Review Nurse Utilization

Sandia Louissaint- Registered Nurse (RN)

Nurse Case Management Email: ****************@*****.***

Resourceful, dedicated, and extremely proficient Nurse with more than 10 years experience, demonstrating expertise in case management, utilization review, catastrophic care, and cost containment strategies in clinical and hospital environments. Compassionate nurse professional exhibiting excellent patient-centric care and oversight with proven ability to communicate. Worked in organizations with HMOs, PPOs, Medicaid, Medicare and home health providers in Miami Dade, Broward County, and West Palm Beach, FL. Provide critical training and management of personnel with strong and comprehensive knowledge of managed care structures and organizations. Fluent in Creole. Authorized to work in the US for any employer

Work Experience:

Corvel Corporation- (WC) Remote Workers Compensation- Medical/ Telephonic Case Management- Apr 2021- Sept 7, 2022

Use nursing and medical knowledge to assist injured workers with their medical care. Contact and assist Injured workers regarding their work-related injury with setting appointments with Specialist such as Orthopedics or the ordering specialist after injury has been examined by the first evaluating physician or practitioner. Request and obtain medical records such as DWC25, office visit notes, and doctors’ orders via company approved method of communication such as email, eFax, and send to an approved vendor provided by injured worker assigned Adjuster telephonically. Onsite at Jackson Memorial Hospital twice a week to assist injured employees.

As a Medical Case Manager- Attend doctors’ appointments or contact the doctor’s office telephonically to confirm scheduled appointments attended. Obtain pertinent medical records and orders, discuss plan of injured worker care with physician or practitioner providing care.

Work in an interdisciplinary team with Adjusters, doctors, doctors’ office, third party vendors such as One Call, Med Risk, Physical Therapy centers, and transportation companies for the injured workers.

Send appointment letters to injure workers, correspondence to injure workers attorney if represented per adjuster request.

Document detailed information in an EHR CAREMC system

Remote Medical International (RMI- per diem basis)

December 2020

Travelled to Devens, Ma, to perform covid testing via nasal swabbing for a onsite film production company crew. Standard Precaution maintained and PPE provided.

ACI Federal- Rapid Response Nurse Covid-19 Per diem

(El Paso, Texas) November 2020- November 2020

Travelled to El Paso, Texas, as a Rapid Response Nurse to work at the Convention Center.

(Harlingen, Texas) October 2020- October 2020

Traveled to Harlingen Convention Center as a Rapid Response Nurse.

(New York) April 2020- May 2020

Travel to New York and worked at Billie Jean King (BJK) center which transitioned to a hospital. Provided care and assistance to patients that are positive with coronavirus, quarantined at the hospital, and cared for patients that were not positive with coronavirus in med-surg unit with proper PPE that was provided at the hospital.

May 2019- Dec 2019

Working in per diem status doing home visits on a temporary assignment.

Sunshine Health- Concurrent Review Nurse

June 2018- May 2019

Responsibilities: Open daily electronic hospital census. Call assign hospital and speak with hospital operator, utilization management nurse, or medical records department to verify patients discharge date or active admission. Request hospital clinicals from utilization department via telephone or centralized system, and medical records dept. Upon receiving clinicals, clinicals were attached to assigned inpatient or SNF authorization to created authorizations. Complete concurrent review using Interqual criteria, when necessary, authorization reviews were sent to medical director if criteria is not met for secondary review. Entered ICD 9/10 codes and or making corrections to diagnosis codes in the EHR system. Place call to patient while in the hospital and Provided education and discuss discharge plans and confirm discharge plans with case management nurse or social worker. Update and re-evaluate discharge plans with hospital disciplinaries and insurance medical director until patient is discharged. Perform electronic reviews and create authorization for Skilled nursing facility (SNF). Assist and coordinated assistance for patients to receive durable medical equipment (DMEs). CRN assisted case management and utilization review team.

Primary Care Coordinator- Cleveland Clinic Hospital

June 2017- Dec 2017

Review hospital census and place call to and visit patients who were currently admitted to the main hospital. Introduce self and provided care coordination services to patients. Followed up with patients at their primary care doctors appointments. Review and updated prescribed medications, diagnosis, and treatment plan.

