Registered Nurse Case Manager
Resume:
Nancy Simpson RN/BSN
*****.*.*********@*****.***
*** ********* **. ** ****, TX 79912 915-***-****
EDUCATION
UNIVERSITY OF TEXAS AT EL PASO, El Paso, TX May 1992
Bachelor of Science in Nursing
Highly skilled Registered Nurse (RN) and case manager with more than 30 years of relevant experience providing superior care while ensuring smooth nursing operations and regulatory compliance. Recognized as an exceptional team leader and problem solver with expertise in quality, utilization and risk management. Notable success in hospital policy and procedure development. Proven in the delivery of excellence in areas of patient care to include pediatric thru geriatric patients
. Areas of expertise include:
Quality Assessments Quality Management Policy / Procedure
Process Improvements Compliance Reporting Protocol Development
Regulatory Compliance Performance Evaluation Training / Development
LICENSES
●Registered Nurse: TEXAS License # 584502 – Expires September 2026
EXPERIENCE
Loyal Source Government contractor
June 2022-October 2024
●Provided training to medical staff on units
●Assured compliance to OCMO standards to onsite clinics for migrants
●Updated training for staff
●Weekly visits to all assigned stations in New Mexico and Texas
Del Sol Hospital
Palliative Care Coordinator November 2021-current
Daily rounds with provider and team of critical care areas
●Met with patients and family members to review goals of care
●Explained Palliative care services and Hospices services in our community
●Communicated with patient and family members their diagnosis, tests, procedures in layman's terms
The Hospitals of Providence Sierra Campus
Case Manager ICU September 2019-October 2021
●Conducted daily reviews of ICU patients
●Met with patients and family members to assure goals of care are met
●Facilitated discharge planning for patients and family members to meet insurance guidelines
●Enable transfer of patients to higher level of care facilities
Genesis The Village, Las Cruces, NM
Assistant Nurse Manager, Desert Willow January 2018-September 2019
●Hiring of staff CNA, RN, LVN
●Scheduling of staff to meet needs of patients
●Review of charts to meet criteria for admission, continued stay
●Ensure compliance of federal and state requirements for long term care
MOUNTAINVIEW REGIONAL MEDICAL CENTER, Las Cruces, NM
Clinical Case Manager / Registered Nurse August 2015 – November 2018
●Conducted daily reviews of patients for appropriate admission criteria and diagnosis
●Utilized MCG and InterQual criteria for Clinical – payers, providers, government agencies decisions
●Worked with medical providers to meet insurance guidelines for inpatient stay
●Facilitated discharge planning for patients and families within parameters of insurance criteria throughout sge continuum
●Advanced knowledge of medical records analytics systems such as Morrisey, Midas, Tele-Tracking, and Clin-View
●Nominated by for Case Manager of the year by the New Mexico Case Management Society 2018
UNIVERSITY MEDICAL CENTER, El Paso, TX
Clinical Case Manager / Registered Nurse; Utilization Nurse May 2011 – July 2015
●Communicated with Providers regarding reviews and corrections of all Ambulatory Surgery Unit Orders in accordance with CMS and providers guidelines
●Relayed clinical information in a timely manner to insurance providers
●Reviewed and overturned all denied claims with pertinent clinical information
●Documented clinical information to assure authorization of in-patient claims
●Facilitated information to medical providers for appropriate Diagnostic Related Grouping (DRG)
●Updated clinicians for prompt claims payment
EL PASO LONG TERM ACUTE CARE, El Paso, TX
Registered Nurse; Charge Nurse May 2008 – June 2015
●Managed a total of 34 bed units
●Provided supervision of staff including the following: RN, LVN, RT, PT, CNA’s
●Reviewed and submitted all clinical information for Providers to meet CMS guidelines
●Facilitated communication between Medical providers, Patients and Family members
DEPARTMENT OF VETERAN AFFAIRS, El Paso, TX
Administrative Officer for Nurse Executive Registered Nurse May 2008 – July 2010
●Reviewed admissions and discharges of veterans with WBAMC
●Attended daily discharge meetings with WBAMC Providers
●Worked closely with WBAMC DC planners for discharge needs of Veterans
●Served as the Interim Infection Control Nurse; passed VA SOARS, worked closely with other VA’s and state agencies to comply with federal guidelines
●Improved documentation and compliance with VA, federal regulations and Joint Commission
COLUMBIA AURORA JOINT VENTURE, El Paso, TX
Recovery Room Registered Nurse September 2006 – May 2008
●Facilitated patients’ post-surgical procedures in recovery
●Assisted medical providers with special procedures
MESA HILLS SPECIALTY HOSPITAL, El Paso, TX
Nurse Liaison / Marketing April 2005 – August 2006
●Facilitated patients’ post-surgical procedures in recovery
●Assisted medical providers with special procedures
SOUTHWESTERN GENERAL HOSPITAL, El Paso, TX
Registered Nurse; Charge Nurse August 2002 – November 2008
●Charge nurse days all shifts ICU
●PRN House supervisor
●Delegation or all staff duties
●Identification, monitoring, and isolation of Infectious diseases
●Updated medical providers of patients’ status
COLUMBIA MEDICAL CENTER, El Paso, TX
Registered Nurse; Emergency Room / Case Manager October 1998 – October 2000
●Case Manager for ER, ICU, CCU, L&D, NICU, GYN and Pediatrics.
●Reviewed all charts for appropriate setting, admission and DRG
●Facilitated discharge planning for patients
●Advised providers and team members of documentation and avoiding denials
ASARCO, El Paso, TX
Health Clinic / Safety Administrator January 1995 – February 1999
●Administered and supervised the Employee Health Clinic with 7 staff members
●Handled all aspects of case management of Workers Compensation Cases
●Insured compliance with ASARCO Medical Department, OSHA, EPA, ANSI, TNRCC
●Created and maintained database of health information international compliance standards for employees and contractors
●Monitored all assessments, immunizations, hearing, vision, and pulmonary function testing of staff and contractors.
●Monitored and tracked all infectious disease processes
CENTRAL CITY DIALYSIS, El Paso, TX
Clinical Coordinator Manager March 1992 – April 1995
●Lead for a 20-station Hemodialysis unit
●Monitored all lab results and medical information
●Trained and supervised over 19 employees
●Provided complete renal care, quality and compliance with end-stage renal network guidelines
●Monitored and tracked Pre and Post renal transplant patients while participated in the Acute Dialysis Team for inpatients in El Paso area hospitals
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