Case Manager Social Services
Resume:
KATHRYN M SCANLON
**********@*****.***
Case Manager RN & MDS RN Coordinator
As RN Case Manager responsibilities included: In depth current knowledge of all insurance contracts with immediate communication to departments including Therapy, Nursing, Billing, and Social Services to provide pertinent information regarding coverage. Knowledge seeking investigations through hospital records to ascertain reasons why resident admitted to acute care settings-short term and long term, inpatient therapy centers. Thoroughly examined the documents to determine: Interventions performed, discharge status, social support systems, cultural considerations, cognition status, prior health status before hospitalization, diagnostics performed and all other relevant information to determine and develop initial admitting Plans of Care.
Assessed newly admitted residents for clinical status’ including determination of Activities of Daily Living abilities, pain, range of motion, infections, skin integrity, identified all indwelling devices. Reviewed with IDT team members all categories of care including cognition, mood, communication, cultural identification, support systems, medication management monitoring, therapy goal progress and barriers, nutritional concerns, follow up appointments, discharge plans with continued development of individualized Plans of Care with reasonable goals and identified risk factors that are specific to each resident.
Met with residents and family members and or guardians to receive and provide knowledge; to determine goals; to determine support networks in the community, to determine need for Durable Medical Equipment; housing concerns, Home Health needs, finances, need for secondary insurance, transportation, follow up appointments and all other clinical and psychosocial matters with IDT present including Social Services, Therapy, Registered Dietician, Business Office, Respiratory Therapists when applicable.
Monitored Resident status and progress towards goals in daily clinical meetings and PDPM meetings with continued collaboration with all disciplines. Maintained frequent contact and provided status updates with Insurance companies including BCBS, Optum, Humana, Aetna, TriWest, Molina, Carelon, Alignment. Received Notice of Medicare Non-Coverage forms from Insurance Case Managers, carried out appeals via Livanta and coordinated Peer to Peer reviews.
Performed and maintained the MDS calendar with attention to the Common Working Files, optimizing top reimbursement and accurate assessments per the RAI manual. Maintained a 5-star clinical rating for the facility with strategic ARD dates of the MDs and continued education to staff.
EDUCATION
BACHELOR OF SCIENCE- NORTHEASTERN STATE UNIVERSITY- Finance MASTER OF THE ARTS- ADELPHI UNIVERSITY-Education
ASSOCIATE DEGREE- COLLEGE OF SOUTHERN NEVADA-Registered Nursing EXPERIENCE INCLUDE
CASE MANAGEMENT IN SKILLED JURSING AND HOME HEALTH OASIS AND MDS ASSESSMENTS
CHARGE NURSE ON VENTILATOR UNIT
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