RN care/Manager
Resume:
RACHEL ANDERSON
St. Louis, MO *****
*****************@*****.***
Professional Summary
An experienced RN, BSN with a pending master's degree in gerontology holding a current compact RN license and BSL certification.
Formerly certified by WOCN Society as wound treatment associate with experience in complex wounds and advanced wound care, including wound vac therapy, as well as previous ACLS certification and neuro/spinal cord massage
Extensive clinical acute care bedside nursing in neurology, telemetry, spinal cord injury, general medical/surgical, and oncology.
Management experience includes charge nurse, house supervisor, and case manager.
Experience in long-term acute care (LTAC) and long-term facility care including skilled nursing, house supervisor, charge nurse, nurse educator, and infectious disease control nurse.
Extensive experience in home health case/care management, family care, residency, and internal medicine clinic care/case management and triage, as well as Medicare Annual Wellness nursing experience with up to 6 Medicare Annual Wellness visits daily.
Advanced training in behavioral health includes trauma-informed care, medically assisted substance abuse treatment, motivational interviewing, zero suicide, PTSD, and behavioral health care/case management.
Established history of significant experience in care and case management, including a thorough understanding of the prior authorization and exceptions process for Medicaid and Medicare CMS guidelines. Expertise includes staying informed about current and evolving Med D guidelines regarding prescription medications, Durable Medical Equipment (DME), specialty physician referrals, and procedures.
Skilled in collaborating closely with clients' providers, pharmacies, and DME companies to obtain necessary documentation for the prior authorization process prior to submission. Proficient in ensuring inclusion of proper ICD-10, CPT, and HCPCS codes to facilitate speedy determination while adhering to mandated timelines, turnaround times, productivity, and quality measure expectations to prevent or address any care gaps or appeals.
Additionally, experienced in assisting clients and appropriate entities with interpreting and understanding billing documents as well as reconciliation of Quest Diagnostic Laboratory billing coding errors.
Throughout my career, I have prioritized patient advocacy and a holistic approach to healthcare. My breadth of experience across various specialties has provided me with a unique perspective on addressing the intricate needs of vulnerable populations including patients with multiple and complex mental and physical health diagnoses, ensuring their voices are heard and their care individualized by establishing a trusting relationship to best facilitate routine and follow-up care with primary care physicians, specialists, and therapists. By embracing trauma-informed care and motivational interview while combining it with evidence-based practices, I have consistently worked to foster trust and understanding, which has proven to be essential for achieving meaningful patient outcomes and reversing the negative trajectory of their chronic illness patterns.
I opted to homeschool and raise my children prior to embarking on a nursing career. Consequently, I sought nursing job opportunities that provided extensive experience and growth potential.
My goal is to leverage my knowledge and expertise to promote health and healing among vulnerable populations through patient advocacy and trauma-informed care, with a focus on developing strong relationships and meeting the specific needs of each patient.
I firmly believe that this approach is the most effective way to create patient-driven care plans that yield positive outcomes and address chronic mental and physical health issues.
With years of experience, I have accumulated a wealth of resources across various areas to enhance patient outcomes.
My strengths include time management, rapid and accurate triage and assessment skills both in-person and via telehealth, trauma-informed care, motivational interviewing, critical thinking, precise documentation, and professional communication with patients, providers, pharmacies, DME companies, and insurance entities such as Medicare and Medicaid, including the prior authorization and exceptions process.
Additionally, I possess advanced technological skills including proficiency with numerous EMR platforms including EPIC and OASIS and data entry programs including all Microsoft applications.
I am committed to aiding in the treatment of substance abuse recovery, HIV/AIDS patients, and those transitioning from life to death, as well as addressing the unique needs of immigrants, refugees, and individuals from diverse ethnic backgrounds.
I strongly believe that effective care and case management form the foundation for managing the care of complex patients, which aligns with my passion and where I achieve significant and marked positive patient outcomes.
Due to personal physical disabilities, I seek remote work from home to accommodate my condition; however, I am open to the possibility of other opportunities under the correct circumstances.
Work Experience
Registered Nurse Case Manager
Friendship Village at Home
St. Louis, MO
November 2023 – October
As a home health nurse case manager, the primary objective is to meet each new patient where they are physically, emotionally, and spiritually.
