Registered Nurse case management
Resume:
Cecelia M. Tisdell
*.*********@*********.***
Summary
Registered Nurse with 37 years of experience delivering quality care to patients. More than 10 years of Acute Care proficiency, with Neurology Intensive Care concentration. Vast knowledge of hospital and private practice standards of care. Committed to patient empowerment through healthcare services, knowledge, and resources, in efforts to achieve and sustain a healthier quality of life.
Career Experience
Career Gap 1/22 to present - medical leave.
5/21 to 1/22 Podimetrics - Somerville, MA
SmartMat Telephonic Care Manager
•Interacted telephonically with Veteran diabetic patients.
•Provided patient/caregiver instructions on the functions, operations, setup, and the benefits of using the SmartMat monitoring unit.
•Analyzed and assess remote scan images for temperature elevations in the feet, indicating potential signs of inflammation, wounds, and/or skin breakdowns.
•Rapid intervention/education to manage risks when detected.
•Protected mobility and promoted early identification of tissue damage, and prevented unnecessary amputations related to diabetic ulcers by combining patient-friendly technology, clinical intervention and human support to patients.
11/19 to 04/21 Aetna Insurance - Arlington, TX
Case Manager
•Telephonic Case Management for Medicare and Medicaid Dual Special Needs Program.
•Collaborated with providers to improve patients' medical management and resolve healthcare barriers. Assisted patients with acquiring necessary wellness programs.
01/19 to 11/19 United Healthcare/Optum - Richardson, TX
Case Manager
•Telephonic Case Management – Call center setting: Provided telephone triage, crisis intervention and plan benefits according to plan guidelines. Engaged members and provided immediate and compassionate support.
•Assessed members' clinical needs, utilizing a variety of advanced clinical analysis which supported the appropriate levels of care and cost -effective clinical services.
•Determined applicable interventions, and action plans, to address members' situational concerns and crisis.
•Provided counseling to individuals, family members/caregivers, regarding the management of issues that impact lifestyle and work life balance. Advocated for family members to find solutions to questions, assist with resolving medical concerns, and overcoming barriers to healthcare.
06/16 to 01/19 United Healthcare/Wellmed - Dallas, TX.
Outpatient Telephonic Case Manager.
•Provided acute, chronic illness, and disease management education.
•Responsible for daily case management and care coordination for health plan members.
•Ensured a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy, to meet and enhance individual and family comprehensive health needs. Promoted patient safety, quality of care, and cost-effective outcomes.
•Coordination of care with Inpatient Care Coordinators for high-risk patients.
06/14 to 06/17 Archway Home Health - Denton, TX
Field Case Manager
•Established and monitored patients' initial and ongoing comprehensive assessment and plan of care. Ensured compliance with Medicaid and Medicare guidelines.
•Performed skilled home health services, disease management and education; collaborated with healthcare providers to facilitate the best possible outcome for patients.
•Supervised and provided clinical direction/training to RNs, LVNs and Home Health Aides regarding skilled care.
11/14 to 06/15 Humana Insurance - Overland Park, KS
Field Case Manager
•Managed Long Term In-Home Care Program. Served as a health coach, and provided disease management, self-care guidance, medication regimen education.
•Reconciliated and identified gaps and barriers to care.
•Acted as an advocate and coordinator for community resources.
06/14 to 11/14 Next Step Home Health - Mansfield, TX
Field Case Manager (contract)
•Established and monitored the initial and ongoing comprehensive assessment and plan of care.
•Ensured compliance with Medicaid/Medicare and private insurance guidelines.
•Provided skilled care and interventions to patients in the home setting.
•Supervised/trained and provided clinical guidance to the RNs, LVNs and Home Health Aides'.
•Performed IV therapy and dressing change, wound care, lab collection, foley catheter placement, administered medication injections, and evaluated home testing performance, educated patient/caregivers on disease management and medication regimen.
•Coordinated with Physicians to discuss effective resolutions when required.
02/12 to 06/14 Approved Home Health - Midlothian, TX
Assistant DON/RN, Case Manager
•Established and monitored the initial and ongoing comprehensive assessment and plan of care in collaboration with Physicians.
•Ensured compliance with Medicare/Medicaid guidelines.
•Monitored staff performance and patient care. Ensured the compliance of activities and home health services with federal, state and local standards, and offered cost effective care.
10/11 to 01/12 Genex Services - Dallas, TX
Workers' Compensation Case Manager (contract)
•Collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet individual and family comprehensive health needs through communication and available resources, to promote quality cost-effective outcomes.
08/10 to 10/11 Medical Edge Healthcare Group/Texas Health Resources - Dallas, TX
Patient Care Coordinator/RN (Risk Adjustment Coder)
•Reviewed Medicare Advantage patients' charts for adequate documentation and coding of diagnosis to the highest specificity. Annual documentation, assessment, and evaluation of chronic disease conditions. Executed coordination of care with Inpatient Care Coordinators on high-risk patients with chronic and acute disease processes.
05/06 to 02/12 Approved Home Health - Midlothian, TX
RN/Case Manager
•Skilled nursing visits in the home setting. Performed initial admissions and recertification evaluations for Medicare clients to establish a plan of treatment in collaboration with the Physicians orders.
•Performed diagnosis coding to ensure appropriate services rendered and reimbursed.
•Supervised/trained ancillary staff, nurse aides and clinical nursing staff's performance and adherence to plan of treatment.
08/07 to 07/09 DATA RAPS - Dallas, TX
Clinical Records Analyzer/Coder
•Performed risk adjustment evaluations for contracted insurance vendor, Secure Horizon; reviewed clinical records for accurate coding and documentation to ensure adequate reimbursement. Healthcare Effectiveness Data and Information Set (HEDIS) analysis/review.
7/05 to 12/06 HAVEN HOME HEALTH - Dallas, TX
RN/Case Manger
•In-home skilled nursing visits; patient education on disease management, medication regimen and health/safety awareness.
•Thorough knowledge and application of the Oasis format for patient evaluation.
•Coordinated/evaluated the quality of care.
08/05 to 09/06 Hunter Medical Services - Duncanville, TX
RN/Case Manager
•Performed skilled intervention visits in the home environment, educated patients on disease management and medication management.
•Maintained home health services quality assurance and cost effectiveness.
•Initiated, and revised plan of care in coordination with Providers.
Education: Licenses and Certifications:
Texas Woman’s University Texas Board of Nurse Examiner –
Bachelor of Science: Nursing (Registered Nurse, BSN - 1986)
Graduation: 1986 Commision for Case Manager –
(Certified Case Management 05/2018)
Skills:
- Typing Speed: 40 WPM.
- Working knowledge of Microsoft Office programs and applications.
- Case & Document Review/Case Management.
- Time Management and Communication expertise.
- Patient documentation and evaluation.
- Quality Assurance.
- Best Practice Evidence based education.
- Treatment Plan development/maintenance, in compliance with agency policies and standards.
- Excellent engagement, motivation, and change management competencies.
- Establish and utilize dependable community resources and programs.
Contact this candidate