Case Management Manager
Resume:
Tawanda Smith
Tawanda A.Smith, RN CCM # *******, WCCM DN-CM
Owings Mills, MD 21117
**************@*****.***
Professional Summary
Nationally Certified; Competent Registered Nurse with a strong skillset in the areas of Occupational Health, Worker’s Compensation, Public Health, Community Health, Medical Field Case Management, Critical Care, Emergency, & Psychiatric Nursing
Authorized to work in the US for any employer
Work Experience
Inpatient/Acute Care Case Manager
Ascension-Baltimore, MD
November 2024 to Present
Transitional Care and Discharge Planning of post acute care needs for inpatient and observation status patients. Daily workflow usage of Telligen, Kaiser Anna, and Careport/Wellsky applications. Acquisition and capture of Medicaid, Medicare discharge services through cost effective MCO and fee for service guidelines. Referrals for Peer Recovery Care, housing assistance, and other community supports. Transitions to Acute Inpatient Rehabilitation, Subacute Rehabilitation, and Long Term Care facilities. Set up of transportation, home health care, and durable medical services. Independent Contractor
T. A. Smith Consulting dba Covenant Care-Baltimore, MD March 2015 to Present
Owner/Independent Contractor
Provider of Case management, HEDIS & Utilization Management, Adult Day Care and Delegating Nurse oversight for ALF, LTC, and DDA-developmentally psychiatric impaired adults of Maryland and the District of Columbia.
Senior Pastor
Rapha Ministries of Baltimore-Baltimore, MD
January 2015 to Present
Rapha Ministries of Baltimore
The Walk At RMOB Outreach
Baltimore City Police Department Community Collaboration Division Workers Compensation Nurse Medical Field Case Manager Aetna, a CVS Health Company
April 2014 to May 2019
Complete medical case management for injured workers within the state of MD, VA, and the District of Columbia. Meeting with interdisciplinary providers, vendors, employers, and attorneys to facilitate return to work within safe guidelines under jurisdiction rule.
~Utilization Management Nurse Consultant
Daily review of submitted provider request for medical necessity; to include prior authorization, outpatient procedures, inpatient stay, retrospective, appeals review. Special projects as assigned per department need.
Weekend Admissions Case Manager
Professional Healthcare Resources-Baltimore, MD
July 2017 to February 2018
Weekend admissions nurse via OASIS measure under various insurance products. Development of plans of care for all disease processes from adolescent to older adult. Proficient with IV therapy, wound management, psychiatric, and the completion of SOC, ROC, REC, and RV. Discharge Planner/Utilization Reviewer/Special Project Manager Amerihealth Caritas District of Columbia-Washington, DC May 2013 to May 2014
Daily investigations and executions of special projects as assigned. Discharge Planner for the entire DC line of business with marketed and established relationships with par and non- par providers. Reviewer/Interpreter of clinical data as it related to the authorization of services and placement criteria for inpatient & outpatient stays, DME, Home Health Care, Hospice, services for plan members. Proficient in the use of Interqual Criteria, Microsoft, and various IT products. Discharge Care Utilization Manager
UnitedHealthcare-Elkridge, MD
January 2012 to May 2013
Transitional Care Case Management
Community & State Product (Medicaid/Commercial)
Maryland/District of Columbia
With the use of Milliman criteria, performed daily clinical reviews of inpatient stays of acute/post-acute patients. Planner & evaluator of inpatient complex care issues that hinder the discharge process. Referral and assistance with social/behavioral health issues. Placement to post acute services to include, but limited to SNF, SAR, LTACH, and AIR. Execution of Single Case/TPL regulations.
Agency Registered Nurse
FlexRN-Stafford County, VA
January 2009 to June 2012
Now American Medical Staffing
PRN Emergency Room, ICU, Telemetry, Perioperative, & Occupational Health Nursing Employee Health Coordinator
Bon Secours Baltimore Health Systems-Baltimore, MD June 2010 to October 2011
Education
A.A. in Nursing
Howard Community College School of Nursing
2000
Coppin State University Helen Fuld School of Nursing 1995 to 1998
A.A. in Surgical Technology
Baltimore City Community College
1991
High school diploma in College Preparatory /Accounting Eastern Senior High - Baltimore, MD
1986
Nursing Licenses
RN
State: DC
RN
State: MD
RN
State: PA
Skills
• Medical coding
• Case management
• EMR Systems
• Public relations (10+ years)
• Laboratory experience
• HEDIS
• Behavioral Health
• Vendor management
• Emergency Care (10+ years)
• Workers' compensation law
• ICD-9
• Product demos
• Medical Terminology
• Hospital Experience
• Employee Orientation
• Customer service
• CPT Coding
• Discharge Planning (10+ years)
• Motivational interviewing
• Home Care
• Supervising experience
• Training & development
• Phlebotomy
• ICD-10
• NCQA standards
• Sales (10+ years)
• Microsoft Excel
• MCG Cerified
• Medical Necessity Review
• Managed Care
• Medical Coding
• Acute care
• Epic
• Hospital experience
• Clinical research
• Utilization Management
• Medical records
• Nursing
• Workers' compensation
• Psychiatric Care (10+ years)
• Critical care experience
• ICU Experience
• Microsoft Office
• Interqual
• Long term care
• Anatomy Knowledge
• Vital Signs
• Adobe Acrobat
• EMR systems
• Cerner
• Triage
• Geriatrics
• Teaching
• Hospice Care
• Supervising Experience
• Medical Billing
• Anatomy knowledge
• Medical terminology
• Orthopedics
• Windows
• Medication Administration
• Communication skills
• Sales
• ICU experience
• Critical Care (10+ years)
• Clinical documentation improvement
• Medical Records
• Computer skills
• Presentation skills
• Nurse Management
• Delegating Nurse (10+ years)
• Public relations
• Analysis skills
• Leadership
• Vital signs
• Perioperative Care (10+ years)
• Benefits administration
• Management
• Microsoft Word
• Medical Management (10+ years)
• Crisis Intervention
• Worker's Compensation (7 years)
• DRG
• Primary care
• Community Health (10+ years)
• ODG certified
• Home Health (10+ years)
• Case Management (10+ years)
• Research
• Care plans (10+ years)
• Occupational Health (7 years)
Military Service
Branch: United States Army
Service Country: United States
Rank: E4 promotable
July 1986 to November 1997
AHMED Regiment
Surgical Technologist
Radiological technologist
Field medic
Awards
Harriet Tubman Legacy in Nursing Award
February 2015
Maryland Black Nurses Association
Provident School of Nursing Alumni
Gamma Chapter
Chi Eta Phi Nursing Sorority, Inc
Maryland Senatorial Recognition in Nursing
February 2015
Senator Shirley Nathan-Pulliam
Governors Citation Excellence in Adult Health
February 2015
Governor Larry Hogan
Baltimore City, MD Mayoral Award in Nursing
February 2015
Stephanie Rawlings-Blake, Mayor
Certifications and Licenses
BLS, ACLS
Present
American Heart
CCM #4252704
February 2021 to Present
Nationally Board Certified Medical Case Manager by CCMC. Registration #4252704 Certified Case Manager
December 2020 to Present
CCCM
WCCM-Maryland #G0826
November 2018 to Present
Certified State of Maryland Workman's Compensation Registered Nurse Medical Case Manager BLS Certification
CPR Certification
AED Certification
Compact State Nurse License
RN License
August 2000 to November 2024
Additional Information
Registered Nurse Washington, D.C.- inactive
Registered Nurse Pennsylvania - inactive
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