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Quality Assurance Case Manager

Location:
Ronkonkoma, NY
Posted:
August 14, 2023

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Resume:

Mission – To utilize acquired professional nursing skills to advocate, facilitate, and provide compassionate caring nursing healthcare to the community

Catholic Homecare – CHHA agency November 2000 to April 2023

110 Bi-County Blvd., Farmingdale, N.Y 11735

Performance Improvement Coordinator/Educator August 2018 to April 2023

Evaluate, assess, audit staff and agency performance in multiple areas of care including documentation. Monthly audits performed to evaluate compliancy, efficiency, performance, and documentation of care provided to patients with wounds, foleys, UTI and hospitalizations, oxygen usage, pleurex catheters, HHA services, and advanced directives. Utilization of MIDAS program to evaluate agency’s performance of medication error, intravenous related problems, and infection for both staff and/or caregiver/patient incidents. Organizer of maintaining agency’s complaint log. Coordinator of monthly utilization chart reviews thus identifying any under/over utilization of services provided to patient. Quarterly reports presented to management with audit outcomes and explanations as required. Record keeping of teams’ performances on dashboard reports in areas of communication, overall performance, census, re-hospitalization, fall incidents, HHA supervisions, oasis functional categories including pain, transferring, healing of surgical wounds, med errors via SHP reporting program. Coordinated audit concerning staff compliancy with flu vaccine or wearing of surgical mask. Assist with reviewing 485’s and set up for outside vendor (QIRT) to review for accuracy. Audits recorded with utilization of Excel, Word, MIDAS. Results discussed with management and individual assigned teams. Monthly team meetings conducted monthly with team manager, care manager, and team staff members to discuss outcomes and agency recommendations for improvement of care. In addition, participant in “Huddle” meetings to inform and be informed of daily happenings within the agency and on clinical teams. Attendance at Performance and Compliance Meetings with participation in providing audit results. Attend PI meetings as arranged by department manager. Can be assigned to clinical SN visits to patients if understaffed.

Care Manager August 2016- August 2018

Facilitate appropriate skilled care provided to patients by review of documentation including oasis responses including initial visit functional responses, interpreting the CMI for individual teams. Also, monitor LUPA rate and educate staff concerning effects of oasis responses and CMI/Lupa rates. Conduct interdisciplinary team meetings to discuss patient care and issues. Assist in providing authorization for managed care patients, and actively write appeal letters to counter denials from insurance companies.

Team Manager February 2013- August 2016

30-Member Interdisciplinary Team of RN/ LPN/REHAB/MSWs to ensure interpretation and delivery of homecare services within the guidelines of Medicare/Medicaid and Managed Care insurances. Ensure cost effectiveness and optimize quality care. Also accountable for education, performance evaluation, staff hiring and termination process Coordinate staff scheduling, facilitate transition of patient to home from various facilities. Communicate with patients and family members concerning positive and negative feedback and issues. Conduct monthly team meeting to communicate and update staff on agency/homecare policies/procedures. Interdisciplinary team meetings held weekly to discuss select patients and their care issues.Facilitate appropriate usage and allocation of skilled visits via authorization process for managed care insured patients.

Committee Member:

oAllscripts - monthly trouble shooting

oWound Care - redesign documentation

oEnvironmental - establish internal “green” procedures.

oSandata Program – pilot testing of Home Health Aide plan of care documentation

Congestive Heart Failure Hospital/Homecare Program – discuss post discharge of CHF patients status with hospital CHF coordinator to ensure continuity of care and prevent rehospitalization

Nursing Team Supervisor April 2005 to February 2013

Catholic Homecare Farmingdale, NY

Administration, management, education, evaluation of 16 –member nursing team

Assistant Nursing Care Coordinator June 2004- March 2005

Catholic Homecare Farmingdale, NY

Assistant to Nursing Team Supervisor

RN Field Case Manager November 2000 - June 2004

Catholic Homecare Farmingdale, NY

Perform skilled nursing care for caseload patients

Director of Nursing/ Quality Assurance June 2016 – December 2019

SCOPE Healthcare – Melville, NY

-Supervision of field RNs, coordinator of staff education

-TBI population

-Quality Assurance coordinator

Community Health Nurse, October 1999-November 2000

Brookhaven Memorial Hospital Homecare Agency Brookhaven, NY

Nursing Case Manager for 25 patient caseload

Field Nurse (per diem), December 1998-September 2000

Self-Help Communities Homecare Services Levittown, NY

Performed skilled nursing visits and evaluations.

Supervision of HHA and PCA personnel.

Participant in Oasis Studies, Denver Colorado.

Instructor for training classes for aides.

Field Supervisor, May 1998-August 1999

Personal Touch Homecare Agency Garden City, NY

Field supervisor of HHA and PCA employees.

Conducted field visits to patients including teaching of disease, medications, and diet.

Field Rehab Nurse, December 1995-August 1997

Crawford Disability Management Company Uniondale, NY

Interview, assess, and pursue injured employees to return to work . Coordinate care required to facilitate successful recovery return to work.

Coordinate and review IME reports, peer reviews

Community Work

HEALTHY SUNDAYS Catholic Health Service Community Program provide preventative screening for blood pressure, seasonal vaccines, and blood glucose testing.

Host Family Program at SUNY @ Stonybrook (2007-2010) provide international students with acclimation to the U.S. and its culture and educational system

Education:

Adelphi University, Bachelor of Science in Nursing ‘79; Sigma Theta Tau Honor Society

Continuing Education Courses:

1.EMR – Garnett Education ., Nurse.com Oct 2012

2.Cognitive-Communication Disorders – Assessment and Treatment of Neurological Impairments. Pesi Healthcare Oct 2011

The Nurses’ Health Study II participant – Harvard School of Public Health and the Channing Laboratory at Brigham and Women’s Hospital. 1999-2009.

Technical Expertise includes: MicroSoft Word, Outlook, PowerPoint, Allscripts/Netsmart

Personal Interests: soapmaking, gardening, baking, willing to re-locate.



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