Case Manager Registered Nurse
Resume:
Jill Francis, RN, BSN
**** ******** *****, *** ***, Dallas, TX 75206
Personal Cell: 972-***-****
*******@*****.***
Education:
Bachelor of Science in Nursing
University of Texas at Arlington May, 2000
Associates Degree in Nursing
Angelo State University, San Angelo TX May, 1992
certification & Licensure:
●Registered Nurse, State of Texas License Number – 583477, Active
●Registered Nurse, State of Nevada, Inactive
●Certified Nurse Case Manager, Commission for Case Manager Certification Number 00143132
●Culture Ambassador – United Healthcare / WellMed – 2016 to 2019.
●ACLS Instructor, 1996-2002, Baylor University Medical Center and Medical City Dallas Hospital
●National Leadership Training for Managers – United Healthcare Group for WellMed Medical Management
Bilingual: English first language.
Spanish, second language.
Current Role(s) :
Medical City Dallas Hospital November 2024 - June 2025
Bone Marrow Transplant ICU & Orthopedic Floor/Med-Surg/Telemetry
7777 Forest Ln, Dallas, TX 75230
Manager: Jeanne Fortne & Brianna, Director of Acute Care, Alex Hickman, Manager RN
Continuous care of Med-Surg/Telemetry & post-op Orthopedic Surgery patients.
Study patient's charts, medication regimens, and test results upon admittance to the unit.
Track routine vital signs, including heart rate, blood pressure, and pulse oximetry measurements.
Interpreting measurements from specialized medical equipment.
Monitor and administer prescribed medication, as well as performing titration of drug doses.
Perform diagnostic assessments on changes in measurements, as well as designated interventions.
Report deteriorating conditions to healthcare specialists and follow intervention instructions.
Update and maintain ward charts, patient files, and medical records.
Oversee Progressive Care Unit nursing assistants and support staff.
Explain treatments and procedures to patients and their families, as well as answering questions.
Full Assessment, health systems review, medications review & research, daily plan of care review & interventions.
Assessment and management of post-of hip, knee replacement. Movement assessment, ROM teaching & post-op care.
Wound care; review, assessment & Interventions including dressings & drains care. Reviews of plan of care with physicians & interdisciplinary teams.
Previous Experience:
Children’s Medical Center Dallas September 2023 - September 2024
PICU Nurse / Pediatric ICU / C12
1935 Medical District Drive
Dallas, TX 75235 Phone: 214-***-****
Manager: Kelly Fordd RN,MSN
Continuous care of pediatric critically patients.
Patient age ranges from 2 months to 18 years.
Assessment and management of ventilator patients, weaning of ventilator patients, tracheostomy patients.
Assessment and management of multiple IV drips. Vasopressors, including levophed, dobutamine, epinephrine (adult dosing).
Kindred Dallas Central June 6, 2023 – September 2023
ICU Nurse
8050 Meadow Rd
Dallas, TX 75231 Phone: 469-***-****
Clinical Director: Juan Bahema, RN,MSN
Continuous care of critically ill LTAC patients.
Assessment and management of ventilator patients, weaning of ventilator patients, tracheostomy patients.
Assessment and management of long-term ambulatory LVAD patients awaiting transplant.
Assessment and management of multiple IV drips. Vasopressors, including levophed, dobutamine, epinephrine (adult dosing).
Texas Health Resources Presbyterian
Hospital of Dallas May 2022 to May 2023
8200 Walnut Hill Lane
Dallas, Tx 75231 Phone: 214-***-****
MANAGER: Shelby Cannon, RN:
CVICU: Cardiovascular Intensive Care Unit
Immediate post-op care of cardio thoracic surgery, valve replacements or heart transplant patients. Responsible for continuous airway management, pain management, hemodynamics, and heart rhythm interpretation.
Care & detailed knowledge of Basic Human Needs & immediate care of the post open-heart patient.
Responds to high priority life sustaining safety, physical, psychological and social needs. Exhibits understanding of basic human needs by demonstrating: a. Attention to emotional, social, and self-esteem needs
Regular assessment and maintenance of comfort
Knowledge of basic physiology and pathophysiology
Knowledge of pain and suffering, pain interventions and pain comfort/theories
Provides safe patient care as evidenced by:Completing accurate documentation in the electronic health record
Completing assessments accurately and in a timely manner
Individualizing care plans specific to the needs of the patient
Providing consistent attention to airway, intake, elimination, sleep, rest, mobility and hygiene needs
White Rock Medical Center August, 2021 to April 2022
(Formerly: City Hospital White Rock / Doctors Hospital )
9440 Poppy Drive
Dallas, Tx 75218. Phone: 972-***-****
Charge Nurse: Lindsay Martel, RN
●Detailed Nursing head to toe Assessments of critically ill patient in the ICU
●Knowledge of high dose Vitamin C IV infusions.
