Case Manager Registered Nurse
Resume:
April Fultz RN, BSN
Registered Nurse Case Manager
New Tazewell, TN 37825
***********@*******.***
I am a registered nurse with over 30 years of experience working primarily in case management and care coordination with patients in the Medicare and Medicaid population. I enjoy working on quality improvement to achieve improved outcomes for both the patient and the provider. I have experience working with NCQA quality metrics, HEDIS, and Outcomes Based Quality Improvement in a variety of settings to include primary care, home health and Long-Term Services and Supports through the MCO. I have been a Certified Case Manager since 2011.
Work Experience
Director of Care Coordination
Rocky Top Care Center – Rocky Top, TN
July 2024 to Present
Complete and update insurance authorizations. Coordinate interdisciplinary care plan meetings. Discharge planning and coordination.
Assistant Director of Nursing
The Nursing Center at Little Creek - Knoxville, TN April 2024 to May 2024
Assisted Director of Nursing in managing day-to-day activities. Registered Nurse
CHEROKEE HEALTH SYSTEMS - New Tazewell, TN
April 2017 to April 2024
Lead Clinical Care Coordinator and liaison for our Medicare Chronic Care Management program and also in recent years worked with Tennessee Health Link and community health coordination. In these roles quality metrics were defined and worked toward meeting goals with the Medicare and Medicaid population in multiple office locations to improve quality of care and outcomes. Worked as a Primary care office nurse providing patient care while working toward quality metrics.
Field Case Manager
GENEX SERVICES - Knoxville, TN
February 2017 to April 2017
Responsible for assessment, planning, coordination, implementation and evaluation of injured/disabled individuals involved in the medical case management process. Work as an intermediary between carriers, attorneys, medical care providers, employers and employees to monitor the progress of the injured worker and report results back to the employer and insurance carrier. Used clinical/nursing skills to help coordinate the individual's treatment program while maximizing quality of care and cost containment.
CHOICES Care Coordinator
BLUE CROSS BLUE SHIELD OF TENNESSEE - Knoxville, TN March 2011 to February 2017
Management and coordination of care for Tenn Care members in their home and at nursing facilities in a Long-Term Services and Supports program. Developed Plans of care to meet needs in the home and community. Identified gaps in care using HEDIS reports and coordinated plan for gap closure. Desk Case Manager
GIRLING HOMECARE - Knoxville, TN
May 2010 to March 2011
Managed the care of a primary home health caseload, including coordination of care between disciplines, development and implementation of care plans, and completion, review and submission of OASIS Assessments. Utilized quality data and implemented plan for outcome improvements and as well as negotiation with the MCO for cost effective care. Worked within Medicare guidelines/restrictions regarding billing information and form preparation. Team Leader
UNIVERSITY OF TENNESSEE HOME HEALTH SERVICES - Knoxville, TN March 2010 to May 2010
Managed the care of a primary home health caseload, including coordination of care between disciplines, development and implementation of care plans, and completion, review and submission of OASIS Assessments. Utilized quality data and implemented plan for outcome improvements and as well as negotiation with the MCO for cost effective care. Worked within Medicare guidelines/restrictions regarding billing information and form preparation. School Nurse
CLAIBORNE COUNTY BOARD OF EDUCATION - Tazewell, TN August 2009 to March 2010
Provided nursing services for local primary school with student population of approximately 500 students. Performed basic first aid for injuries as necessary. Referred students with illness or serious injury to appropriate medical facilities. Administered prescribed medications and treatments to students.
Director of Nursing
NHC HOMECARE - Knoxville, TN
June 2008 to August 2009
Managed office operations, including supervising nurses, home health aides, therapists, and social workers. Negotiated with insurance companies and implemented quality improvements for cost effective care. Implemented marketing efforts that improved community awareness and generated referrals.
