Registered Nurse Case Management

Angela Yvette Webb

RN Multi-State Licensure

Buford, Georgia

Summary:

I am an experienced registered nurse with over seven years of experience in clinical and case management. I excel in coordinating care within multidisciplinary teams, tailoring care plans to individual needs, and leveraging community resources. I am skilled in monitoring patient progress, educating members about proactive interventions, and maintaining thorough documentation. Additionally, I have experience with Epic systems, enhancing my efficiency in managing electronic health records. I also review alternative treatment plans and contribute to policy development as needed, processing and managing prior authorization requests to ensure timely patient access to medications and treatments. Professional Objective:

I am a dedicated and experienced Registered Nurse looking for a rewarding position with an organization that allows me to utilize the skills acquired over my career. Highly skilled professional with clinical experience in a multitude of areas such as Quality Assurance, NCQA Regulatory Requirements and Audits, intensive care, coronary care, emergency room, dialysis, utilization review, discharge planning, case management, HEDIS, Quality, and Appeals. Provided critical care (CCU) to patients in the Intensive Care Unit (ICU), monitoring vital signs, administering medications, and coordinating with multidisciplinary teams. Delivered specialized cardiac care in the Coronary Care Unit (CCU), managing complex cases, performing advanced cardiac life support (ACLS), and ensuring comprehensive patient assessments and interventions.

Professional Memberships:

● License, State of Georgia RN109064, Multi-State Registered Nurse Licensure Professional Experience

Acentra Health, Harrisburg, PA 11/2024- Present

Clinical Reviewer (FTE)

● Assures accuracy and timeliness of all applicable review type cases within contract requirements.

● Assesses, evaluates, and addresses daily workload and queues; adjusts work schedules daily to meet the workload demands of the department.

● In collaboration with Supervisor, responsible for the quality monitoring activities, including identifying areas of improvement and plan implementation of improvement areas.

● Maintains current knowledge base related to review processes and clinical practices related to the review processes, functions as the initial resource to nurse reviewers regarding all review process questions and/or concerns.

● Functions as providers’ liaison and contact/resource person for provider customer service issues and problem resolution.

The Mabry Group, Atlanta, GA

Appeals Reviewer (Contract) 1/2024 - 10/2024

● Review medical necessity: Analyze insurance claim denials to determine if they were warranted and if an appeal is needed. This involves reviewing medical records and code data and considering other factors like the patient's pre-existing conditions and healthcare regulations.

● Provide consultation: Provide consultation on nursing practices, policies, procedures, and regulations.

● Process appeals: Process Medicare appeals for participating providers. This may involve requesting clinical and research data, applying Medicare guidelines, and navigating multiple computer systems

Chickasaw Nation Industries Norman, OK 03/2021 to 03/2023 Case Manager RN (Contract)

● Serve as the primary point of contact to tribes, tribal organizations and territories, and freely associated states as part of the Center for Disease Control and Prevention's emergency response to COVID-19.

● Maintain documentation on key activities, including tracking of information in the COVID-19 response database/platform, and ensure timely completion of activities as appropriate.

● Coordinate with the TSS Deployment Team to deploy teams (remotely or on the ground).

● Work closely with the Tribal Support Section (TSS) Sr. Tribal Advisor (TSA) to assess and address the COVID-19 needs of tribes and tribal organizations.

● Monitored patient progress, educated members for proactive interventions, and maintained thorough documentation with Epic systems

● Initiate outreach to tribes and tribal organizations. Co-facilitate assessment and consensus call with tribes and tribal organizations to identify areas of need and potential CDC support to address needs and to obtain consensus on the support plan.

● Ensure that a Letter of Invitation (LOI) from the tribe and/or IHS is obtained to activate CDC deployment activities.

Tegria for Texas Children’s Hospital, Houston, TX 08/2022 to 02/2023 Clinical Surveyor (Contract)

● Conduct facility and provider site visits virtually or in person as needed

● Complete required documentation following each site visit

● Create and send correspondence to sites that have not followed up on deficiencies as stated in post-site visit documentation

● Review site responses to any deficiencies or conduct a follow-up site visit to review deficiencies as needed.

Genia Harrisburg, PA 01/2020 to 03/2021

Case Manager II (FTE)

● Case Manager responsibilities included coordination of case management services for members who meet established criteria, with an emphasis on promoting quality care and cost-effective outcomes.

● Responsible for the management and oversight of a caseload of high-risk members with complex medical/psychosocial needs.

● Advocates for members and families by helping them to coordinate care and navigate resources throughout the healthcare system.

● Conducts assessments to obtain information for a participant-centered plan of care and determination of acuity level, functional status, activity level, and self-management level. United Health Group, Atlanta, GA 05/2017 to 12/2019 Community Transition Program Nurse (FTE)

● Responsible for clinical operations and medical management activities across the continuum of care

(assessing, planning, implementing, coordinating, monitoring, and evaluating).

● This includes case management, coordination of care, and medical management consulting. Provides health education, coaching, and treatment decision support for members. Includes Health Coach, Health Educator, and Health Advocate roles that require an RN.

● Uses a collaborative process and serves as a liaison between the participant, family, significant others, physician(s), and other members of the treatment team. Humana, Louisville, KY

Acute Case Manager 2014 to 2017

● Review cases and perform concurrent review and discharge planning as needed during a member's stay at a skilled nursing facility, inpatient rehabilitation facility, or long-term acute care facility.

● Develops, implements, and evaluates individualized patient care plans.

● Help members understand their condition/health status and find community resources such as medication assistance, food, transportation, financial assistance, and medical equipment.

● Uses a collaborative process and serves as a liaison between the participant, family, significant others, physician(s), and other members of the treatment team. Aetna Inc., Alpharetta GA

Appeals Nurse Consultant 1997 to 2017

● Independently performed review and resolution of clinical documentation to the complaint and appeals department. Utilizes leadership, experience, and education to review clinical documentation and interpret data for member and provider appeals while adhering to clinical criteria and policies with regulatory and accreditation requirements.

● Collaborates with internal and external Medical Professionals in the resolution of complaints and appeals.

● Processed and managed prior authorization requests to ensure timely patient access to medications and treatments.

Education:

● Bachelor of Science in Nursing - Mississippi University for Women, Columbus, Mississippi

● Obtaining CPHQ Certification

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