Patient Care Human Resources
Resume:
Mary J. Caldera, MSN, RN, PHN
Yuma, AZ 85367
************@***.***
Professional Summary: Dedicated Clinical Manager adept at communicating with nursing staff and administrators to manage staff issues. Specialized in building solid interdepartmental relations. Responsible for planning, organizing, and directing activities which include patient care, internal and external customer service, human resources, and quality operations. Proficient at providing care to patients, promoting better health practices and teaching, performing research, consulting, and advising nurses who provide direct care to patients. Responsible for preparing for healthcare program inspections and evaluations, quality improvement for the unit. Monitor progress and prepare reports and brief management on issues impacting patient care.
United Energy Workers Yuma, AZ part time 2024-present
Home health nurse for elderly patients who have been exposed to uranium and other radioactive materials.
Veterans Health Administration
Southern Arizona Veterans Administration Health Care System SN III, Full-time, Yuma, AZ Retired 2023
Clinical Nurse Manager at a busy community-based outpatient clinic. The clinic has 4800 enrolled members and during the winter season a non-enrolled population of approximately 4000 Veterans from other areas of the United States. Responsible for managing the day-to-day activities of the clinic, ensuring High Reliability Organization values are followed, reporting to the chiefs/director’s quality outcomes, communication between service lines, maintaining community relationships, and planning for future staffing/enrollments/space requirements. Lead, direct, and coordinate mandates for the Primary Care Staff and staff assigned to other Service Lines. Collect information from the local/state Health Departments to analyze and evaluate quantitative and qualitative clinical information affecting clinic operations. Develop new work plans for the clinic staff to accommodate new guidelines for visits, in person, by video connect or by telephone. Complete detailed inspections, audits, and training with staff to ensure readiness for Joint Commission/Inspector General visits. Identifies root causes of clinical problems negatively affecting patient care and work to correct the problems with staff. Responsible for external and internal recruitment and retention of qualified staff for the clinic. Collaborates with physicians, leadership, and other healthcare professionals to develop and determine how best to serve the needs of patients.
CCMS Contracting Company
June 11, 2018-November 2018 Contract position Full-time 40 hrs/week
Health Educator position in Branch Health Clinic at MCAS Yuma. Pilot program to educate high utilizers of TriCare benefits targeted for health education. Instructed and coached active duty, retirees, and dependents on chronic health issues. Collaborated with providers on individual patient care. Managed Veterans/active-duty chronic care issues. Organized group teaching activities. Detailed reports to providers on their individual patient’s results.
Sharp Health Plan San Diego, CA
July 2017-June 2018 Supervisor Ruth Donaldson, 40 hr wk
Utilization management and case management of Managed Health Plan members. Perform utilization review of physician referrals for inpatient and outpatient elective procedures, clinical trials, durable medical equipment, testing, and hospitalizations outside the Sharp Network utilizing MCG Guidelines, InterQual, and URAC guidelines. Audited medical claims and reviewed records for appropriateness of care, irregularities in care, coding issues, trending, high-cost services, and delivered detailed reports to the executive leadership. Case managed complex members. Investigated patient complaints of inadequate services provided by contracted facilities. Coordinated care with community resources and providers.
Veteran's Administration VA Hospital La Jolla, CA.
January 2016-July 2017, SN II Supervisor Teresa Waterbury- Clark 40-hour week
Utilization management Nurse performing reviews of medical and mental health inpatient records in an acute care hospital using InterQual criteria. Met with interdisciplinary teams to review patient status and level of care needs. Reviewed patient records to ensure appropriate level of care of patients and care provided was medically necessary and appropriate. Participated in morning meetings with executive leadership, nursing supervisors, and charge nurses, prepared detailed statistical reports of patients not meeting criteria and over 30-day patient list. Reviewed, consulted, and advised VA medical professionals on appropriate levels of care as recommended by VA policies. Participated in a root cause analysis for the hospital.
