Case Management Registered Nurse
Resume:
Swansboro, NC ***** 828-***-**** ************@*****.*** WWW: Bold Profile
MELINDA ANDREWS
Compassionate and detail-oriented Registered Nurse (RN) with over 30 years of nursing experience, including 25 years in case management, patient advocacy, and chronic disease management across hospital and home care settings. Skilled in developing individualized care plans, coordinating multidisciplinary teams, and ensuring optimal patient outcomes. Extensive experience in utilization review, case management, and healthcare compliance. Passionate about patient-centered care while enhancing operational efficiency. Strong critical thinking and problem-solving abilities, with a solid clinical background in assessment and education. Effective communicator with diverse cultural and socioeconomic groups. Self-motivated, able to collaborate with multidisciplinary teams or work independently. Proficient in UR, UM, InterQual, and OASIS, with the ability to quickly learn and adapt to multiple computer applications.
PROFESSIONAL
SUMMARY
SKILLS ● Care Coordination & Case Management ● Patient Advocacy & Education
● Chronic Disease Management ● Utilization Review & Compliance
● Interdisciplinary Team Collaboration ● Electronic Health Records (EHR) Proficiency
● Medicare & Medicaid Regulations ● Discharge Planning & Transition of Care
● Risk Assessment & Quality Improvement ● Clinical assessment
● HIPAA compliance ● Adaptability
● Teamwork ● Multitasking
● Excellent communication ● Critical thinking
REGISTERED NURSE CARE MANAGER 01/2024 to Current
Jacksonville Children's & Multispecialty Clinic, Jacksonville, NC WORK HISTORY
Provided high quality telephonic complex care management support to individuals utilizing patient-centered, evidence based interventions for patients with chronic diseases and other identified needs.
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Conducted regular patient outreach, education, and follow up while leveraging techniques to empower patients to achieve their best health through development of personalized patient driven care plans.
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Coordinate and facilitated patient care transitions, ensuring seamless continuity between hospital, rehabilitation, and home care settings by collaborating with healthcare providers, payor partners, patients, and families.
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Provide navigation and support to assist with SDoH needs, acting as patient advocate assessing concerns and providing support to needed resources.
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Coordinated and analyzed sustainable person-centered care plans involving internal and external providers, implementing or adjusting interventions accordingly to address changes
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RN CASE MANAGER 08/2016 to 10/2023
Mission Hospital McDowell, Marion, NC
RN CASE MANAGER- HOME HEALTH 09/2007 to 08/2016
Care Partners Home Care, Asheville, NC
in the patient's condition, lack of progress towards goals, preference changes, and transitions in care settings. .
Identified opportunities to optimize communication within cross-continuum teams to drive effective patient flow and sustainable care transitions from hospital and home, within community care settings and implement supplemental care and services for high-risk patients using self-management support and motivational interviewing .
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Facilitated assessment of individual physiological, psychological, financial, cultural and family situation and coordinated social services to address individual and family needs.
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● Worked with providers to define quality metrics and outcome reporting process. Assessed healthcare needs and monitored effectiveness and progress plans to achieve desired outcomes.
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Coordinated referrals to specialists, hospitalizations, ER visits, ancillary testing, and other enabling services for patients.
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Perform medication reconciliation at the onset of care plan and after any change in health status.
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Collaborate with healthcare providers to ensure continuity of care and adherence to treatment plans.
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Educate patients and families on disease management, treatment options, and preventive care strategies.
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● Monitor patient progress, identify potential complications, and adjust care plans as needed.
● Advocate for patient needs, ensuring access to necessary resources and services.
● Maintain accurate documentation and participate in quality improvement initiatives. Managed approximately 20-30 incoming calls, texts and emails daily while maintaining productivity.
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Delivered patient-centered care in a 30-bed hospital, providing comprehensive case management for both inpatient and outpatient settings.
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Conducted thorough assessments of psychosocial, medical, and discharge needs, ensuring cost-effective care without compromising patient safety or quality.
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Developed and implemented individualized discharge plans, aligning patient needs with available resources for seamless transitions.
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Monitored observation patient length of stay, maintaining durations under 48 hours to optimize hospital efficiency.
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Collaborated with multidisciplinary teams, including physicians, nurses, and social workers, to determine appropriate discharge plans.
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Utilized evidence-based tools and InterQual criteria to assess care progression and promote positive patient outcomes.
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Proactively reassessed clinical conditions to identify readmission risks, implementing preventive strategies, including patient education and community resource coordination.
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● Educated patients and caregivers on healthcare protocols and processes. Promoted patient and family comfort during challenging recoveries to enhance healing and eliminate non-compliance problems.
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● Conduct comprehensive patient assessments and develop individualized care plans.
● Administer medications, IV therapy, and wound care while monitoring patient progress.
● Educate patients and families on disease management, nutrition, and medication adherence.
● Utilize EHRs for documentation and maintain compliance with state and federal regulations.
● Collaborate with physicians, therapists, and social workers to ensure holistic patient care. Leveraged feedback and process improvement opportunities to create safer and healthier environment and increase patient satisfaction.
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Used first-hand knowledge and clinical expertise to advocate for patients under care and enacted prescribed treatment strategies.
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Offered exceptional care and support to individuals recovering from acute incidents and dealing with chronic conditions.
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● Implemented care plans for patient treatment after assessing physician medical regimens. Managed a caseload of 30-40 patients while consistently meeting and exceeding productivity requirements.
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Watts School of Nursing, Durham, NC
Associate of Science
EDUCATION
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