the members and their families, clinical support staff, nursing leadership, physicians, and the quality department to achieve goals of proving clinical outcomes for member with chronic diseases; assists with the development of processes that support the quality programs, and performs other related duties as assigned. Works with providers and multidisciplinary team members to assess, facilitate, plan, and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care for members’ health care services. Ensures patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.
Patient Care Manager Jun 2021 to Nov 2021
LHC Group/Assured Home Health Care, 111 Riverfront, Suite 220 Spokane, WA 99201
Ph 509-***-****
Performs overall supervision and coordination of clinical services. Coordinates and supervises an interdisciplinary team of staff to assure the continuity of high-quality care to home health patients assigned to the team's area in accordance with physician prescribed plan of care, and all applicable state and federal laws and regulations. Ensure patient needs are continually assessed and care rendered is individualized to patient needs, appropriate and reasonable, meets home health eligibility criteria, and is in accordance with physician orders. Manages and documents phone calls from physicians, clinicians, patients, referral sources, and communicates patient updates/new orders to clinicians. Uses coordination notes to document, as needed and appropriate. Reviews assessments and plans of care daily, per assigned workflow, and consults clinicians with recommendations, as appropriate Coordinates all aspects of care with all disciplines, physicians, durable medical equipment providers, caregivers/family members, transferring facilities, and any other applicable healthcare providers. reviews, evaluates, and supervises service delivery to ensure appropriateness of care and utilization of services, equipment, and supplies through activities such as random patient visits, medical record reviews and case conferences. Enters infections and incidents/occurrences into the online Risk Management Incident Reporting System, as specified by policy. Assists in the orientation of new agency personnel. Provides direction and leadership to clinical team members in collaboration with the clinical director. reviews, evaluates, and supervises service delivery to ensure appropriateness of care and utilization of services, equipment, and supplies through activities such as random patient visits, medical record reviews and case conferences.
Nurse Consultant Supervisor Medical Director Oct 2010 – May 2020
Medical Rehabilitation Consultants, Inc., 111 W. Cataldo Ave, Suite 200, Spokane, WA 99201-3203, Ph: 509-***-****
Led, organized, and oversaw 8 to 10 Nurse Consultants who provided client care to approximately 20 clients apiece from small, self-insured groups across a 6-state region. Assisted with Nurse Consultant recruiting and conducted initial orientation and training with all new Nurse Consultants. Evaluates Nurse Consultant services and ensured client and account satisfaction. Provided timely feedback and discipline, as necessary. Assessed and scheduled in-services training/nurse consultant procedural training. Conducted regular meetings with clinical staff for oversight, guidance, and ongoing training. Controlled quality of service by monitoring and guiding clinical aspects of all medical case management for high standards, effectiveness, and other qualities as described in the standards for the company and the profession. Provided leadership and problem-solving advice to assigned Nurse Consultants. Provided emergency backup coverage in the absence of the assigned Nurse Consultant. Developed and maintained a productive and loyal relationship with accounts. Acted as liaison between Nurse Consultants and management. Assisted with development of Case Management policies and procedures. Participated in company marketing and training. Conducted emergency on-call status as needed. Proposed and maintained department budget goals annually, including monitoring for and correction of negative trends.
Nurse Consultant Sep 2003 – Oct 2010
May 2020 – May 2021
Medical Rehabilitation Consultants, Inc., 111 W. Cataldo Ave, Suite 200, Spokane, WA 99201-3203, Ph: 509-***-****
Routinely oversaw care for 20 to 25 patients from small, self-insured groups in a six-state region. Collected in-depth information about the clients’ medical and social situation and functioning through in-person or telephonic interviews with client, family, physician, employer, insurance representative and other relevant providers of services. Developed individualized case management plans and initiates case management processes to address needs based on thorough records reviews. Determined specific objectives and goals with an emphasis on time-specific actions designed to meet the client’s needs as identified through the assessment process. Performed all appropriate case management activities and/or interventions, which ensured timely achievement of the goals in the case management plan. Obtained authorizations and records necessary for working on the case and maintaining efficient flow of information. Reviewed medical history, past and current, assessed client’s medical needs through records review and interviews with medical care providers, and identified the impact of current illness/injury on client’s physical and psychological well-being and support system. Established working relationship with all appropriate health care providers for the purpose of providing client advocacy, acting as liaison between them and insurance providers, and identifying the treatment plan. Maintained an awareness of community resources, and their accessibility to the client, alternative funding & services, and any limitations of insurance benefits. Evaluated provider treatment plans for appropriateness, thoroughness, and possibly more beneficial alternatives.
