ANNETTE ROBINSON FNP-C, MSN/MBA/HCM

**** ******* **** ******, ***** Fl, 33619

Cell Phone : (727) -798-3693

Email : adg5ih@r.postjobfree.com

Summary and Qualifications

• Family Nurse Practitioner with over 600 hours of clinical experience

Follows Evidence-base guidelines in delivering care, based on education and experience

Manage chronic illnesses such as Diabetes, COPD, Asthma,

Obtain detailed History, performs physical exams, apply differentials, assess, diagnose, develop a plan of care and treat

Keep communication line open between, patients and the healthcare team

Committed to holistic approach medicine

Ensure quality of care by participating in quality of care measures

Case Manager with over 15 years experience

Knowledgeable of CMS Guidelines and Managed care organizations

Participates clinical rounds on the unit and in medical rounds.

Experience

Nurse Practitioner, Louisiana Disaster Relief Shelter (09/07/2020 to 09/22/2020

Provide health services in a shelter environment

Medication reconciliation/management

Monitoring communicable disease

Discussed plans for dialysis treatment and validating appointment with Case Manger

Educating patient and family of the process during the disaster

Develop plan of care and complex documentation even shift

Collaborating with interdisciplinary team plan of care

Contact Tracer, Florida ( 07/20/20-07 to 08/07/2020

• Performed Swabbing for COVID-19 testing

• Educated patient on technique for self Swabbing

• Collected specimens and ensured registration sheet match patient’s verification prior to submitting specimen

• Informed patient of post-swabbing results webpage and length of time for results to be available.

• Ensure supplies where available at all times

RN Case Manager, Riverside, CA, (Strike) 06/26/2020 to 07/05/2020

Performed ER assessments for inpatient admissions

Completed discharge planning assessments

Arranged intra and interfaculty transport

Collated with interdisciplinary team on patient care/outcomes

Completed documentation in Midas and Meditech as required.

RN Case Manager, Swedish Hospital, Seattle Washington (Strike) 01/31/2020 to 01/08/2020

• Completed discharge planning assessments

• Arranged ongoing support post discharge such as rehabilitation, skilled nursing, DME, ALF Home health Care.

• Collaborated with interdisciplinary team to provide safe discharge and decrease Length of stay

• Adhered to policy and guidelines

• Followed Medicare and Medicare Guidelines

RN Case Manager

City Hospital at White Rock, Dallas Texas. (Travel contract) 02/03/2020 to March 22, 2020

Evaluates and assess Inpatient and ER admissions for medical necessity

Performs utilization management reviews and communicates information to third party payers

Complete Initial discharge plan on inpatient admission

Schedule appeals for denied payments with third party insurances

Acts as a liaison through effective and professional communications between and with physicians, patient / family, hospital staff, and outside agencies

Demonstrates knowledge of regulatory requirements, Ethics and Compliance policies, and quality initiatives; monitors self-compliance and implements process changes to ensure compliance to such regulations and quality initiatives as it relates to the provision of Case Management Services

Document clinical findings appropriate in the medical record programs, Allscripts and InterQual

Collaborates with provider, nursing personnel and patient benefits coordinators that all admission documentation is complete and all referrals for third party resources are complete prior to the departure of patients.

Work in collaboration with the interdisciplinary team to promote a safe discharge.

Nurse Practitioner: Risk Assessment

Advantmed, 10/201 to present

Conduct comprehensive in-home health risk assessments to identify chronic an active disease conditions as well as determine all physical, mental and social needs present at time of visit.

