RN Med surgical unit
Resume:
Jay Washington
Expert nurse consultant in work compensation, progression of medical and litiagated files. Expert in managing high cost work compensation claims nationally. Aubrey, TX 76227
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Experienced in Hospital Case Management, Utilization Review, work compensation Account Executive, litigated claim progression expert, Catastrophic Case Management Work Compensation, Clinical Educator, Quality Improvement,Palliative Care, Hospice,Long-term Acute Care, and Critical Care. Other experience: 15 years as a Behavior Support Specialist, Psychiatric Registered Counselor and Network Development.
Authorized to work in the US for any employer
Work Experience
RN Case Manager
NationwideTherapyGroup-NTG - Travel
November 2022 to Present
Level I/II Medical Centers throughout the US to assist in initial, progress and discharge planning of local or regional patients. Specialize in community resources, private insurance and federal funding for medical treatment. Conduct family and physician care team meetings to ensure safety suits and after discharge. Assist others as apart of the interdisciplinary team to coordinate treatment and prevent delayed hospitalization length of stay. Coordinate transition of care to outside rehabilitation facilities along with appropriate placement to statewide skilled nursing facilities. Work compensation Account Executive
PAM Health - Southern Louisiana
February 2022 to September 2022
Responsible for proactively initiating new client partnerships and cultivating durable relationships with prospective clients while maintaining collaborative relationships with key referral sources within PAM Health’s referring entities
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Utilize strategic business planning and outreach practices, industry/market analysis, internal communication, external promotions and constant in-depth client analysis to uncover workers compensation revenue opportunities for LTACH and IRF
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Generates patient referrals to admission from their assigned accounts and other market accounts through research, referrals, networking and cold calling
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Responsible for assisting with meeting volume and revenue expectations for the market
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Performs relationship development with referral sources that both directly refers and influences patient referrals, such as payors, adjustors, governmental agencies, employers (self-insured) and others as needed
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Initiates relationships with prospective clients by researching jobs and employer organizations and connecting with key stakeholders germane to workers compensation
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Develops strategic plans to effectively manage their accounts and to expand into new accounts as assigned; Plan and prioritize activities based on criticality
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Assists with clinical assessments to determine appropriate level-of-care (LTACH or IRF) for patient admissions and may meet with stakeholders to educate about our hospitals, services and programs
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Active involvement in department activities, transdisciplinary team activities, and PAM activities to ensure individualized, patient-centered health care for all patient populations admitted to PAM hospital Medical Field Case Manager
Paradigm Complex Care Solutions - Dallas-Fort Worth, TX November 2019 to February 2022
This individual is responsible for the medical case management of work related injuries, which includes assessment, planning, coordination, implementation and evaluation of injured/disabled individuals. The Case Manager works with insurance carriers, medical care providers, attorneys, employers and employees, and closely monitors the progress of the injured worker and reports results back to the employer and insurance carrier.
Regional Catastrophic Network Manager/Risk Management Paradigm Catastrophic Claim( dual position) - Dallas-Fort Worth, TX November 2019 to February 2022
Responsible for the medical case management of work related injuries, which includes assessment, planning, coordination, implementation and evaluation of injured/disabled individuals. The Case Manager works with insurance carriers, medical care providers, attorneys, employers, and employees, and closely monitors the progress of the injured worker and reports results back to the employer and insurance carrier.
Presented high cost Risk Management claims to insurance brokers, insurance carriers, physicians and other team members in addition to assisting Director of Clinical Services with claim financial revenue. Case Manager Branch Supervisor
GENEX Services, LLC - Dallas, TX
October 2018 to November 2019
Set goals for performance and deadlines in ways that comply with company’s plans and vision and communicate them to subordinates
Organize workflow and ensure that employees understand their duties or delegated tasks Monitor employee productivity and provide constructive feedback and coaching Receive complaints and resolve problems
Maintain timekeeping and personnel records
Pass on information from upper management to employees and vice versa Prepare and submit performance reports
Decide on reward and promotion based on performance Hire and train new employees
Ensure adherence to legal and company policies and procedures and undertake disciplinary actions if the need arises.
Catastrophic Case Manager Supervisor
GENEX Services, LLC - Dallas-Fort Worth, TX
June 2017 to November 2019
• Utilization review and discharge planning for capitated patients who are hospitalized.
• The review includes coordination of services for medical necessity, cost effectiveness, timelines of service and ensuring that quality standards are met.
• Performs coordination of services for patients whose health plan has an at-risk agreement to ensure that services are medically necessary, cost effective, provided in a timely manner and meet local standards or care.
• Update all parties in a timely manner to anticipate cost reserve, lifetime case expectancy and compensability.
Medical Field Case Manager RN (dual position)
GENEX Services, LLC - Dallas, TX
September 2017 to September 2018
•Uses clinical/nursing skills to help coordinate the individual’s treatment program while ensuring quality, cost-effective care. Performance is monitored daily by supervisors and/or branch managers.
•Serves as an intermediary to interpret and educate the individual on his/her disability, and the treatment plan established by the case manager, physicians, and therapists. Explains physician’s and therapists’ instructions, and answers any other questions the claimant may have to facilitate his/her return to work.
•Works with the physicians and therapists to set up medical assessments to develop an overall treatment plan that ensures cost containment while meeting state and other regulator’s guidelines.
•Researches alternative treatment programs such as pain clinics, home health care, and work hardening. Coordinates all aspects of the individual’s enrollment into the programs, and then monitors his/her progress, to ensure quality and cost-effectiveness of care and minimize time away from work.
