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Nurse Part Case Manager

Location:
Raleigh, NC
Posted:
November 09, 2022

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Resume:

Tracy Beard, RN,

**** ******* **** *******, ** **615 919-***-**** 919-***-****

EDUCATION AS, Nursing, 1996 Daytona Beach College, Daytona Beach FL AS, Criminal Justice, 1987 Ventura Community College, Ventura, CA PROFESSIONAL EXPERIENCE :

June 2021-Present Wake County Health Department Coiv 10 Operations Nurse Manager Implement covid vaccines following CDC, State, and County regulations. Manage all nursing staff, review CDC changes, implement changes in age groups, boosters, following both US and WHO vaccination standards. Implement best vaccine clinical practices. October 2020-Jan 2021 Judge Group Covid Onsite Clinical Administration, Testing site quality assurance and implementation of new testing sites for the State of North Carlolina. Managed the Registered Nurses (RN) COVID-19 performs the Nasopharyngeal/NARES swab to all individuals, including employees, patients, and visitors, entering the facility or location. This role is key to ensuring that the on-site location is a safe and healthy environment for all patrons. July 2018- August 2019 Holly Hills Hospital Staff Nurse • Supervise nursing care of patients • Complete nursing assessments and documentation on patient status and care • Process and implement physician orders • Develop individual treatment plans based on diagnosis and history

• Administer medications • Intervene with patients individually and in group settings • Provide education to patients and family members

3 Feb 2018- July 2018 Rescare Registered Nurse, Staffing educator. The Registered Nurse is responsible for providing care and treatment for clients that are experiencing significant mental health/psychiatric symptoms, who are demonstrating significant functional impairments, and who may have co-occurring substance abuse and/or personality disorder. • Attends and actively participates in weekly team meetings • Provides rehabilitation and coordinates medical needs for clients • Medication Monitoring and Administration by oral medication or needle injections • Medication training for staff • Orders, reviews, monitors, and discontinues medications as ordered by the physician • Assists with keeping within assigned nursing budget • Conducts assessments • Approves plan of care and service delivery methods • Performs competency and skills evaluations on employees who provide direct care • Informs the physician and staff of changes in the client's medical or mental condition and needs • Coordinates psychiatric information with the psychiatric rehabilitation practitioners • Writes progress notes, summaries, and discharges • Group and Individual Counseling • Case Management • Implements the treatment/rehabilitative activities and strategies • Crisis Prevention 4 • Reports significant/major incidents or accidents • Provides and arranges necessary medical services to ensure consumer health and safety • Follows consumer health plans • Provides and promotes consumer choice and facilitate independence • Assists with ensuring compliance with contractual, legal, and regulatory requirement • Performs other duties designed to improve employee effectiveness as a member of the team • Promotes/encourages community integration and choice making • Dependable • Conducts self in professional and ethical manner • Willing to assist others • Works independently and with a team • Handles information in a confidential manner • Communicates in an open and honest manner • Notifies proper authorities of circumstances or situations that present possible health hazards • Assists in maintaining and updating nursing, pharmacy, infection control, and health and safety policies and procedures • Other tasks as assigned Apex Staffing October 2017-January 2018 Blue Cross Blue Shield of North Carolina, Case Manager The Case Manager coordinates the care and services of selected member populations across 5 the continuum of care, promotes effective utilization and monitoring of health care resources, and assumes a collaborative role with all members of the healthcare team to achieve optimal clinical and resource outcomes. • Serve as a team member on a multidisciplinary Health Care Coordination team that monitors utilization patterns; identifies and facilitates appropriate health care service delivery for selected members, providers, procedures, and/or diagnoses; and improves the quality and cost efficiency of care and service. • Perform a comprehensive assessment of the member’s health status, educational, and level of support needs. The assessment includes condition specific issues, clinical history, medications, activities of daily living, mental health status, cognitive functioning, life planning activities, cultural and linguistic needs, caregiver support and resources. • Develop a member centric care plan which includes long and short term goals, a self management plan tailored to member’s needs, and identification of barriers to meeting goals or compliance to plan of care. • Perform ongoing monitoring and management of member including: scheduled follow-up with member, discussion of plan with member, appropriate services/education to address needs, appropriate referrals with supporting documentation to MD, MSW, HLB, etc; assessment of 6 progress towards goals, modification of plan/goals as needed, nurse contact at least every 30 days, complete documentation of calls and faxes with phone and fax numbers • Evaluate and facilitate care provided to members as they move through the continuum of care (physician office, hospital, rehabilitation unit, skilled nursing facility, home care). Review alternative treatment plans for case management candidates and assess available benefits and the need for benefits exception or flex benefit options. • Identify high risk, high cost, or high utilization cases. Encourage pro-active intervention to limit expense and encourage positive outcomes. • Maintain awareness of community resources and funding. Utilize resources and funding sources in the development of the case management plan. • May negotiate and secure contractual arrangements for provision of non-contracting providers. • Collaborate with primary care physician, On-Site Medical Care Coordinator, Discharge Services, Medical Director, Episodic Care Managers, the member, family members and other members of the health care team to develop and/or coordinate plans of treatment and appropriate discharge plans. This includes knowledge of disease process, and understanding of family dynamics, as they relate to the discharge planning/case management process. 7 • Document all aspects of the plan from the initial assessment, development of the plan, implementation, monitoring, and evaluating outcome. Complete all correspondence related to case management. Obtain consents as indicated. Analyze and report case management activity according to department policy. • Authorize appropriate services as defined by the department. Consult the medical director as appropriate. Refer cases that do not meet criteria to the Medical Director. May Issue denials according to department protocols. Document outcome of reviews. Negotiate and secure contractual arrangements for provision of non-contracting providers. Ensure medical necessity reviews and determinations meet all requirements imposed by regulatory agencies such as NCDOI, NCQA, Federal, etc.