●Knowledge & assessment of anaphylactic & infusion reactions.
●Float and work between 2 Store Locations
●IV Starts, Difficult IV starts, IV on dehydrated & hangover clientele. IM injections, Blood draws.
●Review of all Specialty IV drugs & orders given by ordering infusion.
●Full monitoring of patient VS, BP by Sphygmomanometer, Temp, HR, & Resps, during infusions
●Education & Teaching with Patients & Family on IV drugs being given & how to tailor IV supplements for High Performance workouts, health & wellness.
Clinical Research, BioBridges August 2, 2020 to September 2021
Applied Therapeutics
545 Fifth Avenue, Ste 1400
New York, NY, 10017. Phone: 212-***-****
Lead Nurse: James Pratt, RN
●Coordination, assessment and intervention of pediatric research study patients.
●IV lab draws from pediatric patients participating in the study
●Visit of clinical Research study participants in the home for blood draw & education as needed.
●Management of centrifuge for blood studies.
●Education with patient & family as needed
●Coordination of travel long distances to drug study patient’s at home.
Restore HyperWellness IV Therapy Center August, 2020 to August 2021
5509 W. Lovers Lane, Suite A
Dallas, Tx 75209. Phone: 972-***-****
Charge Nurse: Austin Perkins, RN
●Pre-Infusion Assessments of Patients in the Restore Clinics.
●Knowledge of NAD+ Wellness Infusions for health & recovery. (Nicotinamide Adenine Dinucleotide)
●Knowledge of high dose Vitamin C IV infusions.
●Knowledge & assessment of anaphylactic & infusion reactions.
●Float and work between 2 Store Locations
●IV Starts, Difficult IV starts, IV on dehydrated & hangover clientele. IM injections, Blood draws.
●Review of all Specialty IV drugs & orders given by ordering infusion.
●Full monitoring of patient VS, BP by Sphygmomanometer, Temp, HR, & Resps, during infusions
●Education & Teaching with Patients & Family on IV drugs being given & how to tailor IV supplements for High Performance workouts, health & wellness.
Infinity Infusions Nursing / DFW Region August 27, 2020 to August 31, 2021
Home Office: 5717 Hwy 43, Suite B.
Satsuma, AL, 36572. Phone: 1-844-***-****
Supervisor: Khadra Hamm, RN
●Knowledge of high-cost drugs, IViG, Soliris
●Knowledge & assessment of anaphylactic infusion reactions.
●Pre-Infusion Assessments of Patients in the home.
●Difficult IV Starts on Immunocompromised patients.
●Central line Access. Ports accessed by Huber needle.
●Review of all Specialty IV drugs & orders given by ordering infusion.
●Full monitoring of patient VS, BP by Sphygmomanometer, Temp, HR, & Resps, & pulse ox, as needed during infusions
●Education & Teaching with Patients & Family on IV drugs being given.
Texas Health Hospital at H.E.B. Oct 26, 2020 to Dec 21,2020
1600 Hospital Pkwy, Bedford, TX 76022
Phone: 1-844-***-****
Manager: Jemrose Bandoy, RN
PCU/ Progressive Care Unit
●Direct patient care in the PCU / Progressive Care Unit. 12HR shifts.
●4:1 patient ratio
●Full assessment, care and monitoring of patients, VS, BP by Sphygmomanometer, Temp, HR, & Resps, & pulse ox during infusions
●Review of all Drugs & orders given by ordering infusion.
●Care of ICU Stepdown CoVid patients at 4:1 ratio
●Education & Teaching with Patients & Family on drugs & treatments being given.
North Texas Plastic Surgery Center – Southlake, TX. July, 10, 2020 to August 10, 2020
415 E Southlake Blvd #202
Southlake, TX 76092, Phone: 817-***-****
Lindsey Grindle, Facility Administrator
Pre-Op Nurse, PACU, and O.R. / Operating Room Circulating Nurse - Per Diem
●Pre-Op Assessments of Patients. IV Starts, Review & completion of all Consent Forms.
●Pre-Op COVID Screenings and pregnancy screenings.
●Education & Teaching with Patients & Family on Post-Op Procedure Instructions.
●OR Circulating Nurse. Charting documentation of procedure, instruments used, working with Surgeon & Surgical Team.
●PACU/Recovery Room Assessment & Recovery of patients post sedation from procedures, monitoring of VS, getting pts up & moving for Discharge home.
Centene Corp / Superior Health Plan - MMP Feb 3, 2020 to July 10, 2020 ( Contract via Total Med Staffing )
4000 McEwen Rd, First Floor, Dallas, TX 75244
●Nurse Case Manager for MAPD and Transition of Care
●Education of patients and family on Medicare Advantage Plan benefits.