•Works with employers on modifications to job duties based on medical limitations and the employee’s functional assessment. Helps employer rewrite a job description, when necessary and possible, to return the client to the workplace.
•May provide testimony on litigated cases.
•Coordinates injured workers’ appointments and arranges and/or personally escorts him/her to the appointments.
•Maintains all case documents in files ensuring a comprehensive and detailed source of information for all parties involved in the case.
•Prepares detailed evaluation reports, as per account guidelines, and case recording documenting for each phase of activity as it is completed. Reports billing hours in accordance with case activity and billing practices.
•Maintains phone contact with all parties involved to monitor, update, and advance case activity to ensure the progress of the case.
•Compiles a case inventory monthly for submission to the branch manager to allow for proper billing and to calculate hours for bonus purposes.
Admission RN/On call Triage Nurse/ Senior Case Management Magnolia Hospice - Mesquite, TX
August 2015 to March 2017
Responsibilities
The Registered Nurse Hospice Case Manager plans, organizes and coordinates the care of all assigned cases.
The RN Case Manager, in consultation with other disciplines/professionals, select outcome goals and skilled
interventions. Hospice Case Manager effectively use agency and community resources, to achieve patient and family independence with patient care, in the patient's place of residence as well as coordinate the services of all disciplines to achieve outcome goals established by the team. Accomplishments
Correlate medications and needed orders to on-call physician, use several critical thinking skills to advocate for patient needs as well as communicate effectively to facility staff and families. Skills Used
Maintains working knowledge of current home health and hospice coverage guidelines, admission criteria,
documentation requirements, coding guidelines and care planning with IDG/IDT; manages patient care accordingly.
Determines patient eligibility for admission and recertification based on admission and recertification guidelines, and regulatory requirements and the suitability /adaptability /safety of the patient's home for hospice or home care delivery.
Effectively manages initial home visit; introducing services, admission criteria, process for determining patient
eligibility and for obtaining required consents when eligibility is confirmed. Assesses the patient/caregiver willingness/ability/barriers to learn patient care techniques and for achieving
independence in care; documents patient/family response to teaching. Outlines Aide care plan, as applicable; performs ongoing home health aide oversight, revises Aide Care Plan
based on patient progress; evaluates hospice aide care every 14 days or per state payer requirement and state regulations.
Initiates the plan of care and related nursing interventions; conducts goal-oriented visits; ensures other nursing
team members have information needed for continuity of care and progress Advocates for the patient as required.
Quality Assurance/Clinical Educator RN
Southwest Nursing and Rehabilitaation - Fort Worth, TX May 2015 to September 2015
Responsibilities
The Quality Assurance Nurse is responsible for using independent judgment to establish, implement, manage and supervise an interdisciplinary system-wide Performance Improvement, Patient Safety and Risk
Management Program.Interview & screen new nursing employees.Develop, implement, and participate in education of newly hired professional staff. Provide in-home supervision of staff for training or performance
reasons. Perform annual competencies for clinicians.Develop, implement and participate in on-going development of clinicians.Oversee education of clinicians (RN, PT, OT, SLP).Assists with supervision of LPN's.
Ongoing development of Case Management model to include: assessment of patients, development of POC
(485), communication with physician, coordination of services with other disciplines, ordering of supplies, overall collaboration of care.
Assist with planning and preparation for weekly clinical team meetings. Chairs the meeting in the absence of the DON/Administrator.
Provide 15-20 minute educational/training sessions at each staff meeting related to current clinical topics.
Oversee clinical documentation to include medical records audit. Recommends clinical changes to maintain
standards of practice.
Assist with the provision of patient information or orders from physicians, documents and communicates pertinent information to clinical staff.
Create POC teachings for designated diseases (templates). Assistant Director of Nursing
Southwest Nursing and Rehabilitation - Fort Worth, TX May 2015 to September 2015
Responsibilities
The Assistant Director of Nursing Services reports to the Director of Nursing Services. Reporting to this position
are Shift Supervisors, Registered Nurses, Licensed Practical Nurses, Nurse Assistants, Unit Clerk and Medical
Records Clerk.
The Assistant Director of Nursing Services compliments the Director of Nursing Services in planning, developing and supervising the activities of licensed and non-licensed personnel who provide health care and nursing services to Nursing Home residents. This position assists with the development and implementation of nursing services, objectives, policies and procedures in accordance with Federal and State regulations.
The incumbent shares, with the Director of Nursing Services, the responsibility for selecting Nursing Department staff, completing employee appraisals and resolving problems involving employee disciplinary
action.
The Assistant Director of Nursing Services shares responsibility for backing up RN staff on a 24-hour per day, 7 day per week basis.
The Assistant Director of Nursing Services may confer with residents' physicians on an occasional basis to clarify medical orders and direct care.
In the absence of the Director of Nursing Services, the Assistant Director of Nursing Services performs the duties of the Director.
Accomplishments
Currently pursuing classes at Chamberlain College of Nursing MSN program with a specialty in Nursing Education.
Education
ADN
Dallas Nursing Institute
2012 to January 2015
Master's in Education
Chamberlain College of Nursing-Chicago - Chicago, IL May 2015
Nursing Licenses
RN
Expires: December 2026
State: TX
Skills
• Case Management
• Management
• problem solving
• Documentation
• Microsoft Office
Certifications and Licenses
BLS for Healthcare Providers
March 2017 to March 2019
Advanced Cardiovascular Life Support (ACLS)
March 2017 to March 2019
Renewal scheduled 3/1/17
Registered Nurse (RN)
April 2015 to Present
Additional Information
Scheduled to take CCM exam April 2023
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