Joy J. High, RN, BSN

**** ******* ** ** ********** Al 35215

H-205-***-**** C-205-***-****

adt69j@r.postjobfree.com

Objective: A CHALLENGING POSITION IN THE CORPORATE WORLD

Education: 1991: BACHELOR OF SCIENCE OF NURSING, UNIVERSITY OF ALABAMA AT BIRMINGHAM

1994: ADMINISTRATIVE TRAINING FOR CHILD CARE DIRECTORIES

Work experience:

United Health Group, 2021-Present Registered Nurse Case Manager/Educator Remote

Make outbound and inbound calls to assess members' current health status.

Provide patient education to assist with self-management. Interact with Medical Directors on challenging cases. Coordinate care for members and make referrals to outside sources. Educate members on disease processes and encourage members to make healthy lifestyle changes. Document and track findings utilizing milliman criteria to determine if patients are in the correct hospital setting. Facilitate discharge planning to ensure that discharged member’s receive the necessary services and resources.

DaVita Dialysis, 2013-Present Registered Nurse/Charge Nurse/Acute Team/Chronic

Functions as a hemodialysis charge nurse to make sure quality care is given to patients in a chronic and acute setting. Supports DaVita’s policy and procedures and continually assess, monitors, and implements nursing procedures and guidelines. Makes rounds with doctors and acts as a liaison and an educator for patients and their caregivers. I also assist with total care of the patients. Follows all orders administered by doctors. Worked in intensive care and LTAC unit with critically ill patients. Monitors drips, preformed respiratory care etc.

Fresenius Kidney Care, 2018-2018

Function as a hemodialysis Team Leader/Charge Nurse to make sure quality care is given to patients in a chronic setting. Supports Fresenius’s policy and procedures and continually assess, monitor, and implement nursing procedures, and guidelines. Present informational and educational material to patients, caregiver and staff about treatment modalities related to their disease process. Make rounds with doctors, communicate with the interdisciplinary team. Assist in total care of patients. Follow all orders administered by doctors. Educate about disease process and different modalities available

Compassus Hospice Inpatient Unit, 2017-2018

Function as a Case Manager/Nurse Educator in an inpatient critical care unit. Present informational and educational material to patients and caregivers about treatment regimen and prognosis (pulmonary, cardiac, endocrine, and digestive diseases, etc.). Provide palliative care to improve quality of life for patients and families who may also be seeking aggressive treatment for their serious illness. Provide basic nursing principles and medical surgical nursing to improve patient current status and enable them to get better for transition to home or skill nursing facility. Communicate with Medical Director and interdisciplinary team for proper care for patient.

Alabama Hospice Care, 2015-2017

Function as a Case Manager/Nurse Educator in the field, making home visits taking care of critically ill patients with long term care requirements, and also patient with poor prognosis. Present information and educational material related to different type of lung diseases: COPD, Asthma, Pneumonia, and Bronchitis, Emphysema, and Lung cancer. Provided therapy and treatment regimens related to each disease. Also assessed and implemented a plan of care to better serve the physical, mental and spiritual need of the patients and their families. Managing CNA’s through the day. Communicated with Medical director administered medications, prepped patients for respite care when needed. I also educated the patient’s and their families about hospice long term care, and the dying process. Also prepared the bodies for funeral home attendees. Advertise in the community.

Hospice Service of Alabama, 2012-2013 Registered Nurse/Case Manager

Managed CNAs, during in home visits, independently took care of critically ill patients with poor prognosis. Gave information and educated patient and caregivers about their disease process, treatment regimen and an expected prognosis. Assessed patients daily and communicated with doctor about their plan of care and followed all orders. Coordinated patient placement in respite care provider facilities and applied medical necessity criteria to patient medical records Administered narcotics and other medications and peg tube feedings as needed per regimen. Prepared bodies for undertakers after patients passed. Educated family about signs and symptoms related to the dying process and listened with empathy.

Fresenius Medical Care, 2009-2012 Registered Nurse/Preceptor

Manage PCTs, assess patients, dialyze and give quality care, made rounds with doctors and implement individualized plan of care. Educated patients related to hemodialysis and peritoneal dialysis treatment regimen. Dialyzed patients in a 24-chair unit, taught fluid and diet control, gave great customer care Trained new employees

Health Spring of Alabama, 2007- 2009 Solutions Unit Specialist

Prepare provider appeals, research information from provider and members. Work from many medical software solution program. Communicate with providers per letter or phone in regard to claim denial or payment. Followed Medicare guidelines related to HMO plan of care.

Preferred Health Alliance, 2005- 2007 Medical claims reviewer, liaison, and reprice analyst

Review and analyze medical claims at home, to receive a provider contracted discount through four software programs. Research providers and member status, (par or non- par) Assist the IS department with changes related to provider contracts.

Guide Star Health Systems, 2001- 2003 Quality Assurance /Trainer/Analyst/Auditor

Multi-functional and responsible for employees work in claims batch processing area. Audit and Review employees work, making necessary corrections and disciplinary actions if possible. Incorporate new guidelines and train current and new employee

The Oath of Alabama, 1997-2001 Quality Assurance Auditor/Researcher Audit and review reports for HCFA on monthly bases .Audit and review provider and member information .Analyze edit reports applying appropriate guidelines to determine claims payment. Researched and adjust various claims discrepancies. Responsible for 14-20 employees work daily and trained new employees. Extensive Amisys background

Alabama Dialysis Center, 1991-1997 Patient Care Technician

Dialyzed patients with different types of renal problems. Taught and gave patients instructions regarding diet and fluid control. Cannulated grafts, fistulas and monitored vital signs.

UAB University Hospital, 1990-1991 Medical Intensive Care Unit

Provided care for chronically ill patients with multiple diseases. Organized problems by, assessing diagnosing, planning, implementing, and evaluating each case

Worked on various hospital floors

References: Available upon request

Contact this candidate