Educate and counsel patient and family on conditions identified at the time of visit

Develop plan of care based on assessment and diagnosis

Conducts Current Medication review

Completes PHQ9 depression screenings

Complete Six Item Cognitive Impairment test

Complete Fall Risk and home safety evaluation

Perform accu-checks and monofilament testing

Make recommendations and communicate findings to Primary Care Physicians through documented outcomes

RN Care Coordinator/Utilization Review 07/2019 thru 09/2019 (10-week Travel Contracts) St Joseph Hospital, Stockton, CA

• Provides comprehensive and client centered service planning and coordination for a specified group of high risk patients;

• Work collaboratively with providers and other disciplines to develop and maintain high risk patient database to ensure the continuity of care is established;

• Independently develops and maintains resource database to ensure timely and accurate information for patient referrals and minimize fragment in patient care service;

• Develops reports, performance improvement Projects, establish policy and procedures and program objectives;

• Promotes use of evidence base care, as available, in conjunction with the InterQual Care guidelines

• Pursue professional excellence and maintain competence in practice

• Provides service monitors and follow-up to ensure continuity of care, and updates-of the client services are no longer required;

• Arranges for any ongoing support/direct care services that the patient will need pot-discharge in coordination with discharge planners and other entities such a

• Collaborates with provider, nursing personnel and patient benefits coordinators that all admission documentation is complete and all referrals for third party resources are complete prior to the departure of patients.

• Document clinical findings appropriate in the medical record programs, Cerner and Midas

• Participates clinical rounds on the unit and in medical rounds.

ER RN Case Managers/ Utilization Review 12/10/2018 to 5/4/2019, UCI, Irvine, CA

• Performing Admissions and observation InterQual for Medical Necessity

• Providing insight to providers on correct admission status according to InteQual review

• Escalate Reviews not meeting medical necessity to Physician advisor

• Collaborate with managed care organization, for authorization for admission or transfer

• Adhere to CMS guidelines

• Scheduling transfer to managed care contract facilities facilities

• Order DME for patients discharging home

• Sending referrals for SNF and hospice placements

• Collaborating with ER staff for safe and approve discharge through effective communication

ER RN Case Manager 10/18 to 11/18 (6-week Travel Contract) MLK, Compton, CA

• Emergency room admission and discharge screening

• Adhering to IPO, HMO transfer policy

• Scheduling follow up outpatient appointments fo ER patient

• Sending Referrals to Community output resources for undocumented, uninsured, and homeless patients

• Adhering to ER polices and guidlines

• Collaborating with ER staff for safe discharges

RN Care Coordinator/Utilization Review 5/7/2018 to 8/4/2018 (Travel Contract) Mercy Gilbert Medical Center, Gilbert AZ

• Develops a case management plan of care to include identified clinical, psychosocial and discharge needs; coordinates plan of care; plan is documented in the electronic medical record; plan is communicated to appropriate clinical disciplines

• Develops individual plans of care for recurring patients to include education on appropriately accessing healthcare resources, preventative education, and community-based resources

• Review and observe observation patients for appropriate status

• Complete InterQual reviews as required according to hospital policy

• Modify Drug Related Group (DRG) to support the patient’s diagnosis

• Actively seeks ways to control costs without compromising patient safety, quality of care or the services delivered

• Enter Avoidable Days timely and appropriate

• Provide community resources to aid in discharge planning

• Request referrals for Durable Medical equipment, placement and Home Health Care effectively in Navihealth

• Complete case Management Initial Assessment and Discharge template appropriately

• Document clinical findings appropriate in the medical record programs, Cerner and Midas

• Participates clinical rounds on the unit and in medical rounds.

• Provide IM letter to patient in a timely manner and respond to appeals appropriately.

Care Coordinator/ Utilization Review 2/14/2018 to 4/16/18 (Travel Contract) Brandon Regional Hospital, Brandon FL

• Evaluates admissions for medical necessity using approved criteria at defined intervals throughout the episode of care; escalates medical necessity and admission status issues through the established chain of command

• Evaluates and assess ER and inpatient observation patients for appropriateness in observation status

• Offer alternative choices such as Long-Term Acute Care, Hospice, Home Health Skilled nursing when necessary

• Performs utilization management reviews and communicates information to third party payors

• Complete Initial discharge plan on inpatient admission

• Receive appeal notification from Kepro and complete and provide patents with HIN12 notification of appeal.

