Utilization Review Shift Supervisor

L

ynette M. Gordon, RN

Executive Management ~ Administrative ~ Case Management ~ Clinical Nursing

Proactive, seasoned and top performing Leader, demonstrating expertise and broad ranging experience in driving and supporting healthcare operations with a focus on employee engagement, quality care, patient safety, service excellence, fiscal responsibility, and the overall patient experience. Equipped with thorough knowledge of the fundamentals of hospital organization, administration and standards, and regulations and laws applicable to an array of medical facilities operations.

Successful in managing time, prioritizing tasks, and organizing programs to improve the Quality of Patient Care. Exceptional ability to harmoniously implement streamlined operations & change management strategies to create strong effective teams & positive work environments. Computer savvy and familiar with various modern systems and applications, including Microsoft Word, Windows 10, Microsoft Excel, Power Point, HCHB, Tru-chart, Kinnser, Lewis, Health First, and Corporate email.

Key Strengths & Expertise:

Total Quality Management

Operations/Performance Management

Coaching, Mentoring & Training

Employee & Physician Relations

Policy & Procedures Development

Direct Patient Care

Risk Assessment/Management

Staff Supervision & Leadership

Problem Analysis/Resolution

Utilization Review/Management

Continuous Process Improvement

Financial & Budget Management

Education

Registered Nurse Degree

OUR LADY OF THE LAKE COLLEGE OF NURSING

Business Administration Degree

UNIVERSITY OF SOUTHWESTERN LOUISIANA

Professional Experience

CHATEAU ST JAMES REHAB AND NURSING HOME

DIRECTOR OF NURSING JULY 2022-

Direct day to day activities and scheduling of residents clinical activities; Provide patient care-both direct and indirect-reviewing and entering orders and interpreting lab values; Chart audits; Maintain schedules of nursing staff; Work closely with Physicians and NP’s to provide quality patient care on a daily basis; Facilitate daily IDT and QA meetings; State and CMS Surveys; Infection Control Preventionist; Utilization Management; Risk Management; Perform RN and Risk Assessment; Review Admits and Discharges for appropriateness; Incident/Accident Mgr; Weight Control Mgr; Quality Improvement Measures; Payroll; Interview/hire and perform Orientation; R&R; Staff Education/In Services; Performance Evaluations; Suervise a team of RN/LPN’S/C.N.A.’S/PT/OT/ST; Review and implement Policies and Procedures; Emergency Preparedness; Facilitate patient/family meetings and coordination of care with the Case Managers and SW’s; Facilitate Quarterly QAPI Committee Meetings with staff; Manage and order medical supplies; and other duties as assigned.

AMEDISYS HOME HEALTH 2019-2022

DIRECTOR OF OPERATIONS

Review/analyze budgets/planning, monitor NIFO/GM’s and Administrative and Operating Expenses. Direct the day-day operations for one of the 3rd largest home health agencies. Educate clinicians and providers on home health care policies and procedures/oasis, CMS requirements for home bound status, utilization, medical management and F2F documentation/requirements. Review oasis and documentation for medical necessity and appropriate level of care. Collaborate with clinicians on my team (RN/LPN/PT/OT/SW), as well as, d/c planners, case/social workers of various healthcare industries to provide continuity of care for patients using clinical judgment. Work closely with Physicians and NP’s to provide quality patient care, clinical knowledge and discharge planning; Utilization Review; Enter and maintain patient referrals in the EMR after assessing the need and perform weekly audits to ensure medical necessity. Develop and maintain patient’s plans of care with patient specific goals and interventions and ensure orders are being followed as outlined. Monitor and analyze quality measures and trends and educate clinicians as needed; Quality Assurance leader and Compliance Director at care center level. Facilitate process improvement measures to ensure compliance with state and CMS regulations; Maintain clinicians’ schedules to provide patient care in a timely manner; Review and process admit documentation to continue patient care within 24-48 hours post discharge. Develop clinical initiatives to ensure appropriate metrics are being met. Prepare and lead the care center with both State and CMS Surveys; 0 deficiency State Survey in 2020. Performance Evaluations-3/6 months and yearly; Implement Policies and Procedures; Prepare an Emergency Preparedness Plan annually and update as necessary; Maintain and educate staff on Infection Control measures; Orientation; R&R; Manage payroll and oversee NVA’s for appropriate recording.

TRITON HOME HEALTH-N.O., LA 2019-2019

EXECUTIVE DIRECTOR

Supervised and directed the nursing staff, HHA’s and therapists; Reviewed, edited and locked Oasis; Reviewed POC’s before going out for signature; Scheduled; Payroll; Orientation of new employees; Ongoing education; Case Conferences; Budget Meetings; Chart Audits; Utilization Review; Compliance; ICD-10; Emergency Preparedness; Liaison between physician and patients, and other duties as assigned.

