Nurse Manager Case

ATHENA LYNN WHITAKER

**** ******* ******, ******* ** 37865 adt82c@r.postjobfree.com 865-***-****

OBJECTIVE

A nurse case manager with 29 years of nursing experience with 5 years of leadership and/or managerial experience looking to broaden my professional and managerial qualities within United Healthcare.

SKILLS & ABILITIES

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Administered, supervised, managed, and evaluated patient care personnel.

Directed, educated, coached and mentored nurses and non-nursing staff to develop/keep a strong team atmosphere in the work place

Supervised junior nursing employees in their duties and assigned work accordingly.

Evaluated individual employee performance and ensured adherence to all rules and guidelines.

Took lead in role development and process development in new positions and monitored and evaluated the effectiveness of those processes.

Collaborating with department heads to ensure seamless, effective care was delivered in a cost-effective manner without compromising patient care.

Assumed unofficial leadership roles, in guiding and empowering the team to provide excellent services and delivering appropriate outcomes in time sensitive matters.

EXPERIENCE

CLINICAL MANGER UNITED HEALTHCARE

2/9/18-CURRENT

Developed policies, procedures & guidelines for medical and clinical operations. Designed and implemented integrated case management and direct delivery to meet the needs of targeted populations. Reviewed regulatory requirements and determined steps to implement or change processes. Used data and appropriate technology to drive improvement in care coordination, care transitions, end to end referral management, and direct services delivery to meet program objectives. Collaborated and met regularly with local clinical leadership to identify and implemented opportunities>

TRANSITIONAL CARE MANAGER UNITED HEALTHCARE

2/9/15-2018

Responsible for the coordination of care for members in the inpatient setting transitioning to the home setting, ensuring member is receiving medically appropriate services in a timely manner in hopes to prevent re-hospitalization and empower the member to utilize the treatment team to achieve optimal health. I have been the Lead TCM for the past 2 years in this role. This entails managing queues. Completing PCCM and Productivity Reports. Providing Preceptorship for new hires and ongoing education on processes and expectations. Being the point person for TCM questions and issues and routing those to my manager that considered high importance.

UTILIZATION MANAGEMENT UNITED HEALTH CARE

10/2010-2/2015

Case load management of requests for CCFT/CTT, including reviewing initial and concurrent request for services within timeframes set forth by CRA and using clinical judgment in assessing requests and clinical data against medical necessity criteria in guidelines, issuing authorizations, consulting with medical director on denials, and following member cases through completion of service, ensuring the member was receiving the most appropriate level of care in the least restrictive environment.

FIELD CARE MANAGER UNITED HEALTH CARE

10/2009-10/2010

Primary responsibility was working with Lakeshore Mental Health Institution and community agencies to assist in locating appropriate lower level care options for members who had been in an inpatient/subacute setting for years.

PSYCHIATRIC HOME HEALTH CARE GENTIVA HEALTH SERVICES

7/2007-10/2009

Responsible for the development of the psychiatric home health program for the Knoxville Gentiva office. Process and SOP development, interviewing and training of nurses to provide home health care within boundaries of federal, state and insurance regulatory guidelines.

NURSE MANAGER LAKESHOREMENTAL HEALTH INSTITUTE

9/2005-6/2007

Oversight of assigned unit for the appropriate staffing and delivery of nursing care of the acute care setting. Ensuring nursing staff were providing appropriate care via governing policy and procedures. Ensuring staff were properly credentialed and trained and completing staff evaluations based on performance. Overseeing disciplinary action and developing corrective action plans when necessary.

PSYCHIATRIC OUTPATIENT NURSE PENINSULA OUTPATIENT CENTER

9/2004-9/2005

Provided nursing support for 3 psychiatrist in an outpatient setting. Assessed and managed the care for patients seen and prescribed medications in the clinic, ensure members were accessing and taking psychotropic medications, obtaining necessary lab work to monitor psychotropic medications and its effectiveness.

BRIDGE NURSE MANAGER FIDELTITY HEALTH CARE

9/2001-8/2004

Managed a grass-roots program that provided nurse care management for patients in the acute care setting discharged home to ensure the patient was able to access medication, transportation and support necessary to maintain stability and reach optimal recovery.

PSYCHIATRIC NURSE MENTAL HEALTH & RECOVERY OF WARREN COUNTY

8/1999-9/2001

Oversight and/or delivery of the nursing responsibilities for all outpatient clinics (total of 3 offices) for Warren County. Responsible for the ordering and distribution of medications obtained for patients through grant fund programs and pharmaceutical companies.

STAFF NURSE FRANSICAN MEDICAL CENTER

11/1998-8/1999

Assessed, developed plans of care and delivered care based on the assessment for patients on the inpatient adolescent unit. Group development and lead facilitator.

STAFF NURSE CHILDREN’S HOSPITAL MEDICAL CENTER

3/1990-11/1998

Assessed, developed plans of care and delivered care based on the assessment for patients on the inpatient adolescent unit. Group development and lead facilitator.

PSYCHIATRIC NURSE HAMILTON COUNTY JUSTICE CENTER

9/1990-3/1998

Provided nursing care for 2000+ inmate population. Instructor in the Correctional Academy for new correctional officers on abnormal behavior and suicidal behavior in the inmate population and appropriate management of the inmates with psychiatric disorders.

ASSISTANT DIRECTOR OF NURSING VICTORY PARK NURSING HOME

6/1990-9/1990

Nursing administrative duties for a 100 bed nursing home. Including ensuring nursing care was being providing according to federal and state regulations and best practices. Staffing management, including interviewing, training and scheduling. Quality Management.

STAFF NURSE PAULINE WARFIELD LEWIS CENTER

6/1987-6/1990

Nursing care for patients in an acute care, long-term care psychiatric facility on the medical unit. Over sight of the nursing staff of the unit and delivery of care to patients in the medical unit. .

EDUCATION

UNIVERSITY OF PHOENIX, ONLINE

BSN

GPA of 3.85

BETHESDA SCHOOL OF NURSING CINCINNATI OHIO

DIPLOMA IN NURSINTG

GPA of 3.5 graduated 10th in my class with honors

NORWOOD HIGH SCHOOL NORWOOD, OHIO

HIGH SCHOOL DIPLOMA

GPA of 3.44 graduated 10th in my class with honors

COMMUNITCATION

I am a highly motivate, self-driven nurse. I have excellent communication skills, both orally and written, and strive to grow personally and professionally daily. I excel at team work and often take on unofficial leadership roles. This was evident not only her at UHC but in school as well. I always was assigned the lead role in team activities and projects.

LEADERSHIP

Co-workers often look to me for answers and guidance in many of the positions I have held. I tend to step up to team lead roles and known to be dependable and well respected by managers and peers. Previous managers often give me projects and responsibilities as they know that I will get the job done with excellence.

REFERENCES

WILL PROVIDE UPON REQUEST

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