Spectrum Staffing July 2017-October 2017 Central Regional Hospital, Psychiatric Nurse Mental health nurses work as part of a team of professional and medical staff that includes doctors, social workers, therapists and psychiatrists. Typical duties of the job include: Assesssing and planning nursing care requirements, organizing workloads, building relationships with, reassuring, listening and talking to patients, combating stigma and helping patients and their families deal with it, administering medication, agreeing and reviewing care plans and monitoring progress, 8 giving advice and arranging support for patients, relatives and careers, liaising with doctors, social workers and other professionals, assessing treatment success at case conferences and meetings, writing and updating patient records, Shift work and on-call rotations are sometimes be part of the job.

Liberty Home Hospice, Case Manager October2016-July 2017 Hospice nurses work to maintain the comfort and quality of life for those who are diagnosed with terminal diseases. They work in private homes, residential care facilities, nursing centers and other hospice care environments. They may also supervise licensed vocational nurses (also known as licensed practical nurses) and nursing aides in hospital settings. They must be capable of compassionate communication with patients and their families. Hospice nurses need to have keen observation skills, high ethical standards and knowledge of when to alert doctors and others about changes in patient conditions. They must be resilient and sympathetic, and they should have emotional and physical stability to deal with the challenges of severe illness and death. On Call is required. Amedisys Home Hospice. Case Manager June 2016-October 2016 As an on-call and triage nurse for Amedisys hospice you will respond to telephone requests for assistance and perform home visits for hospice and palliative care patients and families in their home setting after-hours and on weekends. 9 • Answer and respond to incoming calls, referrals, and requests for assistance, completes admissions into care, and make follow-up visits on patients admitted the day prior; as necessary. • Communicate significant findings, problems, patient’s needs, reports changes in condition or environment to the physician, clinical manager and other members of the hospice care team and obtains physician orders as required. • Maintain flow of communication between in-house staff, field staff and other departments, for coordination of activities and services. • Participate as a member of the interdisciplinary team in patient care conferences. • Current and unencumbered license to practice as a Registered Nurse specific to that state the employee is assigned to work by the Company. • Minimum of one (1) year of experience as a registered nurse • Current CPR certification • Valid Driver’s License and reliable transportation and agency required liability insurance to complete home visits Blue Cross Blue Shield of North Carolina Clinical Appeals Analyst November 2012-July 2013 Responsible for the analysis, research and completion of complex, non-routine appeals and grievances within the company. Will address all customer concerns and ensure resolution and patient satisfaction. Ensure timeliness, quality and efficiency in all work to comply with mandated, legislative, North Carolina Department of Insurance (NCDOI) and National Committee for QualityAssurance (NCQA) and Federal requirements. Major Job Functions/Components • Provide clinical consultation with non-clinical staff within the Appeals Department. • Coordinate all aspects of the appeals process to ensure compliance with medical necessity criteria, Corporate Medical Policy (CMP), contract provisions, NCDOI, legislative, federal and NCQA requirements, as applicable. • Assist with Level 3 appeals as required. • Analyze complex/non-routine member and provider appeals and grievances for all lines of business, excluding FEP, by reviewing CMP, contract provisions, legislation and/or NCQA requirements. • Identify appropriate documentation collection from multiple external sources such as pharmaceutical companies, attorneys, providers, etc. • Present analysis and documentation to the appropriate physician committee, benefit administrators and BCBSNC leadership, as necessary. • Initiate claim adjustments on individual cases when necessary. • Provide written documentation of case determinations to appellants and/or all involved parties in a timely manner as required by mandates and legislation. 11 • Identify trends and high-risk issues to make recommendations to address future exposure. • Identify and take corrective action on appeals that result from noncompliance of contract provisions, appeal guidelines and/or CMP. • Create action plans to educate internal employees of benefit misinterpretation and/or claim system errors. • Answer member/provider questions via incoming telephone calls in a professional quality driven manner. • May handle complaints/grievances as defined by the federal government. • Coordinates with external vendors and provides requested information as requested. This job description is intended to describe the general responsibilities and type of work being performed by people assigned to this position. The major job functions/components above are the typical functions of the job and are not an exhaustive or comprehensive list of all possible job responsibilities, tasks and duties. Personnel in this position should be aware that the responsibilities, tasks, and duties of the jobholder may differ from those outlined in this job description and various other duties may be assigned as needed. Vascular Access Centers, Durham, NC Center Manager Feb 2012-June 2012 12 The Center Manager (CM) is the Supervisor in each of Vascular Access Centers' (VAC) 24 outpatient interventional radiology clinics nationwide. The CM is responsible for implementing the human resource policies, practices, and techniques established byVAC Is an experienced healthcare professional (RN) to manage all day-to-day clinical operations of our center of excellence in Durham, NC. The CM must ensure quality patient care while working in the outpatient setting. • The RN CM also provides direct patient care, this is a hands on position that requires direct patient care, meaning the manager will administer moderate sedation, assist with procedural circulation, assisting the radiology technician in setting up sterile procedure tables and/or taking down sterile procedure tables post procedure. The RN CM will admit patients, start IVs, perform an initial physical assessment ensuring the patient meets ambulatory care requirements prior to procedures, and when the assessment falls outside of ambulatory care guidelines, immediately notifies the physician and implements alternative plans of care. The RN CM will provide post procedure recovery and discharge. Supervises Client Coordinators, and Clinical Specialists. The manager must also work closely 13 with our Physician Medical Directors to ensure success of our VAC center, The CM must be comfortable in a supervisory and leadership position and be able to communicate effectively across many health-care disciplines. The center Manager is responsible for obtaining, interpreting, and reporting pre-procedure labs to the Physician. Stein Plastic Surgery, Raleigh, NC Aesthetic Nurse, June 2011- December 2011 Skin care Consultations Injectables including Botox, Dysport, Restalyne, and Juvederm. 9/10/2010 -6/1/2011 Wake Med Hospital, Raleigh NC Staff Nurse Endoscopy, September 2010-April 2011 Board Certified Gastroenterology Nurse Staff Education Coordinator ACLS Preceptor Advance Endoscopy Procedures Including ERCP PPD, Durham, NC Nurse Consultant, March 2010-September 2010 documentation of adverse patient events. Outstanding patient nurse communications dealing with patients during high levels of distress. 14 Skillful utilization of medical interventions during patient crises related to adverse medication events.