• Acts as a liaison through effective and professional communications between and with physicians, patient / family, hospital staff, and outside agencies

• Demonstrates knowledge of regulatory requirements, HCA Ethics and Compliance policies, and quality initiatives; monitors self-compliance and implements process changes to ensure compliance to such regulations and quality initiatives as it relates to the provision of Case Management Services

RN Care Coordinator/Utilization Review 10/27/2017 to 02/07/2018 (13-week Travel Contract) Banner Hospital, Mesa, AZ

• Develops a case management plan of care to include identified clinical, psychosocial and discharge needs; coordinates plan of care; plan is documented in the electronic medical record; plan is communicated to appropriate clinical disciplines

• Assessment of discharge needs upon admission to implement plan of care

• Evaluates and assess observation patients for appropriateness in observation status

• Acts as a liaison through effective and professional communications between and with physicians, patient / family, hospital staff, and outside agencies

RN Care Coordinator/Utilization Review 05/08/2017 thru 06/30/2017 and 08/20/17 thru 10/13/2017 (8-week Travel Contracts) St Joseph Hospital, Stockton, CA

• cCase Manager/ Utilization Review 01/24/2017 to 04/21/2017

Mercy San Juan- Carmichael, CA (13-week Travel Contract)

• Perform a comprehensive assessment of the patients’ psychosocial, medical and financial needs to expedite discharge

• Develops a case management plan of care to include identified clinical, psychosocial and discharge needs; coordinates plan of care; plan is documented in the electronic medical record; plan is communicated to appropriate clinical disciplines

• Develops individual plans of care for recurring patients to include education on appropriately accessing healthcare resources, preventative education, and community based resources

• Review and observe observation patients for appropriate status

• Complete InterQual reviews as required according to hospital policy

• Modify Drug Related Group (DRG) to support the patient’s diagnosis

• Actively seeks ways to control costs without compromising patient safety, quality of care or the services delivered

• Enter Avoidable Days timely and appropriate

• Provide community resources to aid in discharge planning

• Request referrals for Durable Medical equipment, placement and Home Health Care effectively in Navihealth

• Complete case Management Initial Assessment and Discharge template appropriately

• Document clinical findings appropriate in the medical record programs, Cerner and Midas

• Participates clinical rounds on the unit and in medical rounds.

Case Manager/Utilization Review 09/26/2016 to 12/24/2016

St. David’s South Austin-Austin, TX (13-week Travel Contract)

• Performs a comprehensive assessment of psychosocial and medical needs of assigned patients

• Emergency room utilization review.

• Develops a case management plan of care to include identified clinical, psychosocial and discharge needs; coordinates plan of care; plan is documented in the electronic medical record; plan is communicated to appropriate clinical disciplines

• Assumes a leadership role with the interdisciplinary team to manage care, through criteria driven processes, for the appropriate level of care, patient status and resource utilization

• Evaluates admissions for medical necessity using approved criteria at defined intervals throughout the episode of care; escalates medical necessity and admission status issues through the established chain of command

• Evaluates and assess observation patients for appropriateness in observation status

• Performs utilization management reviews and communicates information to third party payors

• Acts as a liaison through effective and professional communications between and with physicians, patient / family, hospital staff, and outside agencies

• Demonstrates knowledge of regulatory requirements, HCA Ethics and Compliance policies, and quality initiatives; monitors self-compliance and implements process changes to ensure compliance to such regulations and quality initiatives as it relates to the provision of Case Management Services

• Makes appropriate referrals to third party payer disease and case management programs for recurring patients and patients with chronic disease states

• Documents professional recommendations, care coordination interventions, and case management activities to effectively communicate to all members of the health care team

• Facilitates patient throughput with an ongoing focus on quality and efficiency

• Tracks and trends barriers to care; makes recommendations and develops action plans to improve processes and systems

• Involves patient, family/responsible/significant others in identifying and clarifying needs and expectations to develop mutual and realistic goals

• Assesses patients’ post discharge needs and facilitates the provision of services necessary to meet identified needs

• Actively seeks ways to control costs without compromising patient safety, quality of care or the services delivered

• Identifies patients with the potential for high risk complications and makes appropriate referrals acting as an advocate for the individual’s healthcare needs

• Directs activities to identify and provide for the needs of the under resourced patient population to include patient education activities, patient assistance programs, and community based resources

