Seasoned RN with Triage and Case Management Experience

Nancy Archer

Experience

RN Case Manager St. Croix Hospice, Indianapolis, IN

NOV '24 - OCT '25

Telephone Triage for Critical Care and Pulmonary Services Community Health Organization JUL '24 - NOV '24

PACE Clinic RN Franciscan Alliance St. Francis, US FEB '20 - JUN '24

317-***-**** ******.*******@*****.*** Greenwood, IN 46143 Hardworking, highly motivated professional eager to lend combined knowledge and skills to enhance business performance. Adept at using electronic health records (EHR) to document patient data, maintain medical records and track treatment progress. Extensive experience providing quality patient care in a variety of healthcare settings. Demonstrated ability to quickly assess patient needs and develop comprehensive treatment plans.Operates well in both individual and team capacities, leveraging seasoned work ethic to quickly adapt to different processes and drive company objectives. Resourceful and results-driven with a passion for growth and efficiency to meet company needs and increase service value. Identified potential barriers to success in order to proactively prevent problems before they arise. Assessed patients' physical, psychological, and social conditions to identify appropriate interventions. Provided education to patients regarding their diagnoses, treatments, medications, and self-care management techniques.

Developed and implemented patient care plans based on individual needs, utilizing evidence-based practices. Actively participated in interdisciplinary team meetings to discuss complex cases and develop treatment plans accordingly.

Provided emotional support during difficult conversations with family members regarding end-of-life decisions or other delicate topics.

Maintained accurate documentation of all interactions with clients according to company policies and procedures.

Developed strong relationships with patients through compassionate communication techniques. Monitored clinical progress of assigned caseloads through in-person visits or telephone contacts. Fostered an environment conducive to open communication between patients and families and healthcare providers.

Proficient in HCHB application

Committed to delivering excellent customer service while working in a fast-paced environment. Participated in ongoing training to enhance own job skills and knowledge. Provided efficient and courteous service to customers at all times. Skilled in using various software applications and programs including Microsoft Office and EPIC EMR Collaborated with other Clinic RNs to establish daily schedule to provide excellent patient care in the home care arena, the clinic, and the day room of the PACE center including telephone triage, treatments, acute and wellness assessments, wound care, and nursing care planning of chronic health conditions in the elderly population.

Served as the Intake RN for perspective participants in the PACE program utilizing assessment skills and Utilization Management Nurse 2 Humana, US

APR '18 - NOV '19

Quality Coordinator Anthem, US

JAN '10 - NOV '18

Precertification Nurse Anthem, US

JUL '02 - JAN '10

chart reviews to determine the physical, medical, and safety needs of the individual, then composing a complete and concise evaluation to be utilized by an interdisciplinary team to determine if PACE could best serve the needs of the potential participant.

Collaborated with providers during end-of-life discussions including education and patient advocacy to ensure end of life desires were honored.

Served on falls quality improvement committee to evaluate the root cause of each participant fall and determine a prevention plan for the individual as well as the entire population of the PACE Program. Ensured accurate documentation of nursing assessments, interventions, and evaluations in accordance with clinic policies.

Assisted with scheduling appointments for follow up visits or referrals when necessary. Collaborated with multi-disciplinary team members to ensure optimal patient outcomes. Responded promptly to patient inquiries related to health care services. Utilized problem solving techniques to anticipate and address potential issues or concerns. Provided emotional support and guidance to patients throughout their visit. Prioritized tasks based on urgency and importance while managing multiple assignments simultaneously. Conferred with attending physicians, nursing staff and other care providers to drive optimum quality of patient care.

Employed triage techniques to identify existing or potential health problems and formulate plan of care. Used nursing process in delivery of patient care through data gathering, planning and evaluation. Initiated diagnostic tests according to applicable protocols. Documented nursing assessments and interventions clearly, accurately and consistently to comply with clinic policy.

Performed concurrent reviews on insurance members, determining inpatient or outpatient status based on MCG guidelines and nursing judgment via review of Epic documentation. Coordinated consults between insurance doctors and facility doctors. Discussed discharge needs with members and discussed with facility Discharge Planners to ensure members were discharged to the safest and cost-efficient level of care. Served as onsite and telephonic resources for facility's discharge planners and utilization management nurses regarding policies and network facilities.

Collaborated with case managers in developing individualized discharge plans for complex cases. Reviewed 150+ pre-cert charts monthly to ensure compliance with federal, state, company and contractual standards as well as adherence to NCQA and URAC guidelines. Interpreted audit data to provide action plan suggestions to managers on both individual associates as well as overall department performance.