Care Team Manager-Team Lead POSITIVE HEALTHCARE/ AIDS HEALTHCARE FOUNDATION (AHF) - Fort Lauderdale, FL

May 2014 to May 2016

Responsibilities: Support and supervise staff by providing day-to-day supervision, including direct and non-direct administrative and clinical supervision; complete written performance staff evaluations. Interviewed and hire staff; Provided in-service and ongoing training. Supervise for Special Needs Plan for patients with HIV/AIDS for both Medicare and Medicaid population of pregnant women, pediatrics, adolescent, and adults. Participate as a member of the Management Team, support the organization's mission and philosophy and follow the organization lines of communication. In addition to maintaining a caseload and maintaining accurate and timely documentation of all services provided along with other related paperwork. Coordinate care with primary care providers, infectious disease physician, and specialist. Complete one-to-one monthly audits, hold meetings with colleagues to assign team attend biweekly Team Lead meetings to discuss any team issues, analyze and review statistics. Discuss complex cases with Medical Director. Assure compliance with regulatory requirements.

Acute Care Case Manager- Plantation General Hospital - Fort Lauderdale, FL

October 2013 to October 2014

Responsibilities: Coordinated care at time of admission with completing a discharge plan evaluation (DPE) for hospitalized patients, family, and caregivers to ensure proper discharge planning, and transitioned to the appropriate level of care. Worked in ER, ICU, CCU, Med-Surg/ Telemetry, and Pediatrics units. Work in a multidisciplinary team environment to create an effective plan of care and assure that the patients are receiving prescribed treatment, advocate for services and plans needed during and after their stay with community resources, home health services, skilled nursing facilities, and long-term care facilities, by maintaining evidence-base practice. Attend and discuss patients in daily multidisciplinary rounds.

Nurse Case Management/ Disease Management- Humana

September 2008 to January 2013

Responsibilities: Provide effective quality Case Management oversight to assigned hospital 's. Successfully manages routine caseload. Demonstrate strong working knowledge of Chronic Diseases and co-morbidities. Provide patient and family member education on current treatment plans, available resources, and follow-up care. Assist health plans to ensure cost containment strategies and exceptional quality of care is received. Provide efficient discharge planning and setup initiatives. Able to collect, analyze, and draw conclusions from information and can differentiate between signs and symptoms. Appropriate decisions in the face of ambiguity. Anticipates and resolves barriers and constraints. Discussed special cases with Medical Director.

School Nurse James H. Bright Elementary School - Hialeah, FL August 2007 to September 2008

Provided exceptional nursing care to adolescents and children. Responsibilities included attending to the student's physical and emotional needs, communicating with parents and faculty, performing health screenings, maintaining health records, administering first aid, medications as per doctor's orders. Provided health teaching in a clinical setting.

Miami Jewish Home - Floor Nurse

January 2006 to 2008 Miami, FL

Responsibilities: Uses the nursing process to provide nursing care. Identify problems; formulate a nursing plan of care; Implementing nursing actions. Evaluate and revise the patients plan of action including updating care plan as indicated. Administer complex medications via the oral, intra-muscular, subcutaneous, intradermal, topical, rectal, respiratory, and intravenous routes. Participated in the in-service trainings. Attended various patient conferences with the multidisciplinary team. Provided emotional support to patients. Display knowledge of disease process and response to medical plan and nursing actions, on a continual basis. Communicate patient progress and/or relevant changes in status to the Physician, Charge Nurse, and incoming shift nurse. Teaches patient and family about illness prevention; disease process; pre and post-operative care; diagnostic procedures; use of equipment related to disease/care; expected and possible adverse reactions to medications (as appropriate) and discharge planning.

Unity Health Rehab Center- Charge Nurse

October 2004 to October 2007

Conduct patient rounds on unit and provide patient care including assessment, planning, intervention, and evaluate patient care on a continuous basis. Administered ordered medication according to physicians order.

Document patient care on a ongoing basis and provide updates to incoming shift nurse and MD. observing patient condition and vital signs, assessing findings and recording observations in the patient's charts. Assisted physicians during their rounds and treatments. Transcribed and review physician orders. Provided continuous patient education on there disease process. Performed pre and post-surgical nursing care. Performed wound care treatments throughout the facility such as the HIV/AIDS unit, LTAC unit and Medicare/ Medicaid unit.

Education Graduate ASN Excelsior College (2011).

Bachelor's in Nursing Chamberlain College of Nursing-Chicago - Illinois (2014).

Skills: Travel to Jacksonville to train new staff to the organization, attend Case Management Conference in Tampa, FL, 2016. Perform monthly audits for colleagues and discuss areas that need improvement, and provide positive feedback for work performance. Attended Broward Sheriff Department conference.

Proficient with Excel, Microsoft Office, Microsoft Outlook, PowerPoint, Milliman and Interqual Guidelines, AllScript, Curaspan, EPIC, SNOMED, TRUCARE, Meditech, CGX, Citrix, (10+ years).

Certifications/Licenses Nurse's License: Register Nurse State: FL and Compact.

Short term assignment providing flu vaccines,

Community service at Mount Sinai Hospital.

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