Case Manager Home Health
Resume:
TERESA GILKEY
Experienced
Houston, TX *****
******.******@*****.***
Dependable with excellent communication and a strong work ethics with the ability to work well independently or in a team environment. I quickly and efficiently adapt to change, and thrive on learning new skills.
Authorized to work in the US for any employer
Work Experience
Care Navigator/ Case Manager
CenterWell-Houston, TX
January 2023 to Present
Case management for value based clinics focusing on high risk and rising risk patients with chronic diseases with an emphasis on preventing hospitalizations. Performed transitions of care
Completed medication reconciliations
Registered Nurse
Kelsey-Seybold Clinic-Houston, TX
August 2022 to January 2023
Same as Cigna
Triage Nurse
Cigna Medical Group-Phoenix, AZ
September 2016 to July 2022
• Manage the health care needs of varied patient populations
• Triage adult and pediatric patient calls and concerns
• Assess and triage walk-ins and immediate response events within the clinics.
• Make outreach calls to patients post-hospitalization and after ED visits
• Assist providers in managing the complex healthcare needs of patients including assisting with referrals, obtaining DME
• Lead and support the back and front office staff regarding patient's concerns or center needs
• Start and maintain simple IV infusions; POCT testing including COVID.
• Administer injections, perform wound care as ordere Home Health Nurse/Case Manager
Maxicare Home Health-Phoenix, AZ
August 2012 to September 2016
• Performed skilled nurse visits for homebound patients within a Medicare/Medicaid certified home health agency.
• Completed comprehensive assessment of patient, caregiver, and living situation to determine care needs and DME needed.
• Coordinated with other disciplines and communicated assessment findings and needs. Facilitated admission, case management, and follow-up skilled nursing visits to treat home health patients.
• Evaluated physical, psychosocial, and environmental needs at each visit to maintain optimal care levels.
• Developed written plan of care in accordance with patients' diagnosis, family needs, and physician orders.
• Conferred with physician to develop treatment plan based on physician's orders Disease Management/Case Manager
UHC United Healthcare-Avondale, AZ
September 2015 to July 2016
• Telephonic education of clients on chronic conditions and treatment protocols to aid in compliance and improve outcomes.
• Educated on medications, diet, and exercise plan to maintain patient care.
• Performed health coaching to manifest lifestyle changes
• Modified treatment plans as indicated by patients' responses and conditions Review Analyst
Health Services Advisory Group (HSAG)-Phoenix, AZ
July 2011 to July 2012
• Provided immediate advocacy and conflict resolution at a call center for Medicare beneficiaries who had quality of care complaints
• Initiated investigations by chart auditing for Medicare peer review organization. Telehealth Coordinator
Almost Family Home Healthcare (Apex Home Health)-Orange Park, FL July 2010 to July 2011
• Managed telehealth program by monitoring equipment in patients' homes and educated them on its use
• Monitored the transmission of readings and reported ab norms to provider
• Asked relevant questions to gather information and identify patient concerns and comprehension of advice given
• Documented patient details in Phillips web-based program Home Care Coordinator
TOTAL Medical Solutions-Sanford, FL
January 2005 to June 2007
Coordinated, home care and DME for Worker’s Comp. injured clients. Resource Manager
Halifax Medical Center-Daytona Beach, FL
August 2003 to January 2005
Medical records review to submit appeal letters and obtain retro authorizations, concurrent reviews using Interqual and Milliman criteria
Hospice Nurse
Hospice of the Emerald Coast-Panama City, FL
January 2002 to January 2004
Provided home hospice visits for terminally ill patients. Home Health Nurse
Gentiva home health-Daytona Beach, FL
January 2000 to January 2002
Home health visits of for Medicare/ Medicaid population Education
Bachelor of Science in Nursing
Aspen University - Avondale, AZ
August 2017 to August 2019
Associate in Nursing
Carrington College - Phoenix, AZ
July 2012 to July 2014
Certificate in Practical nursing
Pitt Community College - Greenville, NC
August 1982 to September 1983
Nursing Licenses
RN
Expires: April 2026
State: TX
Skills
• Telehealth Wound Care Documentation Homecare Case management Authorizations Hospice/ Palliative Care Assessments Appeals Interqual/Milliman Criteria Concurrent reviews
• Nursing
• Medicare
• Tube feeding
• Epic
• Patient monitoring
• Medication administration
• Care plans
• EMR systems
• ICD-10
• Experience administering injections
• Vital signs
• Patient care
• Triage
• Medical Office Experience
• Case management (10+ years)
• Documentation review
• Microsoft Office
• Insurance Verification
• Working with people with disabilities
• Nursing
• Communication skills
• Customer service
• Hospice care
• Triage
• Home health
• Epic
• Acute care
• Medical Records
• Intake
• Managed Care
• Care management (10+ years)
• Care coordination (10+ years)
• Hospice (3 years)
• Pediatrics (10+ years)
Certifications and Licenses
BLS Certification
Compact State Nurse License
Driver's License
CPR Certification
ACLS Certification
RN License
Assessments
Protecting patient privacy — Proficient
December 2021
Understanding privacy rules and regulations associated with patient records Full results: Proficient
Indeed Assessments provides skills tests that are not indicative of a license or certification, or continued development in any professional field.
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