HEATHER FISHER, RN, BSN, CCM, CHPN

Bronxville, NY 10709 434-***-**** adkg98@r.postjobfree.com SUMMARY

Diligent and attentive RN with eight years of experience in case management across varied settings, including oncology, primary care, managed care, and hospice. Proven ability to coordinate integrated patient care with a focus on decreasing utilization and improving patient outcomes. Compassionate nurse committed to addressing the unique needs of each patient and family. Knowledge in EMR (Epic and Suncoast). Core competencies include: Nursing Assessment Chronic Disease Management Patient Education Interdisciplinary Team Collaboration Comprehensive Care Planning Motivational Interviewing Advance Care Planning Hospice Care EDUCATION / CREDENTIALS

OLD DOMINION UNIVERSITY, Norfolk, VA

Bachelor of Science in Nursing – GPA 3.97

UNIVERSITY OF VIRGINIA, Charlottesville, VA

Bachelor of Arts in Economics

LICENSES/CERTIFICATIONS:

Registered Nurse, New York, #763633, expires 12/31/2021 Registered Nurse, Virginia, #000******* expires 05/31/2022 Registered Nurse, Kentucky, #1149230, expires 10/31/2021 Registered Nurse, Ohio, #428908, expires 10/31/2021 Certified Case Manager (CCM), Commission for Case Management Certification, expires 05/2022 Basic Life Support (BLS) for Healthcare Providers, American Heart Association, expires 07/2022 Certified Hospice and Palliative Nurse (CHPN), Hospice and Palliative Nurses Association, expires 12/2023 PROFESSIONAL EXPERIENCE

NYC HEALTH AND HOSPITALS, New York, NY 03/2019 – Present Accountable Care Manager - World Trade Center (WTC) Clinic

! Coordinate efficient and effective medical care and covered services for ~150 cancer patients, ensuring alignment with the National Comprehensive Cancer Network (NCCN) guidelines.

! Complete cancer screening assessment questionnaires with cancer and chronic pulmonary illness patients to determine eligibility for the World Trade Center Health Plan.

! Review requested cancer treatment plan of care to verify compliance with NCCN guidelines and recommend approval/denial of treatment; document authorizations/denials in electronic system (Case Trakker).

! Identify correct coding for authorization requests.

! Educate patients on diagnosis and treatment, including disease management, resources, and medications.

! Collaborate with patient and providers to manage co-morbid conditions. Document interventions and patient compliance with recommendations during telephonic outreach and clinic visits.

! Perform medication reconciliation and assess for side effects of oral chemotherapeutic medications.

! Provide patients and families with advance care planning and education on palliative and hospice care.

! Assess emotional and psychological concerns and refer to behavioral health for additional treatment.

! Communicate with each patient's treatment team to maintain updated clinical progress and provider notes.

! Document patient assessment, education, and care plans in EMR (Epic). THE CHRIST HOSPITAL, Cincinnati, OH 07/2017 – 01/2019 RN Care Manager – Comprehensive Primary Care Plus

! Oversaw care for ~150 patients with uncontrolled diabetes, chronic obstructive pulmonary disease (COPD), and high risk of hospital admission to improve disease management and reduce unnecessary utilization.

! Telephonic outreach to patients recently discharged from hospital/emergency room to assess needs, provide education, and assure continuity of care.

! Identified targeted patient populations that would benefit from care management; contacted patients

(telephonically and in-person clinic visits) at needs-based frequency to promote self-management and improve health outcomes.

! Applied motivational interviewing techniques to improve patient engagement and self-management. HEATHER FISHER, RN, BSN, CCM, CHPN 434-***-**** adkg98@r.postjobfree.com Page 2 THE CHRIST HOSPITAL - RN Care Manager - Comprehensive Primary Care Plus Continued

! Developed comprehensive, patient centered care plans with care team, including physicians, behavioral health specialists, and social workers, to improve chronic disease management and prevent readmissions.

! Assessed and resolved barriers to achieving care plan goals by connecting patients with appropriate resources, such as home health services, behavioral health care, and/or community resources.

! Provided individualized, needs-based patient education; taught group classes on diabetes and COPD.

! Documented assessments, care plans, and interventions in electronic medical record (EMR) systems (Epic).

! Reduced number of patients with uncontrolled diabetes through regular patient outreach, patient education, and motivational interviewing to improve self-efficacy. MOLINA HEALTHCARE, Cincinnati, OH 08/2016 – 07/2017 Case Manager – Long-Term Services and Supports (LTSS)

! Coordinated integrated delivery of care for 60-70 patients with dual Medicare/Medicaid and Medicaid waiver benefits, promoting optimum health outcomes.

! Conducted face-to-face assessments in the home at regular intervals per state and federal requirements based upon member risk stratification.

! Assessed member needs and coordinated appropriate Medicare, Medicaid, and/or waiver services to close care gaps and minimize unnecessary hospitalizations/institutionalizations.

! Evaluated covered benefits and advised member appropriately regarding funding source.

! Authorized all appropriate waiver services based on medical necessity assessment.

! Created comprehensive care plans targeting each member’s healthcare needs and barriers to meeting care goals.

! Facilitated interdisciplinary team meetings to collaborate on care plans and approve/deny services.

! Identified, documented, and reported critical incidents, safety concerns, and/or member grievances; developed prevention plans to assure member's health and welfare.

! Maintained electronic documentation of patient assessments, interventions, and care plans. CAPITAL CARING, Arlington, VA 03/2012 – 05/2016

RN – Hospice Inpatient Unit (09/2014 – 05/2016)

! Provided direct nursing care for 4-8 critically ill patients per shift to achieve optimal symptom management, comfort, and quality of life.

! Conducted continuous assessment of pain and comfort level; alerted physicians to changes in patient condition and implemented new physician orders.

! Presented patient status and collaborated on plan of care with medical director and interdisciplinary care team.

! Incorporated patient spiritual and cultural beliefs into care plan; maintained dignity of patient at end of life.

! Completed patient care tasks, including IV drip management, tracheostomy care, and wound care.

! Supervised care provided by 1-4 certified nursing assistants and volunteers each shift.

! Performed admissions and discharges to ensure continuity of care between healthcare settings.

! Provided education to patients and families on disease progression, symptom management, and end of life.

! Documented assessments, interventions, and physician orders in EMR system (Suncoast). RN Hospice Care Manager (03/2012 – 08/2014)

! Coordinated palliative and end-of-life care for caseload of 15-20 patients residing in various settings, including home, assisted living, and long-term care facilities, to ensure quality of life and comfort.

! Collaborated with interdisciplinary team comprised of physicians, social worker, chaplain, and nursing assistants to ensure holistic and compassionate care for each patient.

! Identified and anticipated patient symptoms by performing assessments. Updated physician on changes in patient status and coordinated with physician for new orders as needed.

! Created individualized care plans in collaboration with patients, families, and interdisciplinary hospice team to address physical, emotional, cultural, and spiritual needs.

! Performed patient care tasks, such as medication administration, wound care, and foley catheter insertion.

! Oversaw care provided by certified nursing assistants and volunteers.

! Provided education to patients/caregivers including expected disease course and symptom management.

! Maintained accurate EMR records of assessments, care plans, interventions, and physician orders. Prior Health Care Experience: RN Hospice Care Manager, Heartland Hospice, Fairfax, VA, 12/2010 – 02/2012 Additional experience in Human Resources at Transportation Security Administration (TSA), 01/2006 - 08/2008 and Insurance Underwriting at Travelers, 07/2004 - 12/2005.

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