September 10, 2012 to January 2016, Full time SN II Veterans Health Administration San Diego
Registered Nurse Case Manager- Home Based Primary Care. Supervisor Sheryl Leary 40 hr week
Case management for a panel of 25 Veterans who are home bound and chronically ill using the Patient centered care model, to include assessing, planning, implementing, coordinating, monitoring, and evaluating. Included in this role are care coordination and medical management and evaluation. Facilitate quarterly reports for the Interdisciplinary Team Meetings, works collaboratively with all clinical services across the Medical Center. Monitoring of patients hospitalized in non-VA facilities. Coordination of care for the patient with the VA referring provider and the community provider, recommends transitions to appropriate clinical settings and in collaboration with interdisciplinary medical center resource utilization. Provides nursing care in the home setting, assists with appointments and specialty clinics. Proficient in telephonic patient care assessment, medication recognition, and medical history procurement; knowledge of regulatory compliance requirements (Joint Commission, requirements on Reusable Medical Equipment, OSHA, etc.); Provide patient education related to medical care and determine need for medical or surgical care; has knowledge of medical history of the patients managed. Proficient in the management of patients in the ambulatory setting.
BMC Miramar Naval Medical Center November 2010-September 2012 Department of the Navy, San Diego, CA RN Full time GS 10 Supervisor Commander Stevens-Ross, 40 hr week
Urgent Care RN/Occupational Health- triage and treatment of Active-Duty Military, spouses, retirees with urgent care needs, skills used were IV therapy, medication administration, EKG’s, Spirometry, ear lavage and other needed skills. Proficient in telephonic patient care assessment, ophthalmic medication recognition, and medical history procurement; knowledge of regulatory compliance requirements (Joint Commission, requirements on Reusable Medical Equipment, OSHA, etc.); Provide patient education related to medical care and determine need for medical or surgical care; knowledge of medical history, Proficient in the management of patients in the ambulatory setting, including assisting providers with outpatient minor procedures. Supervised MA and Corpsmen in patient care and documentation i.e., Hedis measures and medicine reconciliation.
Medical Home Port Case Manager RN, Using the Patient Centered Care model performs basic nursing care and triage, direct staff, and nursing care in an acute care clinic for the active-duty military personnel, spouses, and retirees. Administer medications, nebulizer treatments, perform wound care, EKG’s, administer IV therapy, assess for mental health issues, assist physician in minor procedures (Colposcopy, IUD placements). Train new staff: assess for JC readiness, take calls from military personnel who need assistance with UM referrals and to determine availability of clinical services, ensure proper transfer of patient care, participate in collaborative case management planning, utilization review, discharge planning, and other related case management activities including the review of outside medical services based on established guidelines and medical necessity. Case manages patients with complex issues. Follows up on occupationally related medical illnesses, injuries, job related incidence, and other conditions adversely impacting an employee's medical status. Reviews initial assessments and re-assessments of patient condition, response to treatment and other clinical finding and initiates telephone contact, correspondence, and another follow-up. Tracks workers with occupational medical conditions, reviewing medical care and treatment in relation to the worker's ability to return to full or limited duty. Serves as supervisor, mentor/role model for staff and students as they pursue leadership development and clinical expertise.
STG International (contract position) Full time, Registered Nurse, November 2009 to May 2010
Performs triage, direct staff, and nursing care in an acute care clinic for the active-duty military personnel. Administer medications, perform wound care, EKG’s, administer IV therapy, assess for mental health issues, assist physician in minor procedures. Train new staff: assess for JC readiness, assist military personnel who need guidance with Tri Care referrals. Follows up on occupationally related medical illnesses, injuries, job related incidence, and other conditions adversely impacting an employee's medical status
Sharp Rees Stealy Urgent Care Clinics Per Diem RN Per Diem February 2010-2015
Performs triage, nursing care to patients who present to Urgent Care. Administer medications, EKG, wound care, IV therapy, assist with minor procedures, and perform POC testing, glucose, rapid strep, HCG, flu testing, assist physician with eye medications, set up equipment, removal of foreign bodies. Patient teaching and discharge planning.