• Develops individual plans of care for recurring patients to include education on appropriately accessing healthcare resources, preventative education, and community based resources

• Assumes a leadership role in the development, revision, and implementation of clinical protocols which transition patients across the continuum of care or discharge patients to an appropriate service level of care

• Tracks and trends variances to care and barriers to care; makes recommendations and develops action plans to improve processes and systems

• Adheres to established policy and procedure and standards of care; escalates issues through the established Chain of Command timely

ER Case Manager 06/19/2016 to 9/10/2016

Trinity Medical Center- Trinity, FL (13-week Travel Contract)

• Provide first line defense in the ER for inappropriate admissions

• Evaluates admissions for medical necessity using approved criteria at defined intervals throughout the episode of care; escalates medical necessity and admission status issues through the established chain of command

• Evaluates and assess ER and inpatient observation patients for appropriateness in observation status

• Offer alternative choices such as Long Term Acute Care, Hospice, Home Health Skilled nursing when necessary

• Performs utilization management reviews and communicates information to third party payors

• Complete Initial discharge plan on inpatient admission

• Receive appeal notification from Kepro and complete and provide patents with HIN12 notification of appeal.

• Acts as a liaison through effective and professional communications between and with physicians, patient / family, hospital staff, and outside agencies

• Demonstrates knowledge of regulatory requirements, HCA Ethics and Compliance policies, and quality initiatives; monitors self-compliance and implements process changes to ensure compliance to such regulations and quality initiatives as it relates to the provision of Case Management Services

• Makes appropriate referrals to third party payer disease and case management

• Consult with ER physicians on admission criteria

• Actively seeks ways to control costs without compromising patient safety, quality of care or the services delivered

• Identifies patients with the potential for high risk complications and makes appropriate referrals acting as an advocate for the individual’s healthcare needs

Case Manager 08/24/2015 to 5/24/2016

Tuba City Regional Health Care Corporation – Tuba City, AZ

• Provides comprehensive and client centered service planning and coordination for a specified group of high risk patients;

• Work collaboratively with providers and other disciplines to develop and maintain high risk patient database to ensure the continuity of care is established;

• Independently develops and maintains resource database to ensure timely and accurate information for patient referrals and minimize fragment in patient care service;

• Develops reports, performance improvement Projects, establish policy and procedures and program objectives;

• Promotes use of evidence base care, as available, in conjunction with the MCG Care guidelines

• Pursue professional excellence and maintain competence in practice;

• Serves as an outpatient/inpatient coordinator;

• Provides service monitors and follow-up to ensure continuity of care, and updates-of the client services are no longer required;

• Arranges for any ongoing support/direct care services that the patient will need pot-discharge in coordination with discharge planners and other entities such as PHN, Community Health Representatives or Tribal services and

• Collaborates with provider, nursing personnel and patient benefits coordinators that all admission documentation is complete and all referrals for third party resources are complete prior to the departure of patients.

Physician Review Coordinator 02/2015 to 05/2015

Health Integrated – Tampa, FL

• Involvement in day-to-day utilization management functions;

• Discuss determinations with requesting physicians or ordering providers, when available, within the regulatory time frame of the request by phone or fax

• Provide clinical rationale for standard and expedited denials;

• Aid and education to initial clinical reviewers as needed to discuss cases and problems;

• Participate in daily review of aggregate denials with the Medical Director, peers, and/or the Clinical Review Supervisor;

• Utilize medical review guidelines and parameters to assure consistency in the MD review process so as to reflect appropriate utilization and compliance with URAC and NCQA guidelines;

• Document all communication with medical office staff and/or MD provider is recorded in a timely and accurate manner;

• Participate in on-going training per inter-rater reliability process;

• Function as a resource for initial clinical reviewers and the Clients

• Conduct internal audits of clinical reviewers to ensure compliance with regulatory guidelines and policy and procedure and

• Educate clinical reviewers on Milliman and InterQual criteria.