A comprehensive head-to-toe holistically driven Oasis assessment is performed and documented at each start of care. Based on this assessment, a patient-driven care plan is formulated with the patient, their professional care team, and caregivers (if applicable) actively engaged to achieve resolution of acute care issues, address, educate, and motivate the patient and caregivers to reverse a negative trajectory of chronic illnesses, identify social determinants and facilitate assistance with information and referrals to resources as to address needs.
Additionally, wounds are identified, assessed, treated, and documented, including complex wound care and wound vac management. Cognition and mental health needs are assessed, documented, and reported to the patient care team.
A complete medication reconciliation is performed, and assistance with medication management, including education, identification and education provided of high-risk medications, and assistance with setup and management, is provided, including collaborating closely with clients' providers, pharmacies, and DME companies to obtain necessary documentation for the prior authorization process prior to submission. Proficient in ensuring inclusion of proper ICD-10, CPT, and HCPCS codes to facilitate speedy determination while adhering to mandated timelines, turnaround times, productivity, and quality measure expectations to prevent or address any care gaps or appeals.
Additionally, assisting clients and appropriate entities with interpreting and understanding billing documents
Patient and caregiver concerns are actively listened to, care plans and processes are explained, and any questions or concerns are addressed.
Regulatory forms are collected and uploaded, and ordered labs are drawn and delivered to designated diagnostic laboratories.
End-of-life planning is addressed and assisted if indicated.
The role also involves overseeing and assisting LPNs assigned to each patient with a caseload of approximately 40 to 50 patients, performing 30-day supervisory visits, and reporting LPN assessments to upper management, as well as being available to assist with difficult, venipuncture, complex wound care and difficult catheterization as needed.
Communication with the patient care team after each visit and obtaining further orders as needed is required.
Oasis documentation is performed accurately while meeting Medicare established time requirements, including discharge when treatment goals are met, recertification if goals have not been met and are appropriate, and resumption if the patient returns home from the hospital.
On-call services are provided based on rotation.
PCHH Nurse Case Manager
SSM HEALTH GROUP
St. Mary’s Internal Medicine Residency Clinic
St. Louis, MO
March 2023 to October 2023
In this role, I focused on care management and serving vulnerable populations. My responsibilities included:
Education and Empowerment
Transitional Care Management
Behavioral Health Consultant
Managing a caseload of 250 patients required strong time management, delegation, and critical assessment skills.
Unfortunately, SSM has dissolved the PCHH program and ended clinical care management roles.
Triage/Care/Case Manager Clinic Nurse
Mercy Clinic Internal Medicine - Gravois,
Saint Louis, MO
August 2022 to March 2023
Transferred from Olive/Mason to be closer to home as my elderly father required increased care.
Responsibilities:
Managed high volume phone triage calls and walk-in triage.
Coordinated complex referrals and arranged Durable Medical Equipment (DME).
Organized enteral feeding and oxygen supplies.
Obtained prior authorizations from Medicaid and Medicare.
Reconciled billing errors with Quest Diagnostics.
Completed Family and Medical Leave Act (FMLA) and disability forms for physician review and submission.
Reviewed test results and informed patients of their results.
Facilitated facility placements and performed other care management tasks as determined by healthcare providers.
MERCY FAMILY Medicine Residency
Nurse Care Manager/Triage/Annual Wellness Nurse
St. Louis, MO
January 2021 – August 2022
Transferred from Mercy Hospital Oncology floor due to physical issues that limited my ability to perform floor nursing effectively without experiencing personal pain.
Responsibilities included handling a significant volume of phone triage as well as managing walk-in triage cases.
Conducted up to six Medicare Annual Wellness visits per day, which included comprehensive medication reviews and end-of-life planning.
Care/case management duties included arranging complex referrals, ordering Durable Medical Equipment (DME), coordinating enteral feeding and oxygen supplies, reconciling Quest billing errors, obtaining prior authorizations for medications, DME, additional therapy, and specialty referrals and procedures, processing FMLA and disability paperwork, reviewing test results, managing facility placements, and performing other care management tasks as directed by healthcare providers.
Oncology Floor Nurse
Mercy Hospital St. Louis
St. Louis, MO
November 2020 – January 2021
Duties included conducting skilled nursing assessments, managing medications, performing triage, collaborating with other healthcare providers and departments, providing wound care, and executing advanced nursing tasks such as IV placement, catheter placement and management, NG tube placement and management.
Additionally, supported patients and family members throughout their illness journey, utilizing time management and critical thinking skills.
Supervision and delegation as appropriate to CNAs and other supportive nursing staff.
