Case Management Manager

Deidra J. Ogbuanya

908-***-**** ******.******@*****.***

NURSE CASE MANAGEMENT HEALTHCARE MANAGEMENT

Dedicated and highly skilled Nurse Case Manager with over 10 years’ experience in delivering exceptional patient care and accurate data reporting for reimbursement. Proven track record of managing complex medical cases, facilitating effective treatment plans, and collaborating with interdisciplinary teams to optimize patient outcomes. Experience in analyzing medical records for accuracy and completeness. Possess strong communication skills in collaborating with other healthcare professionals to improve documentation quality, maintain compliance with regulations, and enhance communication between medical staff and coders. Possess excellent leadership, team-working, communication, organizational, and presentation skills and the ability to develop strategic ideas for the continuous growth of the company. Very meticulous and great attention to detail. Ability to manage considerable amounts of data. Experience in providing effective medical support related to different therapeutic areas and familiar with federal and local regulations/guidelines related to clinical research.

•Extensive experience in case management, care coordination, and discharge planning.

•Proficient in conducting comprehensive patient assessments and developing tailored care plans.

•Experienced in proper coding and documentation to reflect patient care.

•Collaborative team player adept at fostering a cooperative and patient-centered environment.

•Ability to analyze complex medical data and document findings and observations to convey related information quickly and accurately.

•Technical Skills: Proficiency in MS Office (Word, Excel, PowerPoint), Epic, Cerner

•Areas of Expertise: Nursing, Healthcare Management, Community Outreach, Patient Care, Quality Management, Quality Assurance, Healthcare Administration, Emergency Room Management, Case Management, Utilization Management

•Experienced in cost effective analysis.

CERTIFICATIONS

Registered Nurse Compact License

Chronic Care Professional (CCP) Certification

CCM certification

Basic Life Support (BLS) Certification

PROFESSIONAL EXPERIENCE

Case Manager

Heart Matters 2024-2025

Responsible and accountable for the provision and facilitation of comprehensive care coordination services and quality outcome for patients across the continuum. Promotes effective utilization and monitoring of health services, collaborates and communicates with healthcare team and patient/caregiver to manage care and transitions. Develops and/or implements and comprehensive care plan based on assessment and evaluation of patient/caregiver needs.

Workman’s Comp Case Manager

Genex Services 2021- 2022

Providing cost effective medical case management services to English and Spanish speaking industrially injured employees to ensure they receive proper medical case to eliminate their disability and coordinate their return to work. Responsible for meeting with injured workers and complete an initial assessment on their past medical history, current medical status, educational and vocational history. Meet with the injured worker’s medical provider and obtain current information on the injured worker’s diagnosis, prognosis, treatment plan and coordinate the same to ensure progression in the injured worker’s medical condition. Share information obtained with parties involved in the case verbally and in writing.

Personal Health Support Clinician

Premera BCBS 2020-2021

Provide holistic care model which involves collaboration with members, caregivers, and providers. Perform comprehensive, integrated health assessment of member's current situation and status; identify actionable barriers and obtainable goals to achieve optimal self-care management; monitor member's progress toward goals; facilitate the coordination, communication and collaboration among the member's providers; advocate for members and promote self-advocacy; assist members to obtain appropriate quality care within their benefit plan; and identify resources in the community or within the member's natural support system to fill any gaps within their benefit plan, specifically case managing within the behavioral health population.

•Engage members with medical, mental health and/or substance utilization disorders in services utilizing evidenced-based engagement skills.

•Conduct initial holistic health assessment of member's current conditions, situation and needs and ongoing evaluations. Assessment may include an evaluation of the caregiver's needs as well as an evaluation of the larger system.

•Collaborate with the members, caregivers, and providers to develop a culturally sensitive case management plan that addresses barriers and promotes improved health outcomes.

•Monitor and evaluate the effectiveness of the member's case management plan and continuously update to ensure goals are progressing and remain pertinent; identify and address barriers to completing goals.

•Facilitate communication and coordination among the health care team to minimize fragmentation, eliminate duplication and maximize delivery of appropriate care.

•Provide interventions focused on removing the member's barriers to health improvement; promoting positive behavior change using motivational interviewing techniques; and addressing the caregiver's needs to stabilize the member's natural support system.

•Maintain concise, accurate and timely documentation that supports effective, efficient management of the member and that meets accreditation, contractual and legal requirements.

Clinical Care Manager

WellCare Health Plans ` 2016-2021

Developed and documented care plans for individual patients, tracking processes, patient self-management support, implementation of clinical practice guidelines, and work process/patient flow improvements. Oriented and educated patients and their families and providing educational information in conjunction with direct care providers related to treatments, procedures, medications, and continuing care requirements. Experienced with the Medicaid and Medicare population in addition to managing the DSNP (Dual Special Needs Program) members while promoting quality, cost effective care.

