Case Management Manager
Resume:
Krystal A. Whited, RN
Professional Skills
• 11+ years RN, case management, utilization review, quality improvement, chart auditing, medical
records review, care management, patient assessment, coordination of care plans, direct patients care
and administering medications for patients with chronic and complex conditions
• Discharge planning/continuation of care
• Strong EMR experience: EPIC, Cerner, MediTech MIDAS, AllScripts, Milliman Care Guidelines
• Coordination to assess, evaluate and monitor quality of long-term care provided
• From assessment and evaluation – develop care plans to achieve long-term and short-term goals for
improvement
• Strong attention to details and highly organized with effective communication skills
• Strong computer experience: Microsoft Word, Excel, PowerPoint, outlook for all patient documentation
• Data entry skill of 45+ WPM
Professional Experience
Present Wellcare Tampa, FL
RN Case Manager
• Provided case management over national accounts
• Proactively review NQCA score and Hedis for compensation
• Chart auditing and review
• Reviewed medical records to determined medical necessity
• Discharge planning
• Chart auditing and review
• Developed and implemented a case management plan in collaboration with the member, caregiver
02/2017 – 02/2018 HCA Tampa, FL
RN Case Manager/Utilization Review Nurse (Contract)
• Provided case management services to patients with chronic or complex conditions
• Proactively identified members that may qualify for potential case management services
• Identified patient care requirements by establishing personal rapport with members to better
understand care requirements
• Conducted assessment of patient needs by collecting in-depth medical information
• Assured quality of care by closely monitoring patient’s condition and adhering to care standards
• Developed and implemented a case management plan in collaboration with the member, caregiver
physician and/or other appropriate healthcare professionals to address member’s needs.
• Reviewed medical records to determined medical necessity
• Discharge planning
• Chart auditing and review
• Measured health outcomes against patient care goals
• Made and recommended necessary adjustments
• Documented patient care services
• Coordinated access to third-party services
• Provided patient assessment and coordinated plan of care to family members, friends and caregivers
02/2016 – 02/2017 Central Florida Health Alliance Leesburg, FL
RN Case Manager/Utilization Review
• Concurrent review to make sure patient met in-patient criteria
• 30 patient case load level
• Reviewed medical records to ensure what was charted relates to diagnosis
• Case management for chronic and acute conditions
• Discharge planning
• Chart auditing and Review to ensure medical necessity and appropriate level of care
• Provided patient assessment and coordinated plan of care to family members, friends, and caregivers
• Created and implemented discharge plans
• Provided complete and accurate documentation of patient’s condition and any changes in care of plans
02/2015 – 01/2016 Health First Melbourne Melbourne, FL
Utilization Review RN/Care Manager
• Identified patient care requirements by establishing personal rapport with patients
• Case Management for Chronic and Acute conditions
• Chart auditing and Review
• Implemented procedures and made changes based on findings
• Utilization Review to everything lined up with diagnosis and guidelines utilizing InterQual and Milliman
care guidelines
• Ensured that all protocols were followed according to state, federal CMS guidelines
11/2014 – 02/2015 St Joseph’s Mercy Trinity Pontiac, MI
Utilization Management Nurse
• Reviewed requests for medical necessity
• Provided appropriate consultation and referrals to case management services
• Coordinated course of care and access to third-party and community-based resources
• Prevented complications and prevented readmissions when possible and appropriate
01/2008 – 02/2013 BCBS of Michigan Detroit, MI
Utilization Review Nurse/Transitions of Care/Case Manager
• Developed care plans based on mutual goals of patient, family and provider’s plans
• Monitored patient adherence to plan of care and progress towards goals
• Facilitated changes as needed
• Recognized and responded to opportunities for Quality Improvement
• Patient/Family education
• Conducted in-depth assessments and reported changes/updates to physicians
Education
Oakland Community College
Associate Degree in Nursing, Waterford, MI
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