Nurse Consultant Case Manager
Resume:
Jacqueline Loomis
262-***-**** ******@****.***
Hartford, WI 53027
OBJECTIVE
To successfully manage a team using strong clinical, analytical and communication skills while helping people live healthier lives and creating a positive impact on our members
LICENSES/CERTIFICATION
M&R Certified 2019
MCG· Certified Case Manager 2019
Multi-State RN license-State of Wisconsin Registered Nurse -2005-Present
QUALIFICATIONS
10+ years behavioral health experience
9+ years of supervisory experience
7+ years of utilization management caseloads of 20-40 members
Experience with Microsoft Office, Excel, Word, PowerPoint and clinical programs.
Experience with utilization, concurrent, and discharge planning
Telecommuter experience, strong organizational, multitasking, and autonomy
Accomplished in leading groups and working in a team environment
Strong collaboration skills
WORK EXPERIENCE
United Health Care Milwaukee, WI Care Manager October 2014 – Present
Experience in Managed Care and Utilization Review using MCG guidelines for Medicaid, Medicare and commercial insurance.
Coordinate strategic discharge planning and readmission prevention planning with the goal of designing and delivering interventions aimed at improving patient outcomes.
Exceptional clinical documentation skills using critical thinking to analyze and maintain accurate clinical data, detailed reports, records and census management.
Function as a member of a self-directed team to meet specific individual and team performance metrics established by state guidelines.
Perform utilization and concurrent review of inpatient cases using MCG guidelines and interpretation of state and federal mandates, applicable benefit language, and relevant clinical information.
Consult with the Medical Director as needed to troubleshoot difficult or complex cases and identify the best Plan of Care for patients successful discharge
Arrange alternative care services; contact and maintain communication with acute long term care, acute rehabilitation, or skilled nursing facilities to move patients through the care continuum.
Meet or exceed metrics by moving patients thought the continuum of care, effectively anticipating discharge needs, providing patients with support and services, completing through and timely documentation while follow Standard Operating Procedures.
Post-Acute experience working one on one with IDT Team while providing Plan of Care and anticipated discharge needs for patients.
Centene Managed Health Care Milwaukee, WI Case Manager August 2013 – October 2014
Experience in medical and behavior health, Managed Care and Utilization Review for Medicaid, Medicare, and commercial insurance.
Consult and coordinate with healthcare team members to evaluate patient care plans, determine least restrictive level of care for patients, and monitor appropriate payment for clams.
Coordinate a strategic effort with the goal of designing and delivering interventions aimed at improving health outcomes for patients.
Assess the needs of individuals, families, or communities, including assessment of individuals' home to identify potential health or safety problems and implement programs designed to improve the overall health of patients and communities.
Post-Acute experience working one on one with IDT Team while providing Plan of Care and anticipated discharge needs for patients.
Participate in STARS and HEDIS improvement projects by evaluating, developing and implementing a new process.
Bureau of Milwaukee Child Welfare Milwaukee, WI Nurse Consultant Case Manager April 2010 – August 2013
Management of teams to affect desired outcomes. Responsible for direct reports and supervised IDT for multiple teams.
Direct and conduct recruitment, manage hiring, training and evaluations of personnel.
Establish work schedules and assignments for staff, according to workload, space and equipment availability.
Consult with medical, business, and community leaders to discuss service problems, respond to community needs, enhance public relations, coordinate activities and plans, and promote health programs.
Created and developed a medical model for the Department of Child Welfare, including programs for AODA, mental health, medical resources, drug affected infants, mom and child.
Maintain communication between governing boards, medical staff, and department heads by attending board meetings and coordinating interdepartmental functions.
Monitor, record, and maintain detailed reports on patients' including responsible for State based reports which determine program funding.
Direct or coordinate infection control programs, advising or consulting with specified personnel about necessary precautions.
Rogers Memorial Hospital Brown Deer, WI Psychiatric Nursing Manager July 2006 – April 2010
Direct and conduct recruitment, manage hiring, training and evaluations of personnel.
Evaluate patients' medical and psychological histories, physical assessments, diagnoses, treatment plans, prescriptions and outcomes for effectiveness and efficiency.
Collaborate with interdisciplinary team members, including psychiatrists, psychologists, nursing staff, social workers to develop, implement, and evaluate treatment and discharge plans.
Conduct groups and educate patients and family members about mental health and medical conditions, preventive health measures, medications and treatment plans.
Restrain and aid patients as necessary to prevent injury.
Participate in activities aimed at professional growth and development including conferences or continuing education activities.
St. Joseph Hospital West Bend, WI Registered Nurse, Medical November 2004 – September 2006
Direct or supervise less-skilled nursing, healthcare personnel. and supervise a particular unit.
Consult and coordinate with mental health and healthcare team including members to assess, plan, implement, or evaluate patient care plans.
Educate individuals, families, or other groups on health issues and disease prevention.
Refer students or patients to specialized health resources or community agencies furnishing assistance.
EDUCATION
UNIVERSITY OF PHOENIX Milwaukee, WI: BSN, DECEMBER 2006
WAUKESHA COUNTY TECHINICAL COLLEGE Waukesha, WI: NURSING, DECEMBER 2004
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