11/01/2020 – 01/01/2021
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11/01/2020 – 01/01/2021
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Private Duty Nursing - Self-Employment 1099
St. Louis, MO
June 2020 to November 2020
During the onset of the COVID-19 pandemic, all staff at Family Care Health Centers transitioned to remote work.
However, due to environmental disruptions in my home (a loud and opinionated cockatoo), I sought opportunities to work externally.
Concurrently, a close friend's mother experienced a severe stroke while visiting from Texas. With her extensive long-term care insurance, I was able to assist in her care, providing services equivalent to my previous clinic role.
I provided comprehensive care to an elderly woman with advanced deficits from multiple strokes.
My responsibilities included total care management such as collaborating with her medical team, coordinating office visits and testing, managing medications, conducting daily physical assessments, preventing skin wounds, assisting with ambulation, peri-care, bathing, meal preparation, and other activities of daily living (ADLs). I delivered 40 hours of care per week in this temporary position while the family arranged for her permanent long-term care back in Texas.
I have since addressed the prior environmental disruption, which is no longer an obstacle to remote work.
PCHH Nurse Care Manager
Family Care Health Centers
St. Louis, MO
October 2018 to July 2020
Places for People (prior employer) collaborated extensively with Family Care Health Centers.
I worked closely with the medical staff at Family Care Health Centers on a grant designed to establish patient goals targeting specific chronic illnesses, engaging patients individually to motivate them towards independent actions resulting in positive outcomes.
During this period, my expertise in trauma-informed care and motivational interviewing was recognized, and I was invited to transfer from Places for People to Family Care Health Centers to serve as the PCHH nurse care manager, thereby managing a larger caseload and expanding impact on the population in need.
At Places for People, my primary responsibilities as a nurse care manager included developing comprehensive, patient-focused, multidisciplinary care plans built upon a foundation of trust and confidence.
I actively engaged patients to identify their individual needs and challenges, motivating them to set attainable short and long-term SMART goals with consistent personal assistance and follow-up to empower them to achieve these goals.
As a care manager, I coordinated with each patient's PCP and specialty physicians to ensure consistency of follow-up visits, arranged or provided transportation, accompanied patients to visits, managed medications with frequent reconciliations against pharmacy records, obtained necessary prior authorizations from Medicaid and Medicare for medications, DME, procedures or services, educated patients and caregivers on wound care, and managed wound care including the ordering of supplies.
My caseload comprised of up to 150 patients who were Medicaid and/or Medicare participants, with 90% under medically assisted treatment for opioid abuse.
Maintaining availability for any and all patient needs was crucial to successful care management.
Geriatric Nurse Care Manager
Places For People
St. Louis, MO
May 2017 – October 2018
After earning a degree in gerontology, my primary goal was to serve in a long-term care environment.
After exploring two different roles within long-term care settings, I realized that my skills would be best utilized within an agency focusing on enhancing patient wellness rather than merely managing health decline.
The role of nurse care manager begins with the creation of a professionally crafted, patient-centered care plan.
Building on this foundation involves understanding each patient and their unique needs.
As a care manager, I coordinated primary care provider and specialist visits, including transportation and follow-up, managed medications through regular reconciliations with patients and pharmacy records, educated patients, provided wound care, and managed wound care supplies and coverage.
My caseload included approximately 100 patients who were Medicaid, Medicare, or uninsured participants, all of whom were clinically diagnosed with a major mental illness and under psychiatric care.
It was crucial to be available for all patient needs, and thorough documentation was essential.
I worked within grant parameters to achieve health improvement goals, conducting consistent metabolic screenings that resulted in lower A1C levels, better blood pressure control, increased physical activity leading to healthy weight loss, and smoking cessation, ultimately aiming to reduce emergency room visits and hospitalizations.
Advanced skills in trauma-informed care and motivational interviewing were necessary when working with this population.
Nurse Educator/staff Development
Windsor Estates of St. Charles
St. Charles, MO
January 2021 – May 2017
Duties included but were not limited to orienting all nursing staff, teaching and tracking dementia classes, facilitating all staff in-service trainings, recording and trending infection control statistics and conducting related in-service training sessions, maintaining all employee and resident PPD testing records, and upholding nurse core competencies.
Additionally, I assisted on the floor when needed, rotated as the manager on call, resolved staffing issues, administered medications, monitored medications through central lines, provided one-on-one education on advanced nursing skills, and served as a resource for the wound care nurse on duty.
