Registered Nurse Manager
Resume:
PAULA M. VARGAS
R E G I S T E R E D N U R S E
https://www.linkedin.com/in/paula-m-vargas-546833a2
SUMMARY: Experienced Registered Nurse with a demonstrated history in the healthcare industry working hands on or administratively for over 20 years. Skilled in Med/Surg Nursing, LTC, Short term Rehab, Healthcare Operations and Management including Policy and Procedures, Medicare/Medicaid, Medical Review and Healthcare Consulting. WORK EXPERIENCE:
2/2020 – present Peachtree Orthopedics, Inc. Atlanta, GA RN Case Manager
• Responsible for managing a group of orthopedic patients throughout an episode of surgical care.
• Gather clinical information from the EMR and patients to complete telephonic health assessments to determine risk stratification including a comprehensive assessment of the physical, emotional, psychosocial, and environmental needs of the patient.
• Work with discharge planners at the local hospitals to coordinate post-operative care.
• Document clinical assessments and care plans in web-based case management system.
• Development and implementation of care plans throughout the transition of care to ensure the patients well-being.
• Collaborate with multidisciplinary team members in the acute, post-acute and outpatient settings to identify patient needs such as home health care, DME, physical therapy and community services.
• Follow up with patients at pre-determined intervals and as needed based on patient status, telephonic and on-site.
• Evaluate plan of care and revise on ongoing basis as determined by patient's health status and communicate changes to all other disciplines involved in the patient's care.
• Educate the patient and caregiver of the process and expectations throughout the course of care.
• Communicate with providers and multi-disciplinary care team members to facilitate transition of services throughout the continuum of care.
• Identify gaps or barriers in treatment plans to ensure that discharged patients receive appropriate resources and services.
• Understand the Bundled Payment Program design, implementation, management, monitoring and reporting requirements.
• Adhere to the scope of practice for the Registered Professional Nurse per state regulatory guidelines. Maintain confidentiality of all patient information per HIPAA. 11/2019 – 2/2020 Park Springs, Inc – Part Time Atlanta, GA Weekend Supervisor & Staff RN
• Oversee 3 units as primary contact on shift – Short term rehab, skilled nursing and long-term care
• Supervise staff of RNs, LPNs, CNAs as well as shift assignments and taking callouts
• Track and update communication log with Therapy department
• Investigate all incident reports and follow-up
• Conduct daily audits of all new admission charts and medication carts
• Assist with all Admissions and assessments of members
• Serve as liaison between family, patient, doctor and other departments P
E adii47@r.postjobfree.com A
4002 Lucas Lane
Ellenwood, GA 30294 W
7/2018-1/2020 Aetna, Inc. Atlanta, GA
Medical Review Coord. /Clinical Validation Nurse - RN
• Medically reviewed clinical & inpatient facility DRG coding for medical and reimbursement policies within the claim adjudication process through file review for Workman’s Comp bills &cases. Including interpretation of state and federal mandates for applicable benefit language, medical and reimbursement policies and consideration of relevant clinical information
• Responsible for medically reviewing denials, appeals & auditing client facility Medical Records (MR's) for a variety of national inpatient facilities.
• Performs clinical coverage review of inpatient facility DRG claims, which requires interpretation of state and federal mandates, applicable benefit language, medical & reimbursement policies, coding requirements and consideration of relevant clinical information on claims with aberrant billing patterns
• Medically Review to determine medical necessity and relatedness to initial injury
• Performs clinical coding inpatient facility DRG reviews to ensure accuracy of medical coding and utilizes clinical expertise and judgment to determine correct coding & billing
• Identifies billing patterns and trends, evidence of fraud, waste or abuse, and recommends providers to be flagged for review
3/2019 – 9/2019 Westminster Winter Park Winter Park, FL Weekend Supervisor, RN – Part Time
• Supervise all floor nurses and staff members and provide conflict resolution to issues and replace nurses that call-off or are no-call/no-show.
• Assist the ADON/DON with calculating daily staffing needs based on census requirements.
• Provide hands on care, IV infusion and medication administration when needed or short staffed
• Review doctor’s orders for new and current residents;
• Oversee and assist nurses performing resident assessments as well as managing family concerns
• Coordinate care through communication with resident’s family members, physicians, and other health care providers. Also, ensure that care is being provided based on established standards, Update ADON/DON on important situations related to the residents or the Health Center.
• Enter admission orders in ECS for new residents to the Health Center.
• Assist nurses with managing emergencies in the Health Center or independent living.
• Complete admission documentation in ECS.
• Assist with planning resident care based on physician orders. Enter physician orders into ECS 1/2015 – 6/2015 Central Florida Family Health Center Orlando, FL Clinical Lead / Charge Nurse
• Responsible for the day-to-day oversight of the clinical floor for Adults, Pediatrics, and OB/GYN depts.
• Supervise a staff of 13 consisting of RNs, LPNs and Medical Assistants
• Be the liaison Super User for EMR/EHR and point of contact to assist and train users
• Identify and initiate referrals for social service programs for patients upon discharge
• Coordinate daily staffing at site with other Center Manager, other Clinical Leads and/or Director of Clinical Services to assist in staffing needs
• Oversee and assist to maintain efficient patient flow daily while coordinating care with 8 PCPs
• Maintain all emergency equipment at site in all clinical departments and compile all logs site in all clinical departments monthly within HRSA/HEDIS/AAAHC requirements
• Perform chart audits, monitor staff desktops on a daily & adhere to Universal Precautions at all times. EDUCATION: 2015 – 2018 Jersey College School of Nursing Tampa, FL Major: Registered Nurse, ASN
RN License – RN9500678
2007– 2009 Orlando Tech – OCPS
Major: Practical Nursing
PN License – PN5186696
Orlando, FL
CERTIFICATIONS: Currently enrolled in HEDIS AND CCM certification classes
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