Case Manager Registered Nurse

CHRISTINE K. MACFARLAND

*** **** ***** ****** ***. Gloversville, NY 12078

518-***-**** *************@***.***

EMPLOYMENT

MVP - Remote April 2023 – present

Registered Nurse – Nurse Case Manager

• LTSS program, CDPAS, PCS services

• Variance with NYIA

• Read UAS assessments to develop plan of care

• Utilize Zoom, Microsoft Outlook and Teams, and Care Radius

• Manage caseload of 300 patients with 10-15 phone calls per day

• PCSP development

• Perform reassessments and initial assessments

• Review information to develop authorizations

Maximus Inc. – Remote/Face-to-Face March 2022 – April 2023 Registered Nurse – UAS Assessor

• UAS initial assessments: expectation 3 per day

• Utilize Zoom, Microsoft, Max eb and Panviva

Fidelis Insurance – Remote/Latham, NY August 2021 – March 2022 Nurse Case Manager

• MMC program – suspensions, terminations, ER follow ups, and monthly follow ups

• UAS – initial assessments, priority assessments, and reassessments

• Follow up on ER reports and authorizations

• Work with Facets and CCM

Blue Cross of North Eastern New York – Remote/Latham, NY November 2020 – July 2021 Registered Nurse – Utilization Management

• Utilization management of outpatient services under the Manage Medicare ProgramUse CMS guidelines, corporate medical policy, and evidence-based Blue Cross to determine policy standards

• Work with all levels of outpatient services

• Experience with denials, approvals, missing information, following timeframe guidelines and sending to MD for review

• Out-of-network experience with Care Radius and Facets EDDY Visiting Nursing – Troy, NY April 2020 – November 2020 Registered Nurse Case Manager

• IV certified, BLS certified, bloodwork-certified

• Visited patients in the Saratoga county region for all aspects of care Anthem Insurance – Albany, NY April 2019 – April 2020 Registered Nurse Case Manager

• Started out managing high risk patient cases post-discharge

• Transferred to complex case management for long-term

• Worked in conjunction with MD

• Maintained RN licensure within 12 states and mandatory CEUs Fidelis Insurance – Latham, NY September 2015 – April 2019 Registered Nurse Case Manager

• MLTC intake specialist nurse, MLTC program

• Utilization management Registered Nurse

• Precertification of all outpatient services

• Medicaid, Harp, Chp, Fhp, Hbx programs

• Peer to peer, reconsiderations, OON experience

• Microsoft word, outlook, facets, mcg

• MD reviews

Living Resources – Albany, NY July 2015 – September 2015 Registered Nurse Case Manager

• Nurse case manager for home care

• Assessment skills involving all medical issues, physical, psychosocial. With oasis documentation.

• Organized each paient visit schedule, interaction with physical therapy, occupational therapy, MSW, RD. Implement plan, MD notification.

• IV certified, PICC line, central line, iv antibiotic, iv IG, and pain med administration.

• Wound VAC, wound care

• UAS assessments

Anthem – Albany, NY June 2014 – May 2015

Registered Nurse Case Manager

• Case management and utilization management of inpatient and outpatient services of national accounts Northrup Grumman’s

• Mcg guidelines

• Computer charting, Microsoft work outlook, mcg

• Work with medical doctors, MSW, peer reviews, multidisciplinary conferencing to reach optimal pt goals

Albany Visiting Nursing – Albany, NY November 2013 – June 2014 Registered Nurse Case Manager

• Nurse case manager home care

• IV certified

• Oasis charting

• Computer charting

• Experience in wound care wound VAC therapy

WellPoint – Albany, NY August 2012 – November 2013 Registered Nurse Case Manager

• Case and utilization management

• Perform full assessment on pts social, mental, physical status

• Develop a plan of care that is unique to pts needs

• Follow up with frequent monitoring of members’ conditions and coordinate services that are applicable to each pts needs

• Place in appropriate services that are needed to assist member in advancing with health

• Collaborate with other team members, MSW, and discharge planners

• Telecommunication, computer, telephonic systems

Gentiva Home Health Care – Malta, NY October 2011 – July 2012 Registered Nurse Case Manager

• Manage patient medical issues, disease processes, home care evaluations, and complete full-body assessment to develop a plan of care to keep patient safe at home

• Coordinate with speech, occupational, physical therapists and social worker to facilitate group communication

• Maintain communication with MD with all aspects of patient care and issues for optimal home safety

• Process home care admissions, transfers, discharges, and re-certifications with OASIS documentation

• Perform insurance verification; obtain prior approval with all forms of insurance companies

• ICD coding with diagnoses; IV certified

Seton Home Care – Troy, NY February 2002 – October 2011 Registered Nurse Case Manager

• Complex case manager responsible for coordination of all of members’ home care needs

• Developed plan of care designed on their diagnosis either from hospital discharge or referral from MD office

• Organize home care visits with home care needs; perform full assessment on physical medical, mental, behavioral, psychosocial needs; IV therapy, wound care, wound VAC experience

• Develop plan of care working with a team of members, pt, ot, msw, rd, to reach our end goal; organizing each day with home care visits

• Computer charting

Schenectady Visiting Nursing – Schenectady, NY February 1996 – June 2005 Registered Nurse Case Manager; Home Health Aide Supervisor

• Managed short term and long-term cases. Experience with Medicare, Medicaid, and all private pay insurances

• Medicare and Medicaid experience

• Supervised all aspects of medical, psychosocial, and home care needs. Oasis charting, admissions, discharges, rocs, transfers

Planned Parenthood – Gloversville, NY June 1995 – February 1996 Registered Nurse

• Completed patient assessments for OB/GYN Clinic

• Assisted nurse practitioner with patient care

• Performed blood work, followed up on pap smears, and managed clinic

• Instructed family planning and HIV counseling

Nathan Littauer Hospital – Gloversville, NY March 1994 – January 1995 Registered Nurse

• Functioned as Float Pool Nurse

• Trained to work on Medical Surgical Emergency Room, ICU, Pediatrics, and Obstetrics Community Health Center – Johnstown, NY February 1990 – June 1995 Registered Nurse

• Experience in case managing long-term and short-term programs

• Wide experience in patient teaching, patient counseling, and medical treatment in the home setting

• Experience with Medicare and Medicaid reimbursements 485, 486, and 488s

• Home care IV experience

Cataract Care Center – Johnstown, NY November 1988 – February 1990 Ophthalmic Technician/Registered Nurse

• Trained to retract eyes, prepare patients for surgery, and obtain histories and physicals

• Performed administrative tasks

Saratoga Hospital – Saratoga, NY November 1987 – November 1988 Registered Nurse

• Worked on Cardiac Step down Unit from ICU

• Performed primary care nursing, medication administration, and patient teaching Nathan Littauer Hospital – Gloversville, NY January 1987 – November 1987 Registered Nurse

• Worked on Medical Surgical Floor, team nursing, telemetry, and medication administration EDUCATION

St. Mary’s School of Nursing – Amsterdam, NY December 1986 Diploma: Registered Nursing License

Broadalbin High School – Broadalbin, NY June 1984

Regents Diploma: Major in Math and Business

CERTIFICATIONS

• Cardiac Advanced Life Support

• Intravenous Therapy

• Patient/Family Teachings

• Phlebotomy

• Identification and Reporting of Child Abuse

• Clinical Sciences of Keratometry and Infection Control in Primary Nursing

• Bloodwork

• IV

• BLS

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