PRN Nursing February 2010 to May 2012 Per Diem RN
Performs IV therapy. measure and photograph wounds for Research Study Patients
California Department of Corrections and Rehabilitation
October 2006 to November 2009 Registered Nurse Full time
RJ Donovan CF/Centinela State Prison
Registered Nurse-Performs nursing care to inmate patients in a clinic setting. Performs wound care, EKG’s, dispense over the counter medications per nursing protocols, education, etc. Worked as Staff Development Nurse training new staff and current staff new policies and procedures, CPR, CDCR requirements for Plata, Coleman, and Armstrong lawsuits etc. Assigned to the reception yard assessing new inmates for mental health issues, scheduled appointments for 4 psychiatrists, noted orders. Administered Keyhea court ordered medications.
Sharp Grossmont Hospital May 2005- October 2006 Full time Lead Nurse PACU
Supervised 10 RN's, 2 Nursing Assistants.
Lead and educate PACU registered nurses. Performs nursing care to post anesthesia patients, assisted psychiatrists with ECT therapy. Assisted with cardioversions. Set program standards for clinical practice, administration, education and assures their implementation. Scheduled staff, budget, delivered performance appraisals, conduct staff meetings, and provides direction to staff. Assisted with long range program planning & development of nursing & related programs for effective delivery of post anesthesia services. Serves as mentor/role model for staff and students as they pursue leadership development and clinical expertise.
Alvarado Hospital Medical Center February 2005- May 2005 Full time. Infection Control Practitioner
Performs rounds to identify infection control issues, survey charts for nosocomial infections, surgical site infections, report infection rates, and provide support to the floor nurses on infection control issues. Member of various committees, reported findings, trends, quality issues to the Medical Executive Committee. Educated and oriented staff regarding infection control procedures and personal protective equipment.
California Department of Corrections and Rehabilitation- RJ Donovan Correctional Facility
Registered Nurse (Clinic) June 2004 –February 2005 Full time
Performs nursing care to inmate patients, starting IV's, EKG's, assessments, mental health assessment. Scheduled appointments, performed wound care, administered medications, etc. Administer first aid, assess on the job injuries. Teaching and counseling staff and inmates regarding injuries and illness.
California Department of Corrections. RJ Donovan CF Full time October 2002- June 2004
Correctional Health Care Services Administrator. I supervised 8 staff members directly and indirectly 75 staff members. Responsible for the operations of the medical department services, Nursing, Medical Records, Laboratory, Radiology, Food Services and Pharmacy. Responsible for budget, hiring of personnel, long range program planning, research. Inspection readiness, and development of nursing and related programs for effective delivery of health services. Planned, coordinated, and conducted extensive pre-inspection research, monitor team members progress, and provide guidance for licensure of Correctional Treatment Facility. Interpreted clinical information identified potential problems and reported findings to the executive leadership. Drafted impactful written reports, executive summaries, and briefings to the Chief Medical Officer, Warden, Office of Medical Executive.
California Department of Corrections
Supervising Registered Nurse II Full time May 1997-October 2002
•R.J. Donovan Correctional Facility, San Diego, California Supervised 18 RN's, 32 LVN's
•California Medical Facility, Vacaville, California Supervised 10 RN's and 25 LVN/MTA's
•Centinela State Prison, Imperial, California Supervised 15 RN's, 30 LVN/MTA's
Performed as the Director of Nurses, supervised a staff of 60 + RN's and MTAs to provide nursing care for a 4500-5000 inmate population.
Supervised staff in acute care setting and Correctional Treatment Center setting. Supervised the Outpatient Clinics, Mental Health Units and Specialty Clinics. Assessed contracts for utilizing supplemental staffing. Budget planning, reporting data and recommendations for patient care to leadership. Sets program standards for clinical practice, administration, education and assures their implementation. Taught Bloodborne Pathogens class to medical and custody staff. Responsible for long range program planning & development of nursing & related programs for effective delivery of health services Performed hiring interviews for medical staff. Responsible for external and internal recruitment and retention of qualified staff for the clinic.
