Care Manager Case
Resume:
Mona M. Lewis, RN, BSN, CCM
404-***-**** *********.*****@*****.***
SUMMARY
Experienced RN with 10+ years in managing DSNP, Medicare, Medicaid members within the state of NY, CA, OH, IL, GA, FL, IN. I have years of experience in Medical Surgical, Case Management, and Home Health care. Specialized in managing complex medical conditions like oncology, heart failure, diabetes, and more. Demonstrated skills in teamwork, organization, critical thinking, and leadership.
SKILLS
● Bilingual in Haitian Creole and
English
● Skilled clinical judgment
● Resource management expertise
● Disease prevention and intervention
specialist
● Interdisciplinary team collaboration
● High level communication
LICENSES / CERTIFICATIONS
Registered Nurse Licensure: California New York Nevada Ohio Georgia (Compact) AHA Basic Life Support
EXPERIENCE
Nurse Care Manager Village Care Max
July 2024 - Present
● Provide telephonic care to DSNP (Dual Eligible Special Needs Plan) and MLTC (Managed Long-Term Care)
members who require specialized care due to age,
disabilities, or chronic conditions. Review prior
authorizations for treatments and procedures for required services.
● Conduct Assessment to identify the member’s medical, social, and behavioral needs. Collaborate with Healthcare providers, Social Workers, Behavioral Health, and family members to ensure the members are receiving appropriate and timely care.
● Maintain accurate records of all members' interactions, care plans, assessment as per Federal and State regulations. Participate in interdisciplinary team meetings to discuss complex cases by ensuring all aspects of care are
addressed. Assist members during transition of care from hospital, Acute rehab, or Skilled nursing Facility to home and ensure continuity of services.
Transition of Care Nurse/Nurse Care Manager Cityblock Health August 2022-May 2024
● Telephonically assessed member’s physical, mental, and environmental skills through clinical knowledge and experience to provide utmost care for members.
● Create interdisciplinary, member driven care plans to achieve goals and address gaps in care.
● Recommends alternative levels of care and ensures compliance with federal, state, and local requirements.
● Promoted to TOC team, supporting members in the first thirty days post discharge.
Clinical Care Manager II Humana
October 2018-August 2022
● Contact members/family members every six months
telephonically to assess, educate, and assist as needed.
● Independently plans, develops, assesses, and evaluates cares and discharge plans provided to dual-risk members.
● Assist co-workers with daily calls to minimize over due calls.
● Maintain Multi-State Licensure to perform work duties. Clinical Care Manager I Anthem, Blue Cross Blue Shield May 2018 - September 2018
● Telephonically assessed member’s physical, mental, and environmental skills through clinical knowledge and experience to provide utmost care for members.
● Guided members and families of learning benefits resources available through their health plan.
● Collaborated with Medical Directors, Social Workers, Registered Dietician, and Exercise Physiologist on meeting members' well being.
● Identified gaps in care and intervened by educated members and family members on gaps and provided support in closing gaps.
● Contacted members via telephone to perform post discharge and pre-admission assessment and educated members on preventing readmission.
● Participated in weekly case rounds to obtain insight from Medical Directors and colleagues.
Clinical Care Manager Mega Stone/ACCM (Aetna Better Health Members) March 2014 - July 2018
● Collaborated with RN Assessment nurses, performed and reviewed UAS assessment, finalized and implemented service plan.
● Identified gaps in care and delivered patient-centered care based on member’s needs and preferences.
● Created authorizations for attendant care, social day care, DME’s, and Skilled visits.
● Collaborated with an interdisciplinary team to coordinate care and services.
Staff Nurse Harlem Hospital New York, NY
2013 - 2014
● Responsible for delivering professional nursing on medical surgical units.
● Utilized the nursing process in assessing, planning, implementing and evaluating care
● Provided care for patient’s comfort and wellbeing through adapting the nursing process of assessment, planning, intervention, and evaluation.
● Clinical documentation, discharge planning, patient’s admission, and supervised PCA’s work assignments.
Registered Nurse Preferred Home Care Brooklyn, NY 2013 - 2014
● Provided psychosocial, physical and pain assessments on adult and geriatric populations.
● Implemented measures to de-escalate crises and make appropriate referrals as necessary.
● Developed coordinated care plans in conjunction with other disciplines, patient and family.
● Educated and coached patients to foster autonomy and empowerment.
Visiting Nurse Able Health Care Elmhurst, NY
2012 - 2013
● Performed comprehensive assessment on pediatric and OASIS assessment on adult and geriatric patients
● Supervised HHA/PCA and developed and updated care plan
● Provided education, Medication pre-pour and management EDUCATION
Bachelor of Science in Nursing (BSN), Long Island University, May 2012
Bachelor of Art in Urban Studies (BA), Hunter College, December 2003
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