The company was sold to new management that prioritized increasing monetary revenue while reducing the quality of patient care. This business strategy did not align with my values, and I sought to work in a medical field that would have a greater impact on enhancing patient quality of life.
Charge Nurse
Delmar Gardens of Chesterfield
St. Louis, MO
August 2016 – January 2017
Responsibilities included general nursing tasks such as medication administration through various routes, wound care, tracheostomy care, respiratory therapy, comprehensive and focused assessments, precise and appropriate documentation, coordination with physicians, family members, and administrative staff, supervision of CNA personnel and other support staff, development and implementation of care plans, education of staff, residents, and family members, and addressing both immediate and long-term needs of residents.
Sought other opportunities due to concerns related to unresolved patient safety.
Spinal Cord Injury Nurse
VA Medical Center, John Cochran
St. Louis, MO
May 2015 to August 2016
Responsibilities included, but were not limited to:
Team nursing
Critical patient assessment
Critical thinking and implementation of accurate nursing judgment
Care plan development and management
Professional communication with physicians and other healthcare professionals to maintain continuity of patient care
Advanced nursing skills encompassed:
IV placement and maintenance
Venipuncture
NG and G tube management
Extensive wound care and ostomy care
Foley & SP placement and care
Nephrostomy care
Tracheostomy care
Medication management, calculations, and administration
Bed baths
Skin assessment and documentation
Additional duties involved educating patients and family members on a wide range of diseases, providing support, and accompanying physicians at bedside to ensure accurate assessments and collaborating effectively to meet patients’ needs and goals.
Essential competencies included:
Correct identification of EKG/defibrillation heart rhythms
Administration of life-saving medications as indicated by heart rhythm
Recognition of potential causes for rapid deterioration and appropriate treatment knowledge
Maintenance of airway and intubation if needed
Provision of postmortem care
With a degree in gerontology, I specifically sought opportunities to work with the elderly population.
House Supervisor
Kindred LTAC
St. Louis, MO
February 2015 to May 2015
This was a temporary position undertaken to cover for a nurse on maternity leave. I recognized the value of gaining extensive experience in this unique setting and accepted the role.
My responsibilities included, but were not limited to:
Pulling daily reports on unit census and acuity levels to relay at daily hospital bed board meetings.
Participating in daily conference calls with clinical liaisons regarding potential patient admissions.
Overseeing all unit admissions and discharges.
Participating in bi-weekly team conferences with case management, physicians, and therapy staff to plan and coordinate patient discharge dates.
Creating staff schedules and resolving staffing issues, including handling staff call-ins.
Conducting daily assessments of RNs and techs.
Performing documentation, medication, and lock box audits.
Additionally, it was the house supervisor’s responsibility to manage and organize full code situations from initiation to debriefing, necessitating sharp Advanced Cardiac Life Support (ACLS) skills.
Charge Nurse
SSM/Select Medical Care
St. Louis, MO
October 2014 to February 2015
This position involved a transfer from SSM Home Health to accommodate changing family needs and to allow more time at home.
The role required working three twelve-hour shifts. Duties included pulling daily reports regarding unit census and acuity levels for daily hospital bed board meetings, participating in daily conference calls with clinical liaisons regarding potential patient admissions, overseeing all unit admissions and discharges, participating in bi-weekly team conferences with case management, physicians, and therapy staff to plan and coordinate patient discharge dates, creating staff schedules, resolving staff call-ins and other staffing issues, being responsible for daily RN and tech assessments, and performing documentation, medication, and lock box audits.
Nurse Case Management/Wound Care Nurse
SSM Home Health
St. Louis, MO
October 2013 to October 2014
Provided complex wound care RN visits in Jefferson County, holding WOCN wound associate certification.
Key responsibilities included detailed documentation, effective scheduling, time management, and precise multitasking to avoid burnout.
Companion nurse/RN
Nurses for you, LLC
St. Louis, MO
April 2007 - January 2014
Demonstrates the ability to work with difficult and highly medical patients. Proven to act quickly and accurately under stressful medical emergencies.
Recognized repeatedly by patient’s families for demonstrating applied knowledge, going over and beyond, and giving advanced care.
Exhibited skills in multitasking with a sharp memory, able to care and record accurately.