California Department of Corrections
Utilization Management Nurse Full time May 1996-May 1997
Collaborated with other institutions to determine availability of clinical services, ensure proper transfer of patient care, participate in collaborative case management planning, utilization review, discharge planning, and other related case management activities including the review of outside medical services based on established guidelines and medical necessity. Reviewed request for services per Milliman and Robertson Criteria and InterQual criteria. Traveled to the local hospitals and reviewed inpatient records, conferred with physicians to provide quality care to the inmate patients. Reviews initial assessments and re-assessments of patient condition, response to treatment and other clinical finding and initiates telephone contact, correspondence, and follow-up to the Chief Medical Officer for inpatient and outpatient care. Promotes discharge planning and continuity of care in collaboration with the health care team when clinical reviews no longer support meeting the Inter-Qual Criteria for intensity of services and severity of illness. Coordinated with custody staff to facilitate transportation to appointments.
Was certified as CPUR. Promoted to SRN II.
Imperial Valley Home Health Brawley, CA Full time May 1995-May 1996
Nursing Supervisor
•Supervised staff of eight RN's, four LVN's, and ten HHA’s in a home care agency.
•Supervised the billing to Medicare, Medical and private insurance companies.
•Supervised the documentation of home care given and provided on the job training to staff.
Pioneers Memorial Hospital Brawley, Ca Full time. January 1993-May 1995
Medical Staff QA Nurse/ Infection Control/Safety
•Performed chart audits and inspected facility. Identified potential problems. Focus on quality improvement.
•Provided detailed reports to the medical staff committees.
•Taught employee orientation classes, Quality Improvement using PDCA methodology and infection control policies.
• Infection Control auditing, analyzing incidents, generated reports for the Imperial County Health Department for communicable diseases.
Kimberly Quality Care/Gentiva (Olsten) Home healthcare. El Centro, CA Full time August 1990- January 1993
Business Manager/ Case Manager Home Health
•Supervised billing of Medicare, Medi-Cal, and insurance
•Purchased new equipment, handled move of office.
•Provided case management and nursing care for caseload of 30 patients.
•Billed for pharmaceuticals. Supervised Payroll of staff.
Applies advanced clinical knowledge for the interpretation and evaluation of clinical data to determine compliance with established criteria for third party and other cost recovery payments. Prepares reports, summaries, correspondence and other written products to the third-party payers, patient findings, assessments, and care provided. Problem solves care delivery issues using the interdisciplinary team at the unit/program or service level. Case managed a panel of 30 patients in the home setting, provided coordination of care, nursing care for chronic care and post-surgical care patients. Supervised one LVN and 5 Home Health Aides.
El Centro Regional Medical Center El Centro, Ca Full time August 1986-August 1990
Registered Nurse/Head Nurse Recovery Room
•Performed Nursing Care of Post-op patients. Conscious Sedation.
. Purchased new equipment for department.
•Hiring of new staff.
Supervised a staff of 4 RN's, one LVN and one nurse assistant.
Oklahoma Osteopathic Hospital Tulsa, Ok Full time May 1982-August 1986
Registered Nurse/Head Nurse PACU Supervised a staff of 7 RN's and 2 nurse assistants.
Performed Nursing Care of Post-op patients. Serves as mentor/role model for staff and students as they pursue leadership development and clinical expertise.
Hiring of new staff. Purchased new equipment for the department.
EDUCATION
MSN Western Governor’s University
BSN/PHN University of Phoenix, San Diego, CA
ASN Tulsa Junior College Tulsa, Oklahoma
Oklahoma State University, Stillwater, Oklahoma General Studies.
Certifications:
CA License RN 406007
AZ RN License 243812 Multistate
Public Health Nurse,
BLS/AED.
Trainings:
CPUR, Hostage Negotiator Training, Conflict Management Training,
Attended Medical Management in Tricare Environment, Certificate in Case Management.
APIC Training for Infection Control Professionals.
Completed IRR for InterQual and Milliman Care Guidelines.
Completed HRO training for medical personnel.
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