Case Manager 10/ 2014 to 01/2015

JBER Elmendorf Hospital –Anchorage, AK

• Coordinate with the interdisciplinary team to provide high quality care within the facility

• Advocated and supported the case management process, matching an individual’s needs with the appropriate level and the type of medical, psychological health or social care/services;

• Identified and achieved timely patient care needs with implementation of the plan of care appropriate, resourceful and valuable;

• Assessments of patients pre and post operatively with ADRETE score

• Worked efficiently with other officials associate with patients’ care;

• Assisted in Pre, during and post op procedures in the surgical suite.

• Started IV’s prior to procedure and administered medication;

• Monitored patients’ outcome post procedure;

• Addressed complications and provided patient education and

• Provided discharge instructions upon release.

• Documented in Electronic Medical Records for DoD and VA

Utilization Review 9/2014 to 10/2014

All Medical Staffing (Heath Integrated) – Tampa, FL

• Contributed to UM program goals and objectives in containing health care costs and maintaining a high quality medical delivery system through the program procedures for conducting UM activities;

• Knowledgeable of URAC requirements for clinical staff for UM accreditation; Performed telephonic review for outpatient services using InterQual criteria

• Collected only pertinent clinical information and documents all UM review information using the appropriate software system;

• Communicates directly with physician providers/designees when appropriate to gather all clinical information to determine the medical necessity of requested healthcare services;

• Participates in UM program CQI activities;

• Communicated all UM review outcomes in accordance with the health plan client profile procedures;

• Followed relevant client time frame standards for conducting and communicating UM review determination;

• Identifies and communicates to the Director of Utilization Management supervisor all potential quality of care concerns and patient safety;

• Maintained courteous, professional attitude when working with Health Integrated HealthCare staff, hospital and physician providers, and health plan client;

• Active participation in team meetings; and.

• Performs other duties as requested by the Director of Utilization Management.

Staff Development Coordinator 01/2013 to 08/2014

Rehabilitation Healthcare Center of Tampa – Tampa, FL

• Responsible for consulting with Department Supervisors to develop performance

improvement measures.

• Educated and prepared staff for Staff Audits/ annual inspections;

• Developed on-the-job training for new employees, to include, OSHA Regulations on Air and Blood Borne Pathogens, to include HIV, Hepatitis A, B, and C, MRSA, and C- diff and Infection control procedures.

• Maintained, updated and audited employees’ competency, and medical folders according to HIPPA Guidelines.

• Audited 100 percent of the staff license to ensure compliance with FL Standards.

• Designed employee orientation programs and provide leadership training for new

supervisors and managers.

• Provided continuous training on EMAR and Point Click Care (PCC) with return

demonstration and follow-up.

Case Manager-08/ 2013 to 07/2014

Army Reserves Medical Management – Pinellas Park, FL

• Organized and reviewed performance data and worked with the Army Reserve

Surgeon's office to tailor processes to meet specific United States Army Reserve

wounded, ill and injured Warriors;

• Coordinate with USAR Recovery Care Coordinator for non-medical case management and Family needs, in order to deliver the highest possible quality of care support;

• Established a collaborative and cohesive relationship with Senior Office in Washington D.C. to expedite Line of Duty (LOD) forms for the soldiers;

• Decreased wait times LOD's from 2 years to estimated Three months on our team;

• Organizing soldier’s cases for the Medical Examination Board (MEB) by managing their profiles and gathering documentation;

• Collaborated with civilian and VA medical staff;

• Outsourced to community to seek treatment for non-service connected veterans and

• Adhere to policy, procedures and guidelines to support findings and requirements for MEB submission.

Unit Manager 06/2012 to 01/2013

Bay Point Nursing Pavilion – St. Petersburg, FL

• Oversee responsibility and accountability for nursing care service provided on the unit;

• Nurse unit managers establish standards of nursing care for the unit, applying

Evidence-based standards and health care research;

• Monitor patient care to ensure it meets the facility's standards, and review patient records to analyze the effectiveness and efficiency of the care provided by the unit;

• Adhere to the standards of care; provide assessment, monitoring and implementation of physician orders; ·

• Address questions or complaints brought forward by customers;

• Established employee policies and procedures;

• Led, planned and organized duties for the unit daily;