•Identified and engaged appropriate adult and pediatric patients for care plan enrollment by providing education on program benefits.

•Developed, documented, and implemented care plans and coordinated services for patients identified through various healthcare programs.

•Supported patients in achieving physician and patient identified health goals through education, care coordination, advocating, and resource finding with the intention of helping the patient reach stability and maximal health.

•Advocates for the managed long-term support and services member/family among various sites to coordinate resource utilization and evaluation of services provided.

•Provides field-based and telephonic case management activities specific to the managed long-term support and services case management program.

Emergency Room Nurse

Trinitas Psychiatric Emergency Room 2017-2020

Assess, plan, implement, evaluate and document nursing care for patients experiencing life-threatening problems requiring complex assessment, high-intensity therapies, and interventions. Collaborate with all members of an interdisciplinary team, therapists, social workers, doctors, and pharmacists.

•Efficiently and knowledgeably provide RN care for all ER patients.

•Decisively and confidently make judgments on patient conditions based on vital signs, patient presentation, and initial assessment; triaged to appropriate zone; activated specialized team when indicated.

•Apply expertise in data analysis by monitoring laboratory results, blood work and urinalysis.

•Demonstrate exemplary documentation skills by accurately maintaining nurses' notes and promoting sufficient communication among care staff.

Director of Quality Assurance

Crane’s Mill SNF 2015-2016

Developed training and educated staff according to state and local regulatory guidelines. Created and implemented corrective action plans in accordance with JACHO regulations. Led interdisciplinary team meetings and mediated the best course of action.

•Managed and supervised a team of nurses and ancillary staff. Managed and supervised a team of nurses and ancillary staff.

•Data entry of nursing documentation and assessments, and physician’s documentation and orders into the Vision database for clinical reimbursement from Medicare in compliance with timelines set state of New Jersey.

•Data entry of patients individualized care plans based on their medical, physical, and emotional needs to provide high-quality care in accordance with their needs.

•Audit and implemented corrective action needed in preparation for state, federal, DOH, or corporate compliance surveys.

•Analyzing data and creating reports

•In-service staff, train staff

•Familiar with OSHA regulations

•Monitoring overall functional status of each resident’s quarterly or if there is significant change in status whether improvement or decline in functional levels including any adverse events or any medication and other products used.

•Creating care plan for the residents on the Skilled Nursing Unit

•Coordinating all the assessments in each discipline, nutrition, activities, rehabilitation, social aspect, and nursing, for each resident on Medicare and submitting it to the state for reimbursement for services provided to residents in the SNF for short term rehabilitation.

Clinical Manager

Community Access Unlimited/Homecare Qualified Medicare 2012-2015

Supervised, mentored, and prepared personnel evaluations and administrative reports for 50+ personnel and advised and provided consultation to both physicians and nursing staff on the treatment and management of patients, ward policies, and procedures.

•Created, implemented, and managed a centralized Referral Center to track volumes and decrease processing time for referrals, thereby increasing customer satisfaction and quality of care.

•Obtained referrals from hospitalists, specialists, and community-based physicians for hospice, home care, and palliative care services and assisted in the transition from hospital care to community-based care.

•Serving as an important member of an interdisciplinary team and developing good relationships with key opinion leaders as well as helping with setting and providing strategic direction in therapeutic areas in compliance with established policies.

•Prepared workload data reports and memorandums, established and enforced policies, regulations, and procedures, implemented performance improvement activities and training.

Psychiatric Nurse

Meadowview Psychiatric Hospital 2010-2014

Provided direct quality care to patients, including daily monitoring, recording, and evaluating psychiatric medical conditions of up to 20+ patients per day. Administered medication/treatments and documented administration with reaction in client's clinical charts. Observed, recorded, and initiated appropriate action to medication and therapeutic procedures.

•Provided education to patients on detox and withdrawal, medications, addiction, recovery, coping skills, and community resources.

•Assessed patients in active withdrawal and provided interventions to manage physical and psychological withdrawal symptoms.

•Provided behavioral/emotional support and supervision for those with psychiatric disorders such as bipolar disorder, schizophrenia, personality disorders, and addiction.

•Accurately documented all elements of nursing assessment, treatments, medications, discharge instructions, and follow-up care.

EDUCATION

Bachelor of Science in Nursing

Felician College, Lodi, New Jersey

Master f Science in Nursing – Psychiatric -Mental health Nurse Practitioner (PMHNP) Expected Graduation: 2026

Walden University

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