Corvel, Raleigh, NC Telephonic Nurse Case Manager, June 2009-March 2010 Managed the care of injured workers successfully saving the State of North Carolina over $250,000 The only nurse case manager to coordinate care for patients internationally. University of North Carolina Hospitals, Chapel Hill, NC Staff Nurse Endoscopy and Radiology, 2007-April 2009 Board Certified Gastroenterology Nurse performing all stages of endoscopy procedures. ACLS Floater to Interventional Radiology performing vascular procedures such as lower limb stenting, and carotid stenting.

Duke University Hospital, Durham, NC Staff Nurse, December2005-January 2007 Critical Care CCU and CTICU on the Heart Service ranked number 6 by US News and World Reports Best Hospitals. Advance Critical Care skills including Intra-aortic Balloon pumps, Pulmonary-Arterial Catheters, Continuous Veno-Venous Hemodialysis.

Consult Care Inc., Orlando, FL QualityAssurance/Staffing Coordinator, Aug2004-November 2005 15 Managed 18 nurses in 5 clinics. Responsible for hiring, firing, and training of all nursing staff. Doubled the number of facilities awarded with “Deemed” status for quality care indicators. Brought the second largest facility in Florida with a failing grade of 52% to a passing score of 85% the second best quality assurance score for the facility. Center for Digestive Endoscopy, Orlando, FL Staff Nurse, August 2002-August 2004 Educator for the center. Board Certified Gastroenterology Nurse Rounding Nurse for the Medical Director. Manned triage line for physician staff.

Health Central, Orlando, FL Staff Nurse May 2000-November 2005 Board Certified Gastroenterology Nurse Preceptor on Advanced procedures including ERCP. Emergency Room nurse part time. Florida Hospital, Orlando, FL Staff Nurse, October1997-January 2005 Board Certified Gastroenterology Nurse ACLS 16 Emergency Room in addition to Endoscopy Nursing. Advanced airway management skills.

EKG interpretation skills. Crawford And Company, Orlando, FL Telephonic Case Manager, Jan 2000-May 2000 Managed care for injured workers successfully saving a single client $225,000 on a single claim.

ACT Corporation, Daytona Beach, FL Staff Nurse, Jan 1997-October 1997 Authored Basic Living Skills, a comprehensive education course for the adult chronic mentally ill, enabling patients to live more independently. Crisis stabilization of chronic mentally ill patients. Osceola Mental Health, Kissimmee, FL Staff Nurse, November 1996-Jan 1997 Crisis Stabilization for mentally ill adults and children. Central Florida Regional Hospital, Sanford, FL Staff Nurse, July 1996-November 1996 OCN ChemotherapyAdministration.

LICENSES & CERTIFICATIONS Board Certified Gastroenterology Nurse, Registered Nursing License, Florida and North Carolina. BLS Instructor and ALS instructor. Line item exam writing for the CBGN. Presentation: UNC Chapel Hill Endoscopic Retrograde Cholangeopanreatography, Indications and Solutions Intraprocedure. Continued Professional development: University of Texas Nursing program.



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