Case Management Primary Care
Resume:
Stephanie Stacy-Hibbler
Franklin, Va. 23851
********@***.***
PROFESSIONAL SUMMARY
Licensed Practical Nurse
High skilled career professional with over 25 years practical experience in Hospital, In-Home Health Elderly / Geriatric Care, MS Case Management, Primary Care, Internal Medicine, Adult / Geriatrics Care Management,
Clinical Case Management Services, Developmental Pediatrics and Chronic Case Management. Established in critical and chronic care patient support including assessments, counseling, disease management education
and education regarding medications and treatment, lab work, documentation with care plan for diagnosis, and administration of treatment procedures.
CREDENTIALS
LPN State of Virginia 7/30/07 -10/31/2025 000*******
SPECIAL SKILLS
Proficient in MS Offc., Medicare Appeals System (MAS), other CMS mainframe systems. Basic computer skills in WP and spreadsheet utilization, MS Offc. Suite. Knowledge of Utilization Management Guidelines, ICD-9-10, CPT-4 coding. Howie at Home, All Standard Computer Software (MS Office 2015 - All), EMR-Novel, Citra, Physician Portal, Adobe Reader v9, Ecare, Allscripts – Clinical, Allscripts Scanning, IDX (QVT Term), MD Office (Clinical), MD Consult (Clinical), EHR / EMR, InContact, Citra Health, EzCare, Care Centered Time and Attendance, Time Clock, Procure Plus, HIMS (ID Only), Up To Date (Clinical), EPIC (from Sentara Hospital Systems), Micro-soft Word, ICD-9 / ICD-10 Coding, ImpactS Medical Records Scanning, IDX Web. Mgmt health care experience with Medicare SNF, inpatient, or Part B of A. Experience with claims review, proficiency in understanding medical policies and criteria. Effective communication of health information to fellow clinicians and Analytical abilities . Experience working in acute care Professional knowledge of Nursing Theory, Practice and Critical Thinking, Judgment and Decision Making, Certifications: BLS-, Heart Saver First Aid / CPR– Healthcare Provider, Adult CPR and AED, Child CPR / Environment, Infant CPR.
EXPERIENCE
Utilization Nurse Review Nurse II / Anthem / Elevance Health Solutions 09/18/2018 – 02/14/2025
Job Duties: Evaluated medical records, treatment plans, and patient outcomes. ensuring the appropriate and consistent administration of plan benefits by working closely with HC Providers. Collected clinical information necessary for pre-auth services, assessing medical necessity, and determining the appropriateness of treatment settings. Applied medical policies, clinical guidelines, and scripted algorithms within the scope of licensure to ensure compliance with department guidelines and member eligibility. Conducted various types of reviews, including pre-certification for outpatient, inpatient, SNF, retrospective, and out-of-network reviews. Built positive relationships with physicians and healthcare service providers to improve health outcomes for members. Utilized clinical knowledge to coordinate care effectively, consulted with peer clinical reviewers and Medical Directors to ensure quality and cost-effective care throughout the medical management process. Educated members about their plan benefits and referred treatment plans to peer reviewers.
Multiple Sclerosis Society / Senior Bridge – Case / Care Manger 06/02/2017 – 2018.
Job Duties: Completed face to face in home assessments of MS members, assisted member(s) to help maintain their independence and live better with MS. Linked members with available items, services and resources for which they were eligible / qualified to receive. Helped to organize services for member and advocated for member. Connected member with other professionals and volunteers to help build a network of social support for member.
Humana / (Acuity Healthcare Solutions) (FCM) Field Case Manager 06/19/2014 – 06/01/2017
Job Duties: Completed weekly face to face in HH assessments of elderly / geriatric clients, based on each client’s health, nutritional status, psychosocial status, functional and other health related needs for 3.5 yrs. Provided indirect care to elderly / geriatric members and their families according to the established plan of care. Provided a complete physical assessment and history of current and previous illnesses; Coordinated and assisted in the delivery of a plan of health care as developed for the elderly / geriatric client’s needs. Provided counseling to the patient / family in meeting nursing and related needs. Provided HC instructions to the patient / family as appropriate per assessment and plan of care. Identify discharge planning needs as part of the CP development and implements prior to discharge of the patient. Act as Care / Case Mgr. when assigned by Clinical Supervisor and assumes responsibility to coordinate patient care PC for assigned caseload. Prepares clinical notes and updated the PCP when necessary and at least every 60 days; and assures that progress reports are made to the MD, PA, or advanced NP when the patient’s condition changes or there were deviations from the POC. Worked with the Md and care management team regarding the patient’s needs and reports any changes in the patient’s condition; obtains/receives physician’s orders as required. Communicates with community health related persons to coordinate the care CP. Instructs, supervises and evaluates HHA on care to be provided weekly.