Collaborated with multiple department leaders to develop best practice documentation across multiple departments nationally. Adhered to all internal delivery schedules. Assisted in developing new auditing tools and usage manuals. Evaluated existing systems and processes for effectiveness, making recommendations for improvements as needed.

Performed precertification and concurrent reviews for national accounts via live call, voice-mail, and fax. Determined if criteria was met and referred to Physician Consultant as needed. Developed the role of denial consultant to send all denials to correct state physician consultant, ensuring Nurse Triage Call Center Supervisor St. Vincent Hospital, US JUL '01 - JUN '02

Telephone Triage Nurse St. Vincent Hospital, US

JUL '99 - JUL '01

Registered Nurse II St. Vincent Hospital, US

JUN '88 - JUL '99

denial rationals met criteria, as well as making all call outs of denials to ensure timeliness of notification and appropriateness.

Excellent written and verbal communication required to obtain adequate clinical information, communicate approvals and denial rationals as well as to document the needed information in the medical record. Managed time efficiently while balancing multiple priorities simultaneously. Maintained accurate records for each patient encounter according to established standards. Provided 24/7 leadership to a team of Registered Nurses. Developed process improvements to enhance efficiency and effectiveness of inter-department call center operations.

Co-developed the call center's operations, quality control and training processes to increase customer satisfaction and service center profitability. Trained staff on how to improve customer interactions. Formulated and enforced Service Center policies, procedures and quality assurance measures. Worked with upper management to ensure appropriate changes were made to improve customer satisfaction.

Developed effective relationships with all call center departments through clear communication. Addressed customer service inquiries in a timely and accurate fashion. Applied effective communication techniques when interacting with patients and families Managed time efficiently while balancing multiple priorities simultaneously. Utilized strong assessment skills to determine necessary patient care. Delivered high-quality and compassionate treatment to indigent and low-income patient community. Actively participated in unit-based Quality Assurance Program. Sound, ethical and independent decision-making ability consistent with medical protocols. Quickly established rapport with patients while providing necessary triage and health education for patients. Documented all conversations within electronic medical records system accurately and completely. Provided appropriate guidance on the next steps for care based on patient symptoms and concerns. Explained complex medical information in an easily understandable way for callers. Assessed caller needs while providing accurate medical advice according to established protocols. Adhered to HIPAA guidelines when handling confidential patient information over the phone. Actively participated in unit-based Quality Assurance Program. Sound, ethical and independent decision-making ability consistent with medical protocols. Effectively adjusted floor assignments based on evaluation of staffing requirements. Implemented total patient care through a team nursing process covering 8-10 high acuity patients per shift. Assisted patients with multiple chronic diagnoses including COPD and CHF. Accurately documented all elements of nursing assessment, treatments, medications, discharge instructions and follow-up care.

Provided direct patient care, including assessment and evaluation of health status, development of individualized plans of care and implementation of nursing interventions. Educated patients about their diagnosis, medications, nutrition requirements, pain management strategies. Protected patients' rights and dignity by delivering care without judgment or discrimination. Educated patients and family members about treatments, care requirements, and other relevant information. Education

St. Elizabeth School of Nursing, Lafayette, Indiana JAN '88

Graduated with Honors

Skills

Care coordination Clinical assessment HIPAA compliance Case evaluation Utilization review Quality improvement Multitasking Excellent communication Problem-solving abilities

Certifications

Registered Nurse, Indiana Board of Nursing, 09/01/88-10/31/2027 Volunteer Experience

Show Co-coordinator for Agape Performing Arts

Co-op Enrichment Class Mentor for Holy Families Home Educators Children's Christmas Choir Director

Assumed leadership role when supervising staff nurses or students in clinical rotations. Assisted physicians during examinations and procedures as needed. Initiated resuscitative measures to reduce disability and death from acute circulatory and respiratory emergencies.

Obtained specimens and performed EKG tests using proper techniques and procedures. Administered medications and treatments according to physician orders. Collaborated with the production team for three shows. Educates adult participants and volunteers on Safe and Sacred program (child protection program mandated by Indianapolis Roman Catholic Archdiocese) and maintains records to ensure the safety of the children involved in the program.

Participates in leading meetings with parents of performers to ensure relevant information regarding attendance and Safe and Sacred completion is communicated. Supports Show Chairman in any duties assigned.

Developed curriculum for early elementary classes - Introduction to Anatomy and Physiology and Introduction to World Cultures.

Presented information using verbal presentation techniques, hands-on activities and videos. Coordinated guest presenters.

Provided updates on class subjects to parents through written communication. Average class size was 30 students.

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