Case Manager Quality Assurance

SHEILA BRIGGS

*********@*****.*** 907-***-****

Objective

I am compassionate with a self-starter attitude looking to pursue a challenging position in a growth-oriented company. Over the course of my career, I’ve gained diverse experience as a nurse involving care coordination and management, health care service including ambulatory, and skilled nursing.

Work Experience:

RN 3West, Providence Hospital

November 2023- Present

Responsible for working on clinical floor, administering medications, wound care, Gtube feeding and care, assessing patients during 12 hour shift, Communication with the multi-disciplinary team, and Family.

RN case Manager OB, Southcentral Foundation

Dec 2022- July 2023

Responsible for performing case management, utilization review, quality assurance, and discharge planning for Pregnant Patients, Responsibilities specific to Discharge Planning includes assessment, identification of specific needs post-partum.

RN Case Manager, Alaska Regional Hospital

Anchorage, Alaska

March 2022 - July 2022

Responsible for performing case management, utilization review, quality assurance, and discharge planning first. Responsibilities specific to Discharge Planning includes assessment, identification of specific needs, and social service intervention or referral while in the acute setting. Awareness of services available to patients and their families are an important part of this assessment. Determining patient needs on basis of diagnosis; prognosis and social support system/person information are included in the initial assessment process. Upon individual recognition and staff referral, the discharge planner will contact the appropriate agency to meet the patient's social, emotional and spiritual needs. Responsibilities specific to Utilization Review include performing admission and concurrent review.

Director of Health Services, Baxter Senior Living

Anchorage, Alaska

October 2019 - February 2022

Manage 80 residents’ cases including evaluation and implementation of health care plans on-call emergency during nights and weekend Utilize nursing process daily to oversee and coordinate the care of 80 residents with multiple co morbidities and varying levels of ADL needs. Oversee medication management, checking in and verifying medications from multiple pharmacies and families. Reconcile medications for move ins, obtain physician orders, and develop MARs. Direct, train, and supervise 20-25 unlicensed assistive personnel ensuring they consistently follow ISPs and provide thorough, detailed, and objective documentation of their care. Responsible for filling out accident and injury reports and workers compensation claims. Maintain a high degree of resident satisfaction. Implement programs and changes to enhance residents’ well-being. Establish and maintain open and effective communication with residents, families, employees, and other members of the management team. Collaborate with health care providers and care coordinators to promote continuity of care. Assume on-call responsibilities on a rotational basis for after-hours response to triage resident emergencies. Submit Critical Incident Reports to the State of Alaska. Assist Administrator with interviewing process and managing scheduling and payroll. Provide both positive feedback and progressive disciplinary action to staff.

Director Of Resident Services, Marlow Manor

Anchorage, Alaska

July 2018 - July 2019 Utilize nursing process daily to oversee and coordinate the care of 48 residents with multiple co morbidities and varying levels of ADL needs. Oversee medication management, checking in and verifying medications from multiple pharmacies and families. Reconcile medications for move ins, obtain physician orders, and develop MARs. Direct, train, and supervise 18-20 unlicensed assistive personnel ensuring they consistently follow ISPs and provide thorough, detailed, and objective documentation of their care. Responsible for filling out accident and injury reports and workers compensation claims. Maintain a high degree of resident satisfaction. Implement programs and changes to enhance residents’ well-being. Establish and maintain open and effective communication with residents, families, employees, and other members of the management team. Collaborate with health care providers and care coordinators to promote continuity of care. Assume on-call responsibilities on a rotational basis for after-hours response to triage resident emergencies.

673rd Medical Group Elmendorf Hospital, DOD

Elmendorf Air Force

December 2015 - June 2018

Responsible for performing case management, utilization review, quality assurance, and discharge planning first. Responsibilities specific to Discharge Planning include assessment, identification of specific needs, and social service intervention or referral while in the acute setting. Awareness of services available to patients and their families is an important part of this assessment. Determining patient needs on basis of diagnosis; prognosis and social support system/person information are included in the initial assessment process. Upon individual recognition and staff referral, the discharge planner will contact the appropriate agency to meet the patient's social, emotional and spiritual needs. Responsibilities specific to Utilization Review include performing admission and concurrent review.

RN Utilization review, Alaska Native Medical Center

Anchorage

November 2014 - November 2015

Responsible for reviewing medical records and preparing clinical appeals on medical necessities, level of care, length of stay, and authorization denials for medical center patients in accordance with Certified Medicare, and private insurance guidelines. Have clear understanding of the severity of ranges of illnesses, intensity of service, and coordination needs. Integrate clinical knowledge with billing knowledge in order to review, evaluate, and appeal clinical denials related to the care provided patients. Assist the multidisciplinary team with assessments and improvement of the denial management, documentation, and appeals process. Conduct audits and analyze patient records for quality patient care and appropriateness of services. Analyze information collected by investigation, and report findings and provide recommendations. Modify patient treatment plans as indicated by patients' responses or case history.

RN Administration, We Care ALH

Anchorage

January 2007 - November 2014

Directly responsible for managing all assisted home operations. Provided immediate response to all emergencies, both psychiatric and medical. Formulated and submitted all Critical incident reports. Supervised all nursing staff and scheduled work shifts. Managed medication sheets, narcotic inventory, progress note, and menus in accordance with the Health Insurance Portability and Accountability Act (HIPAA). Provided efficient, effective and safe nursing care to eight residents to include dialysis, Insulin and narcotics, G-tube feeding, and case management in coordination with all members of the multidisciplinary team. Evaluated needs for admission. Supervised the disposition of hazardous waste in accordance with the Occupational Safety and Health Act (OSHA). Conducted Case Management of all residents from admission to discharge. Conducted care conferences. Developed staff by evaluating growth needs and providing in-service education. Evaluated employee performance.

Education

College of Staten Island

AAS/Nursing, Nursing

Sep 1996 - Jun 1998

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