• Set work schedules, delegate assignments, assign tasks; Ensures the

Environment is safe for resident, visitors, family and staff;

• Attend interdisciplinary plan of care meetings (Standards of Care, Care Plans, and Quality Assurance) designated by the Director of Nursing;

• Evaluate employee job performance; Counseling/Disciplining employees

According to company's policies and procedures;

• Mentor nurses offering clinical and career advice;

• Set goals and standards for the unit, and may hold regular staff meetings in which they give directions or discuss areas for improvement;

• Oversee budgets for the unit, including personnel, supplies and other expenses;

• Ensure the department is well-stocked with medical supplies, including medications and equipment and

• Assessed new admission, provided wound care and place wound vac machines,

• Inserted and managed feeding tubes, tracheotomies, and high Flow oxygen,

• Administered Medication; ordered and interpreted labs, and EKGs,

• Started IV’s and monitored infusions and

• Proficient in verbal, oral and written communication.

Health Systems Specialist 11/2004 to 11/2011

VA Office of Inspector General, Bay Pines, FL

• Responsibility is to conduct oversight, monitoring and evaluation of Veterans Health;

• Administration (VHA) Quality Assurance Programs;

• Develop, monitor and evaluate programs in VHA in our Combined Assessment Program (CAP);

• Conduct comprehensive Quality Assurance Projects to improve quality of care within VHA;

• Planned, develop, implement, national projects, complex hotlines, and coordinate CAPs for review;

• Train and evaluated regional offices on projects t performed on CAPs and national reviews;

• Review and research media information for potential hotlines;

• Ensure that quality assurance activities are adhered;

• Participated in Critical Care Product Line group to develop, assess, implement analysis and evaluate new projects for reviews;

• Up hold the mission of Office of Health Inspection (OHI) and to the Veterans and

families who have served our country;

• Delegate activities and work effectively with staff within other regions to ensure the job is done effectively;

• Initiated work plans for new reviews on CAP or National reviews;

• Keep abreast of changes occurring in the community that may impact VA care;

• Developed a National project which led to a national policy in all 152 VA's and 800 plus Community based outpatient clinics;

• Frequently travel (50 percent) to VHA hospitals, Community Based Outpatient Clinics;

• VET centers for medical record inspections in comparison to policy guidelines.

• Developed cost analysis to determine cost for specific projects;

• Conducted entrance and exit briefings to senior leadership to include VHA Headquarters;

• Team leader and supervised staff during CAP's;

• Report writing that are issued to State Representatives, Senators, Medical Center Directors and several government agencies;

• Knowledge in developing Excel spreadsheets, Power Point development and

presentations and data input into Access database and

• Proficient in verbal, oral and written communication.

ER Clinical Care Coordinator (Utilization Review) 07/2005 to 01/2009

Countryside Hospital – Safety Harbor, FL

• Responsible for hospital wide Case Management activities to include

Geriatric, Psychiatry, Pediatric, and Maternity, labor and Delivery, ER, Telemetry,

ICU;

• Ensure that patient tests were appropriate and necessary and carried out within the established timeframe and that results were promptly available;

• Conducted Utilization reviews for appropriate utilization of services from admission through discharge;

• Evaluated patient satisfaction and quality of care provided;

• Assist mental health patients with community resources for outpatient treatment and Mental Health Placement;

• Provided resources for indigent patients such as; medication assistance and with burial services and

• Conducted reviews for appropriate utilization of services from admission to discharge and determined based on InterQual Criteria if the stay was observation status or a full admission.

Case Manager 06/2003 to 11/2004

Morton Plant Hospital – Clearwater, FL

• Responsible for hospital wide Case Management activities to include

• Geriatric and pediatric populations in the following areas: ER, ICU, Med surgical,

Neurology, Orthopedic, Telemetry and Urology;

• Duties included but not limited to; assessed patient care required throughout continuum of care for diagnosis, procedures and DRG's;

• Communicate with physicians at regular intervals throughout hospitalization and

developed an effective working relationship.

• Assist Physicians to maintain appropriate cost, case, and desired patient outcomes;

•

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