Documentation Specialist Case Manager
Resume:
DB Debrayda Bryant
Grovetown, GA ***** 706-***-**** *********@*****.***
PROFESSIONAL
SUMMARY
Healthcare Administrator with proven to deliver exemplary level of healthcare service delivery to patients. Coordinate admission and discharge of patients. Plan and implement strategies for developing improved health care management. Proven problem solver and excellent communicator. Strong organizational skills, superb understanding of data collection and performance metrics. Recognized for staff development leading to high performing teams. SKILLS Administrative Oversight
Patient Care Improvement
Nursing Staff Management
Case Management
Staffing Requirements
Hospital Procedures Expertise
Nursing Standards
Medical Issues Management
Nursing Strategy Improvement
Utilization Management
Medicare Compliance
Quality Control Procedures
WORK HISTORY ADMINISTRATIVE NURSING SUPERVISOR 10/2014 to CURRENT Doctors Hospital Augusta, GA
Maintained nursing supplies inventory by studying usage reports and identifying trends.
Completed patient care requirements by scheduling and assigning nursing and staff.
Promoted patient's independence by establishing patient care goals. Assessed patient care requirements on each unit by making rounds in an acute care department and all other areas of hospital. Maintained nursing guidelines by writing and updating policies and procedures.
Developed and updated policies and procedures, maintaining compliance with statutory, regulatory and local, state and federal guidelines relating to HIPAA, benefits administration and general liability. Anticipated potential problems that may occur on shift and set shift priorities accordingly.
Direct day-to-day administrative and operational functions for 370-bed facility, providing guidance and leadership to over 800 employees across more than 30 departments.
MANAGER OF CASE MANAGEMENT AND CDI 09/2020 to 06/2022 Doctors Hospital Augusta, GA
Referred clients to appropriate team members, community agencies and organizations to meet treatment needs.
Developed and created programs and monitored effectiveness against individual participant needs.
Oversaw staff development through in-depth trainings, workshops, seminars and other learning opportunities.
Referred families to shelters, legal resources and educational programs. Recruited, interviewed and hired staff members offering exceptional talent and brought great skills to team.
Quickly learned new skills and applied them to daily tasks, improving efficiency and productivity.
Developed and implemented variety of innovative policies and strategies to promote client self-sufficiency.
Coordinated individual referrals to obtain community services, advocated for client needs and resolved roadblocks.
Used critical thinking to break down problems, evaluate solutions and make decisions.
RN CASE MANAGER 05/2012 to 10/2021
University Hospital Augusta, GA
Effectively communicated with physicians regarding patient needs, performance, medications and changes.
Completed initial assessments of patients and family to determine and address individual home care needs. ·
Coordinated with interdisciplinary professionals to develop plans of care, administer tests and monitor patient status.
Advocated for patients by communicating care preferences to practitioners, verifying interventions met treatment goals and identifying insurance coverage limitations.
Evaluated healthcare needs, goals for treatment and available resources of each patient and connected to optimal providers and care. Conducted regular re-evaluations to address changes in needs and conditions, introducing revisions to care plans.
OBSERVATION/UTILIZATION REVIEW CASE MANAGER 05/2017 to 09/2020 Doctors Hospital Augusta, GA
Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
Performed prior authorization review of services requiring notification. Performed admission reviews based for medical necessity based upon Interqual and Milliman specification.
Obtained authorizations from multiple insurance carriers for various levels of care.
Supervised and maintained all utilization review documentation through Midas.
Submitted cases to Physician Advisor for criteria failures and helped facilitate resolutions and approvals.
Devise or identify solutions for irregular requests and issues. Served as subject matter resource, providing information related to continued stay review situations.
CLINICAL DOCUMENTATION SPECIALIST 04/2015 to 05/2018 Doctors Hospital Augusta, GA
Maintained strong knowledge of medical terminology, diseases and conditions and procedures.
Questioned physicians regarding missing or unclear health record documentation and requested further information for clarification purposes. Communicated with physicians, nurses and other caregivers to explain importance of accurate and clear documentation.
Managed electronic clinical documentation and uploaded changes or updates using Iodine software program.
Used classification manuals to gain additional knowledge of disease and diagnoses processes.
EDUCATION Master of Science Nursing Informatics EXPECTED IN 12/2023 Grand Canyon University, Phoenix, AZ
Bachelor of Science Nursing 08/2015
Walden University, Minneapolis, MN
ADDITIONAL
INFORMATION
United States Army Veteran
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