Medical Temporaries / CHKD Developmental Pediatrics - LPN 09/13/2016 – 01/01/2017
Job Duties: Performs a wide variety of patient care activities and accommodative services to support the medical practice. Demonstrates excellence in nursing practice characterized by quality patient care and participation in formal and informal patient and staff education. Provides developmentally appropriate psychosocial and clinical care. Reports to Practice Manager/Supervisor and works in close cooperation with and under the clinical guidance/supervision of the practice physician(s) and/or Registered nurse. Performs other duties as assigned
Medical Temporaries (Diabetes Nurse LPN, Infectious Disease Triage / Immunization Nurse LPN 11/2011 – 4/2012, Eastern Virginia Medical School, Norfolk, Va.
Job Duties: Managed patient flow of elderly / geriatric patients, triaged patients. Administered injections. Prepared patient for exam by reviewing history, collecting current information and appropriate vital signs. Documented in the EMR. Performed a variety of patient communication activities in accordance with established standards and practices. Performed EKG’s. Administered Immunizations. Assisted with Pap examinations. Arrived patients in IDX Web.
Telephone Triage Advice Nurse / Back Office Floor Nurse – LPN 11/19/07- 2/26/2010, Temp. – To Permanent Hire, Eastern Virginia Medical School (E.V.M.S.), Department of Internal Medicine, Norfolk, Va.
Performed a variety of patient communication activities in accordance with established standards and practices. Provided telephone advice and education utilization by guidance approved by the associate professors and medical staff. Received, triaged and responded to telephone calls from patients requiring medical and nursing advice by assessing the patient’s problems and utilizing approved guidelines. Set emergent, urgent, routine and same day appointments. Communicated with physicians and healthcare team related to patient triage. Provided instructions and education on health maintenance and disease prevention utilizing appropriate guidelines. Documented calls regarding lab results, test and procedures in accordance with established workflow. Refilled medications in accordance to established guidelines and protocols.
Geriatric / Elderly Home Health Office Manager, 11/03 – 02/07, Edwards Personal Care Services, Virginia Beach, Va.
Job Duties: Responsible for in home assessment of new geriatric / elderly clients. Responsible for interviewing potential employees, and new geriatric / elderly clients for over 3.5 yrs. Hiring of employees. Provided training on departmental policies, procedures and quality assurance related to the care of the elderly and geriatric. Processed HH orders. Provided assistance in problem resolution within the agency and, made recommendations to prevent future quality issues. Ordering office supplies. Facilitated a positive communication between the clients, staff and CEO. Filing, answered phones, relayed messages to CEO. Assisted CEO in exceeding company goals and objectives. Performed yrly. assessments of elderly / geriatric clients as defined by CEO. Performed yearly evaluations of employees as defined by CEO.
Administrative Secretary – 6/2001 – 9/05, Greater Revival Center, Inc., Portsmouth, Va.
Job Duties: Provided a variety of administrative duties for 2 clergy, to support an established organization. Duties included but were not limited to phone management, filing, typing, relaying message to Clergy, Planned and scheduled appointments and meetings. Prepared correspondence and reports. Coordinated special events.
Home Health / Private Duty - 05/2004 – 07/2006 Sentara Home Health (Elderly - Geriatric Private Duty Dept.)
Job Duties: Performed personal care of elderly / geriatric patients for over 2 yrs., (bathing, grooming, etc). Assisted with mobility. Prepared meals and feeding. Escorted patients to appointments. Controlled infections. Fall / safety prevention and education. Assisted with ambulation and transfer. Monitored vital signs including height and weight. Pressure ulcers precautions / prevention. Performed skilled nursing services and medication management.
Stephanie Stacy-Hibbler
33569 Edgehill Drive
Franklin, Va. 23851
********@***.***
PROFESSIONAL REFERENCE
Tamara Jacobs (Clergy)/ (Postal Worker)
Salem, Na.
PERSONAL REFERENCE
Lee McKnight Jr. (Customer Service Associate)
5615 Campus Drive
Virginia Beach, Va.
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