●Encouraged routine prevention and screening in accordance with HEDIS guidelines
●Responsible for Complex Case Management of High Cost Claims including patient education.
●Assisted patients to find and establish care with in-network physicians
( 3 month Employment Gap after leaving UHG: 10/18/2019 to 2/02/2020: 3 months : Relocation / Move from Las Vegas, Nevada back to Dallas, Tx. )
Continued:
United Healthcare / OptumCare Nevada July 2014 – November 2019
2716 N Tenaya Way, Ste 500, Las Vegas, NV 89128
Phone: 1-800-***-****
Sr Quality HEDIS Nurse, Medicare Advantage Quality Team for OptumCare Nevada, 01/2019-10/2019:
●Transfer to Las Vegas, NV to Establish Role & Responsibilities for Quality & HEDIS Nurse Team.
●Project leader of Quality and HEDIS measures needed for end of year directives.
●Development market business plans to motivate providers to engage in improving Stars measures to be 4 Stars or higher.
●Serves as the primary go to person for all STARS related activities within the assigned market working with a matrix relationship which includes Quality corporate operations & Regional / Market Operations.
●Work to develop solution-based, user-friendly initiatives to support practice successes with the Region / Market.
●Responsible for detailed review of EMRs & various platforms for optimum documentation needed to meet NCQA, CMS & HEDIS Standards,
●Use of & knowledge of Risk Adjustment and appropriate coding, specifically for Medicare Risk Adjustment, utilizing CMS/HCC guidelines
●Performing audits of Primary Care Physician medical records per optimum Quality & HEDIS Standards purposes per CMS guidelines for Medicare Advantage patients
●Collaboration with CDQI Team: Physicians, Medical Directors, Data Analysts & Physician Business Managers to efficiently review & report data back to National UHC Team for Quality & HEDIS Reporting per NCQA deadlines.
Manager, Inpatient Care Management, for WellMed/Optum Dallas October 2016-January 2019
●Promotion within department
●Management of 15 Nurse Case Managers and 15 Clerical Team Staff. 20plus
●Management of human resource responsibilities.
●Recruitment, interviewing, hiring, training of Staff needed; RNs and clerical support staff.
●Annual and quarterly performance reviews, and disciplinary actions as needed.
●Facilitation and education of staff of acute inpatient case Team with Case Managers and Market Medical Director to ensure appropriate level of care and discharge planning for Medicare Advantage population including detailed case reviews & clinical review
●Directly responsible for Concurrent, Expedited, and Standard authorization requests meeting turnaround time per NCQA requirements using MCG Guidelines ( Previously InterQual )
●Implement quality improvement projects and initiatives and ensure adherence to CMS, NCQA, and contractual guidelines
●Participate in on-site UHC Health Plan Delegation Audits
●Collaborate with Lean consultant to update workflows and develop operational best practicesTransition Care
Lead Nurse Manager for SNF Facility Admission and LOS
04/2015-10/2016 – WellMed /Optum Dallas
●Project management and review of medical necessity and authorization requests for admission to inpatient and skilled nursing facilities utilizing evidence-based guidelines such as InterQual and MCG
●Collaborated with facility case managers, patients, and families to develop comprehensive discharge plans for Medicare Advantage patients admitted to acute and skilled nursing facilities
●Education of patients and facility staff on Medicare Advantage Plan, and allowable SNF days per CMS regulations
●Encouraged routine prevention and screening in accordance with HEDIS guidelines Clinical Coding Nurse
Physician Educator and Coding Consultant, 07/2014-04/2015 – WellMed /Optum Dallas
●Project management and education of physicians and their office staff on risk adjustment and appropriate ICD9 coding, specifically for Medicare Risk Adjustment, utilizing CMS/HCC guidelines
●Performance of on-site audits of Primary Care Physician medical records for appropriate coding for risk adjustment purposes per CMS guidelines for Medicare Advantage patients
●Direct education of participating Physicians regarding routine prevention and screening in accordance with HEDIS guidelines
●Education & in-services programs with physicians, office staff, and business managers to educate on Focus On Care Tools, Attestation Tools and appropriate documentation to meet CMS Star Rating goals
Blue Cross Blue Shield of Arkansas 05/2013–07/2014
Regional Nurse Case Manager
●Responsible for Complex Case Management of High Cost Claims including Transplant patients
●Assisted patients to find and establish care with in-network physicians