Catastrophic Case Manager
BLUE CROSS BLUE SHIELD OF TENNESSEE - Knoxville, TN December 2007 to June 2008
Utilization review of homecare services for Tenn Care members using Milliman Care Guidelines. Coordination of care between homecare agencies, physicians and other healthcare providers. Participated in care conferences to discuss patient status and ensure achievement of treatment plan objectives. Worked within Tenn Care guidelines/restrictions regarding billing information and form preparation. Staff Nurse / Case Manager
BAPTIST HOSPITAL HOME HEALTH SERVICES - Knoxville, TN August 2007 to December 2007
Managed the care of a primary home health caseload, including coordination of care between disciplines, development and implementation of care plans, and completion, review and submission of OASIS Assessments. Utilized quality data and implemented plan for outcome improvements and as well as negotiation with the MCO for cost effective care. Worked within Medicare guidelines/restrictions regarding billing information and form preparation. Staff Nurse
FAMILY HOME HEALTHCARE - Maynardville, TN
July 2007 to August 2007
Managed the care of a primary home health caseload, including coordination of care between disciplines, development and implementation of care plans, and completion of OASIS Assessments. Utilized quality data and implemented plan for outcome improvements. Worked within Medicare guidelines/restrictions regarding billing information and form preparation. Contract Staff Nurse
UNIVERSITY OF TENNESSEE HOME HEALTH SERVICES - Knoxville, TN March 2006 to October 2006
March 2007 to July 2007
Managed the care of a primary home health caseload, including coordination of care between disciplines, development and implementation of care plans, and completion of OASIS Assessments. Utilized quality data and implemented plan for outcome improvements. Worked within Medicare guidelines/restrictions regarding billing information and form preparation. Quality Improvement RN
NHC HOMECARE - Knoxville, TN
October 2006 to March 2007
Completed chart reviews, case conferences, and reviewed data for improvement in outcomes in quality care. Used Strategic Healthcare Programs to track and improve quality data. Identified and worked with staff to implement best practices and reviewed outcomes. Staff Nurse / Case Manager
CLAIBORNE COUNTY HOME HEALTH AND HOSPICE - Tazewell, TN March 2003 to March 2006
Managed the care of a primary home health caseload, including coordination of care between disciplines, development and implementation of care plans, and completion of OASIS Assessments. Utilized quality data and implemented plan for outcome improvements. Worked within Medicare guidelines/restrictions regarding billing information and form preparation. Case Manager
HOUSECALL HOME HEALTH - New Tazewell, TN
November 2002 to March 2003
Managed the care of a primary home health caseload, including coordination of care between disciplines, development and implementation of care plans, and completion of OASIS Assessments. Utilized quality data and implemented plan for outcome improvements. Worked within Medicare guidelines/restrictions regarding billing information and form preparation. Staff Nurse / Relief Charge Nurse
FRESENIUS DIALYSIS CLINIC - Knoxville, TN
April 2000 to November 2002
Provided care for dialysis patients and managed shift operations on an as needed basis, including supervising employees and making nurse-patient assignments. Ensured compliance with infection control, quality control, and other procedures/standards. Staff Nurse / Night Shift Manager
ST. MARY'S RESIDENTIAL HOSPICE - Knoxville, TN
July 1999 to April 2000
Held a dual role for overseeing the evening shift operations as well as providing direct patient care for this 18-bed facility. Coordinated patient care, delegated assignments to support staff, ensured the quality of patient care services, and performed tasks related to pain management and comfort measures.
Staff Nurse
MORRISTOWN HAMBLEN HOSPITAL - Morristown, TN
April 1999 to July 1999
Provided general patient care on the med/surg unit. Case Manager / Branch Manager
COMPREHENSIVE HOME HEALTHCARE, INC - Harrogate, TN October 1992 to April 1999
Managed the care of primary home health/hospice caseload, including coordination of care between disciplines, developing and implementing care plans, and making home visits. Managed branch office operations, including supervising nurses, home health aides, therapists, and social workers. Negotiated with insurance companies and implemented quality improvements for cost effective care. Implemented marketing efforts that improved community awareness and generated referrals. Staff Nurse
CLAIBORNE COUNTY HOSPITAL - Tazewell, TN
May 1992 to October 1992
Provided general patient care on the med/surg unit. Education
Associates Degree in Nursing
LINCOLN MEMORIAL UNIVERSITY - Harrogate, TN
1992
Bachelor's Degree in Nursing
LINCOLN MEMORIAL UNIVERSITY - Harrogate, TN
2003
Certifications and Licenses
RN
State: TN
Expires: June 2024
Skills
Experienced Nurse
Quality Improvement
Case Management
Care Coordination
Utilization Management
Team Oriented
Certified Case Manager
November 2011 to November 2025
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