PACE-N.O., LA 2016-2019

DIRECTOR OF CLINICAL AND DAY CENTER SERVICES

Oversaw day to day activities; Supervised and scheduled daily clinic activities; Patient care-both direct and indirect; Worked closely with Physicians and NP’s to provide quality patient care; Coordinated daily IDT meetings and recorded notes; Scheduling of 180 patients; State and CMS Surveys; Compliance; Risk Management; Quality Improvement Measures; Utilization Review; Payroll for 50+ employees; Orientation; R&R; Staff Education; Performance Evaluations-6 months and yearly; Implemented and Updated Policies and Procedures; Emergency Preparedness; Infection Control; Coordinated patient/family meetings with the Care Managers and SW’s; Worked with outside entities to ensure coordination of patient care; Home Visits; Coordinated Quarterly PAC Committee Meetings with staff, patients and family members; Member/Lead for PAC, EP; QAPI; Infection Control Meetings and Executive Team Committee Member’ and other duties as assigned.

PELICAN REHAB HOSPITAL New Orleans, LA 2013-2016

Chief Nursing Officer

Provide hands-on oversight to daily hospital operations and nursing activities while implementing best practices, utilization review, and policies and procedures to drive continuous improvement in patient outcomes. Member of Governing Body Board.

Formulate and implement nursing and patient care policies to ensure compliance with all applicable laws, regulatory and accreditation requirements consistent with current professional standards.

Manage and maintain hospital quality assurance and oversight/improvement program through evaluation of services rendered (quality improvement, audit of medical records, utilization review, patient visits and counsel with hospital staff.

Coordinate all infection control processes, including surveillance, analysis, interpretations and reporting of hospital acquired infections.

Direct and supervise a staff of physical therapists, occupational therapists, speech therapists, case managers, dietician, and social services to assure adequate hospital coverage and quality care.

Facilitate discharge planning meetings, yearly employee evaluations, orientation and educational programs, recruiting, and scheduling of nurses, aides and therapists.

Develop, implement and interpret nursing and patient care policies, objectives and standards for measurement and maintenance of quality nursing care.

Recommend and participate in development of new patient care programs for expansion of nursing care services.

Represent hospital in health care programs and professional organizations of associates to serve in a public relations capacity and to stimulate professional growth.

Work closely with physicians and patient/family members and Case Managers/Social Workers

Payroll; Manage Care Contracts; Floor/Charge Nurse; D/C Planning; Physician Liaison

UNIQUE HOME HEALTH CARE INC. Baton Rouge, LA 2003-2013

Administrator/CEO

Effectively ensured the efficient delivery of medical services by overseeing Quality and Performance and implementing overall nursing care organization plans that focused on clinical excellence. Ensured compliance with professional standards, policy and procedures and Federal, State and local licensing standards. Served as Governing Body Board Member.

Generated administrative and financial reports, compiled audits, Oasis and ICD-9 codes, Insurance Pre-certs, DRG’s, and comprehensive Care Plans.

Reviewed and approved manage care contracts, payroll and major expenditures.

Served as Compliance Officer, Infection Control Committee member and nurse.

Developed nursing and patient care policy and procedures, provided direct and indirect patient care, and oversaw master nursing services staffing, retention and recruitment measures.

Integrated data into an individualized patient plans of care and 485’s.

Supervised nurses, home health aides, 12 therapy groups and office staff, and conducted yearly employee evaluations.

Prepared and lead the company through State and Medicare Audits and JCAHO with several Zero deficiency surveys.

Implemented Best Practice Measures and developed yearly Emergency Preparedness Plans and Implementation.

Utilization Review

Liaison between physician, patients and staff

HOME HEALTH CARE 2000 Baton Rouge, LA 2002-2003

Director of Nursing

Directly responsible for providing direct and indirect patient care, implementing Quality and Performance Improvement measures, and supervising nursing staff, home health aides and therapies. Served as a PAG member.

Contributed significant efforts leading the company in achieving a Zero Deficiency State Audit Survey.

Coordinated chart audits, infection control, case management, staff orientation, and yearly employee evaluations.

Developed annual Emergency Preparedness Plans and implemented Best Practice Measures.

Accountable for Oasis and ICD-9 codes, Insurance Pre-certs, and DRG’s.

Previous Engagements

Night Shift Supervisor/Nurse: HEALTHSOUTH REHAB HOSPITAL - Baton Rouge, LA

Assistant Director of Nursing: HIS Nursing Home Gonzales, LA

Director of Nursing: INTERIM HEALTHCARE INC. Baton Rouge, LA

Director of Nursing: UNITED HOME HEALTH CARE, INC. Baton Rouge, LA

Director of Nursing: LASHEAS HEALTH CARE OPTION Baton Rouge, LA

Case Manager: HEALING HANDS Baton Rouge, LA

Neuro, Ortho, Med Surg, Oncology, SDS and Rehab Floor and Charge Nurse: OUR LADY OF THE LAKE Baton Rouge, LA

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