●Completed discharge Medication Reconciliation reviews
●Negotiated rates for out of network care and reimbursement, as applicable
St. David’s South Austin Medical Center 11/2012–05/2013
Case Manager, Med-Surg/Tele Unit
●Utilized InterQual for review of appropriateness of care & medical necessity of admissions, continued stay & discharges
●Reviewed care plan and alternative treatment options with physicians and interdisciplinary team
●Managed resources for participants including: transportation, home care, vendor services, and nutrition
Bunch & Associates, Inc. 06/2012–11/2012
Nurse Case Manager, Workers Comp
●Performed Case Management of 30-40 patients dealing with work injury issues
●Executed care planning for each patient using a team approach with physician, surgeon, physical therapy & family
●Gathered extensive knowledge of State Work Injury regulations, and the fulfilling of those requirements
●Responsible for supervision of Program Assistants and Medication Aides, included hiring, training, reviews and staff development
HealthSmart Benefit Solutions 09/2010–06/2012
Nurse Case Manager
●Education & extensive consultation with dialysis & transplant patients for extended treatment plan
●Implemented care plans by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements
●Negotiated rates of reimbursement, as applicable
CIGNA Disability Group Insurance 02/2009–09/2010
Nurse Case Management Specialist
●Actively participated in review of Disability files with managing claims personnel
●Complied with all federal, state and local laws and regulations as appropriate for the position
●Organized and coordinated care with appropriate referral to specialty teams and internal/external resources
●Initiated appropriate preventive and rehabilitative nursing procedures
Temporary ( Per Diem ) Bedside Nursing Assignments during BSN Studies 10/2005–2/2009
All About Staffing
PRN ICU Agency Nurse, DFW Metroplex Hospitals 10/2005-02/2009
CareStaf Medical Staffing
PRN Agency Staff Nurse, 06/2007-06/2009
RPNT Acute Dialysis Services, Inc.
PRN Acute Dialysis Nurse, 03/2008-10/2009
DaVita Dialysis Outpatient Center
Staff Nurse/Chronic Dialysis Clinic, 09/2007-03/2008
US Nursing Corp/Fastaff Travel
PRN Strike/Relief Nurse, 06/2006-06/2008
Presbyterian Hospital of Allen 9/2005-3/2006
PRN ICU Staff Nurse
●Provided direct patient care for ICU patients, monitored and treated cardiac status
●Maintained ACLS certification
Baylor Regional Medical Center of Plano 11/2004 - 9/2005 Full-time
Staff Nurse, ICU/CVICU: Grand Opening of Hospital
(Before there was Baylor Heart Plano )
Manager: Karis Rojas, RN
●Completed patient assessments and administered appropriate medication in a timely manner
Medical City Hospital of Dallas 10/2001 – 11/2004 Full-time Staff Nurse, CVICU and Interventional Radiology
●Care of post CABG/surgical patients
●Sedation & care of patients undergoing Radiology procedures: Endovascular studies,
CompHealth Nurse Staffing Agency 1/1997 – 10/2001
Per Diem ICU/Critical Care, Recovery Room
●Provided direct patient care for ICU patients, monitored and treated critical status
St. Paul Medical Center/Cardiovascular Institute 9/1997 – 1/1999 Infusion Nurse – CHF Clinic
●Assessed, evaluated and treated pre- Heart & Lung Transplant Candidates
●Direct care and evaluation of patients needing intermittent IV inotrope infusion for Class III-V Heart Failure & Cardiomyopathy
●Performed infusion of critical care inotropic drugs for patients awaiting transplant, as needed
Red Bird Home Health/PRO Health Care 9/1996-9/1997
Director of Nursing/Clinical Care Coordinator & Field Nurse.
●Actively participated in development and implementation of individual treatment plans for patients with broad range of health issues
●Ensured that doctors' orders were effectively carried out, including testing, medical procedures, consultations and stat orders
Baylor University Medical Center Dallas 5/1992- 11/2000
Full-time Staff Nurse - ICU/CCU
●Completed Critical Care Internship: Sept 1993 to December 1993
●Provider of direct patient care for ICU patients, monitored and treated cardiac status
●Cared for critically ill patients on Ventilator, IABP/intra-aortic balloon pump & VADs/Ventricular Assists Devices.
REFERENCES:
1.Treva Dutter, RN – THR Dallas
Charge Nurse, Night Shift Supervisor.
***********@*****.***
Phone: 940-***-****
2.Davion Pezzola, RN,BSN
**************@*****.***
Phone: 707-***-****
3.Myra Macias, RN: Charge Nurse: THR Dallas
Phone: 214-***-****
Email: *********@******.***
4.Julie Hawk, RN
Charge Nurse: White Rock Medical Ctr.
Phone: 469-***-****
5.Cole Clayton, RN,BSN -
Manager & Co-Manager
UNITED HEALTH CARE / WELLMED - 2014 – 2019
6.Stephanie Fannin, RN,BSN
Manager, 2014 – 2019
***************@***.***
Contact this candidate