Doris Rayfield

**** *. **** ******, ****** City, MO 64132

816-***-****

adzbic@r.postjobfree.com

Objective

To utilize my experience in Nursing in an environment conducive to care management and utilization review

Education

•Metropolitan Community College – Kansas City, MO - LPN, Nursing Diploma Program - 2008

•Samuel Rodgers Health Care - Diabetes Empowerment Education Program Facilitator Certification - 2017

•First Aid Mental Health Certification – 2017

•CPR and BLS certification

•Kansas City Business College-Kansas City, MO- Associate Degree, Business Administration - 1999

Experience

MAXIMUS Federal Services (Center for Disease Control)

Health Specialist (Remote)

Kansas City, MO

April 2020 – December 2021

•Provide advanced and accurate clinical inquiry responses to health related, disease control and prevention issues to the public and health officials

•Advanced database searches

•Performed assigned work in accordance with quality assurance measures.

•Responded to inquiries in both verbal and written formats.

•Clinical knowledge of CDC related topics.

•Proficient internet search skills

•Working knowledge of Microsoft Office, Excel, Outlook and the ability to utilize other software applications

•Excellent listening, comprehension, communication, problem solving and customer service skills

•Ability to work independently and organize simultaneous tasks.

Swope Health Services

Referral Coordinator

Kansas City, MO

August 2018 – February 2020

•Coordinated referrals, prior authorizations, insurance verification and patient referral appointments and verified insurance information.

•Utilization management

•Scheduled outpatient referral appointments in collaboration with hospitals and clinics.

•Relayed test preparation instructions, hospital registration requirements, and physician instructions to patients.

•Contacted patients about abnormal labs and imaging results and scheduled follow up appointments

•Addressed telephone encounters from providers for medications, labs and diagnostic imaging

•Supervised activities of Medical Assistants

•Roomed patients and reconciled charts and medications.

•Responsible for clinic medication reconciliation

•Ensured cleanliness of clinic and stocked supplies.

•Strong PC, EMR, Microsoft Word, Outlook and Excel skills.

•Excellent verbal and written communication skills

Samuel Rodgers Health Care Center

LPN Population Health Clinical Care Coordinator

Kansas City, MO

July 2016 – August 2018

•Provided patient-centered care management and disease education for patients with chronic diseases and comorbidities.

•Strong presentation skills and critical thinking skills with the ability to encourage and promote health and behavioral change in people with chronic diseases.

•Engage with members and caregivers to understand their needs.

•Promote quality, cost-effective care, and patient outcomes

•Utilization management to assess appropriateness and quality of care

•Certified facilitator of Diabetes Empowerment Education Program.

•Ability to communicate in person, by phone or via e-mail in a professional and friendly manner.

•Provided chronic disease education for a diverse population of patients via phone interpreter.

•Coached patients to improve management of their chronic conditions, including medication compliance, medical appointment compliance, nutrition and exercise and preventative care compliance to improve overall health

•Tracked healthcare outcomes for Population Health patients

•Abstracted data from medical records regarding HEDIS compliance and preventative care measures

•HEDIS compliance utilizing knowledge of quality measures to aid in the audit and review of patient charts for quality measures information.

•Conducted outreach to patients to address open quality care gaps; assisted patients with scheduling appointments and placing orders for the care they needed to remain healthy.

•Participated in meetings regarding quality improvement plans and efforts.

•Facilitate biweekly diabetes insulin titration program

•Strong PC, EMR, clinical charting, documentation and typing skills.

•Utilization management - Educate patients on alternative care options to patient hospital stays and emergency room visits

Humana Health Plans, Senior Bridge Program

Medicare Nurse Care Manager (Remote work from home)

Kansas City, MO

September 2012 to July 2016

Perform initial outreach and post discharge follow-up

•Quickly develop rapport and with patient and caregivers.

Act as a patient advocate to ensure individual needs are met in the most effective way

Case management and medical records review

Assist member in the coordination of additional tests and appointments to ensure positive outcomes.

Assist patient in navigating the healthcare system to ensure they have the necessary resources and support to achieve their health goals and improve their quality of life

Provide disease education and medication education to encourage improved management of chronic conditions

Develop care plans in partnership with patient and continuously evaluate progress.

Educate on appropriate care settings to reduce emergency room visits and hospital stays

Timely documentation of patient contact

ICD-9/ICD-10 coding

HIPPA compliance

Ability to work independently and prioritize work load.

Carestaf, Inc.

Pediatric Home Health Licensed Practical Nurse

Overland Park, KS

November 2008 to September 2012

•Provided direct nursing care and evaluated patient’s response to care

•Performed personal care, wound care, tracheostomy care, ventilator care, suctioning, G-tube feedings, and urinary catheterizations

•Performed physical therapy range of motion under instruction of physical therapist

•Provided emotional support for patients and families

•Provided medication administration

•Timely documentation of care provided

•Excellent communication skills and ability to establish rapport with patients and families quickly

•Ensured cleanliness of environment

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