Duties include, but are not limited to: Ordering appropriate assistive devices, organizing and attending doctor’s appointments, assisting family members with organizing and arranging end of life care and preparations, assessing patients and reporting back data, full bed baths with shampoo, shave and massage, assist with shower and bathing, assist with full and partial transfers, assist with feeding and meal prep, peri-care, wound care, medicine organization and administration, blood sugar monitoring, blood pressure, respirations, heart rate and O2 monitoring, oral care, assist with ADL’s, tracheotomy care, catheter care, G/J tube feedings and care, skin breakdown precautions, assist with PT, OT and SP exercises, light housework and companionship.
Neurology Floor Nurse
SSM St. Clair Hospital
St. Louis, MO
September 2012 - October 2013
Responsibilities included team nursing, critical patient assessment, critical thinking, and implementing appropriate nursing judgement.
Duties also involved care planning development and management, professional communication with physicians and other healthcare professionals to ensure continuity of patient care. Advanced nursing skills encompassed:
IV placement and maintenance
Venipuncture
NG and G tube management
Extensive wound care and ostomy care
Foley & SP placement and care
Nephrostomy care
Tracheostomy care
Medication management, calculations, and administration
Bed baths and skin assessment/documentation
Performing neuro-specific exams, such as the NIH Stroke Scale, multiple times per shift and throughout other areas of the hospital as needed
Educating patients and family members on a wide range of diseases
Providing support and being a resource for patients and their families
Companion Nurse/Care Manager – Self Employed 10909
St. Louis, MO
August 2010 – April 2013
Referred by word of mouth.
Provided weekly services to individuals with various conditions such as cancer, dementia, Parkinson’s disease, and other medical issues. Responsibilities included:
Time and financial management
Ordering appropriate assistive devices
Organizing and attending doctor’s appointments
Assisting family members with end-of-life care arrangements and preparations
Assessing patients and reporting data to relevant parties
Providing full bed baths with shampoo, shaving, and massages
Assisting with showering and bathing
Aiding in full and partial transfers
Assisting with feeding and meal preparation
Performing peri-care and wound care
Organizing and administering medication
Monitoring blood sugar levels, blood pressure, respiration rates, heart rate, and oxygen levels
Providing oral care
Assisting with Activities of Daily Living (ADLs)
Caring for tracheotomies and G/J tubes
Implementing skin breakdown precautions
Assisting with physical therapy (PT), occupational therapy (OT), and speech therapy (SP) exercises
Conducting light housekeeping and offering companionship
Preparing comprehensive care plans
Patient Care Associate
St. John’s Mercy
St. Louis, MO
August 2008 - November 2008
Completed an eight-week CNA equivalent class with high scores. Responsibilities included:
Patient comfort measures and support for families
Vital signs monitoring every four hours
Intake and output recording
Admitting and discharging patients
Supplying room essentials, bathing, and peri-care
Notifying nurses of medical emergencies
Worked night shifts on the pediatrics floor, managing up to twenty-two patients and honing multitasking and organizational skills.
Education
BSN in Nursing
UNIVERSITY OF MISSOURI - St. Louis, MO
May 2010 to Present
MASTER'S DEGREE in GERONTOLOGY
WEBSTER UNIVERSITY
September 2012 to August 2015
ASSOCIATE CERTIFICATE in WOCN
July 2014
Skills
•Catheter Care
•Nursing
•Motivational Interviewing
•Medication Administration
•Home Care
•Social Work
•Meal Preparation
•Caregiving
•Crisis Intervention
•Hospital Experience
•Infection Control Training
•Case Management
•Vital Signs
•Dementia Care
•Tube Feeding
•EMR Systems
•Behavioral Health
•Laboratory Experience
•Crisis Management
•Training & Development (10+ years)
•Triage (5 years)
•Critical Care Experience (5 years)
•Hospice Care (5 years)
•Documentation Review (5 years)
•Addiction Counseling (5 years)
•Individual / Group Counseling (5 years)
•Managed Care (5 years)
•Management Experience (5 years)
•Quality Assurance/Quality Control (5 years)
•ICD-10 (5 years)
•Supervising Experience (5 years)
•Tracheotomy care (5 years)
•Phlebotomy (5 years)
•Wound Care (5 years)
•End of life planning (5 years)
•Disability documentation (5 years)
Awards
St. Louis region Professional Woman of the year for 2024
Worldwide Woman’s Association
Top RN Case Manager in 2017
The International Nurses Association
Current
RN Compact License
August 2012 to April 2027
BLS Certification
Current
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