Intensive Care Nurse, Neuro, Medical and Cardiac Acute Care Units Sep 1999 - Feb 2003
Deaconess Medical Center, Spokane, WA 99204, Ph: 509-***-****
Cared for patient needs throughout their recovery in ICU. Evaluated and monitored patients’ progress. Identified sudden or subtle changes in patients’ medical condition. Delivered regular updates to doctors, patients, and family members. Began treatment and monitored doses. Responded to medical emergencies and alerted appropriate doctors. Maintained patient records.
Assistant Supervisor and Staff Nurse Mar 1998 - Jul 2001
ABC Nursing Agency (No longer in business), Spokane, Washington 99212
Accomplished nursing human resource objectives by selecting, orienting, training, assigning, scheduling, coaching, counseling, and disciplining employees; communicated job expectations; planned, monitored, appraised job contributions; recommended compensation actions; adhered to policies and procedures. Met nursing operational standards by contributing information to strategic plans and reviews; implemented production, productivity, quality, and customer-service standards; resolved problems; identified system improvements. Met nursing financial standards by providing annual budget information; monitored expenditures; identified variances; implemented corrective actions. Identified patient service requirements by establishing personal rapport with potential and actual patients and other persons in a position to understand service requirements. Maintained nursing guidelines by writing and updating policies and procedures. Completed patient care requirements by scheduling and assigning nursing and staff; followed up on work results.
Cardiovascular Nurse Physician Assistant Jul 1990 - Jul 1993
Midwest Cardiovascular Center, 1104 W 8th Street, Sioux Falls, SD 57104, Ph: 605-***-****
Worked under the supervision of interventional cardiologists treating critically ill cardiovascular patients. Assessed patient health problems and needs, developed and implemented nursing care plans, and maintained medical records. Monitored cardio and vascular readings for patients. Educated postoperative cardiovascular rehabilitation activities to the patient, such as postoperative home care needs; necessary changes in diet, nutrition and exercise to improve heart health; and how to administer heart medication and recommended physical therapy at home.
Intensive Care Nurse, Medical and Thoracic Aug 1987 – May 1990
Veterans Administration Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI Ph: 734-***-****
Cared for patient needs throughout their recovery in ICU. Evaluated and monitored patients’ progress. Identified sudden or subtle changes in patients’ medical condition. Delivered regular updates to doctors, patients, and family members. Began treatment and monitored doses. Responded to medical emergencies and alerted appropriate doctors. Maintained patient records.
EDUCATION
Bachelor of Science in Nursing, May 1987
Previously West Texas State University School of Nursing, 2501 4th Ave, Canyon, TX 79016
3.9 G.P.A. Magna Cum Laude Honor Graduate
SCHOLARSHPS/AWARDS
Department of Veterans Affairs Health Professional Nursing Scholarship Award (1986 &1987)
LICENSES/CERTIFICATIONS:
Registered Nurse Licenses
Washington #RN00125836 Active Feb 1997 – Present
Montana #RN158857 Not Active April 2020
California #RN95067775 Not Active July 2017
Alaska #100327 Not Active June 2015
Oregon, #200540527R Not Active Feb 2010
South Dakota, #R-024050 Not Active July 1990
Michigan #470-***-**** Not Active Aug1987
Texas #540095 Not Active Aug1987
Advanced Achievement in Transplant Management Certification (AATMC) Sept 2014 – Present
Commission for Case Management Certification (CCM)* May 2006 – May 2017
01 /21/2021– Present
Advanced Cardiac Life Support (ACLS), American Heart Association May 2023
Basic Life Support (BLS), American Heart Association July 2023
Certified Dialysis Nurse, Fresenius Dialysis Corporation Sept 2003
Certification for Adult, Pediatric and Neonatal Critical Care Nurses (CCRN) 1990 to 2002
Trauma Nursing Course Certified (TNCC), Emergency Nurses Association May 1999
RECENT COURSE WORK
Ethics and Issues in Contemporary Nursing
Nursing Ethics for the 21st Century (12 Contact Hours) 23 CEU 07/22/2023
Holistic Nursing
Section A 22CEU 07 07/2021
Section B. 22CEU 05/17/2021
Core Curriculum of Case Management:
Section A. 4 /24/2020
Section B. 11/2020
Cancer Symptom Management
Section A 24 CEU 09/18/2018
Section B 24 CEU 10/15/2018
Section C 24 CEU 11/05/2019
Professional Guide to Diseases: (24 CEU) Aug 2018
Using HLA Methods to Assess Risk and Monitor Efficacy Pre/Post-Transplant: Dec 2014
Advanced Achievement in Transplant Management: AATMC Certification Sept 2014
The New Leadership Challenge: Creating the Future of Nursing: (19 CEU) Aug 2013
Addiction Treatment - a Strengths Perspective: (48 CEU) Dec 2013
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