Registered Nurse
Resume:
QUINTELLA LAUDERDALE, BSN
RN, CCM LNC
Rochester, NY, USA
************@*****.***
www.linkedin.com/in/quintella-l
auderdale-bsn-rn-ccm-lnc-dnp-ca
ndidate-41370b96
S K I L L S
L A N G U A G E S
English — Native
Motivated Registered Nurse with
over 21 years of experience in care
coordination, specializing in post-
acute transitions and patient
advocacy to improve health
outcomes and optimize resource use.
Expertise in managing complex
cases, leading interdisciplinary teams,
and driving quality improvement
initiatives. Certified Case Manager
(CCM) and Legal Nurse Consultant
(LNC) with a strong commitment
to patient advocacy and compliance
with CMS guidelines. Currently
pursuing a Doctor of Nursing
Practice (DNP) degree to enhance
leadership skills and clinical expertise
relevant to advanced nursing
practice and healthcare systems.
Complex Case Management
& Care Coordination
·
Telehealth, Triage, and
Remote Nursing
·
Behavioral Health &
Substance Use Management
·
Population Health & Clinical
Consulting
·
CMS Guidelines &
Compliance Support
·
Legal Nurse Consulting &
Chart Review
·
Medical Coding,
Documentation, ICD-10,
CPT & HCPCS
·
Clinical Leadership & Patient
Advocacy
·
·
E X P E R I E N C E
Nurse Liaison Mar 2024 — Sep 2025
CareCentrix -Hybrid Rochester, NY
Clinical Nurse Consultant/RN Oct 2022 — Mar 2024
AssureCare Remote
RN Nurse Medical Management Nov 2019 — Oct 2022
Elevance (formerly Anthem) Remote
CARE MANAGER RN & 24/7 NURSE TRIAGE
Utilization Review Nurse Aug 2020 — Jul 2021
Excellus Blue Cross Blue Shield Remote
Case Manager RN Apr 2018 — Oct 2019
UnitedHealthcare Remote
RN Assessment Nurse Oct 2017 — Mar 2019
HCR Home Care Rochester NY
E D U C ATION
Doctor of Nursing Practice DNP 2020 — Present
Capella University Online
Bachelor of Science in Nursing BSN Oct 2004 — Jul 2006 University of Phoenix Online
Associate of Applied Science in Nursing
AAS
2002 — May 2004
Monroe Community College Rochester NY
Certification Legal Nurse Consultant
(LNC)
2021 — Dec 2021
SUNY Binghamton Online
C E R T I F I C ATIONS & C O U R S E S
Registered Nurse, Licensed in NY, NJ, MI, VA, TX, PA, GA Certified Case Manager
Legal Nurse Consultant
BLS (CPR/AED)
H O N O R S & AWARDS
P R O F E S S I O N A L M E M B E R S H I P S
Active member of the American Nurses Association and the Case Management Society of America, participating in continuous learning and networking opportunities.
Directs and optimizes diverse hospital caseloads, effectively reducing discharge delays and improving patient experiences.
·
Serve as a subject matter expert in discharge planning and readmission prevention, ensuring CMS/InterQual compliance and lowering avoidable readmissions.
·
Partner with physicians and multidisciplinary teams, utilizing excellent communication skills to facilitate seamless care transitions and address patient concerns.
·
Educate hospital staff on Medicare post-acute care guidelines, promoting smoother transitions and better patient experiences while advocating for patients.
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Lead performance improvement and regulatory compliance initiatives, consistently achieving 100% quality audit scores.
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Achieved a 98% success rate in avoiding readmissions for Medicare patients post-discharge through effective care coordination.
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Proficient in coordinating admissions and discharges, ensuring continuity of care during transitions.
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Expert in assessing patient needs and collaborating with multidisciplinary teams to develop tailored care plans.
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Collaborated with internal project managers and technical consultants on multiple customer deployments of MedCompass, a CM/UM/Appeals platform, engaging with clinical sponsors such as educators, nurse managers, and executives.
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Conducted workflow analysis and provided consultation on adapting workflows to implement new functionalities to MedCompass, ensuring designs met both technical and clinical needs.
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Facilitated system testing and obtained acceptance from clinical stakeholders. Developed and executed a comprehensive training plan for a smooth transition of solutions to customers.
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Conducted pre-certification, continued stay, and retrospective utilization reviews in compliance with NYS Medicaid, InterQual, and internal medical policy.
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Collaborated with medical directors to assess care appropriateness and manage appeals for denied services.
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· Facilitated member transitions across the healthcare continuum. Managed high-risk members with chronic conditions through effective telephonic case management.
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Provided triage and patient education for adults and children based on established protocols.
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Facilitated improved health outcomes by coordinating care and resources for patients with complex medical needs.
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Evaluated inpatient, outpatient, and DME claims using InterQual and CMS guidelines, ensuring adherence to medical necessity standards and supporting denial determinations with the medical director.
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Offered constructive feedback to enhance utilization review processes, contributing to improved efficiency and accuracy in claim evaluations.
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Managed Medicare patients post-discharge, achieving a 98% success rate in avoiding readmissions.
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Acted as a liaison between patients and multidisciplinary healthcare providers to ensure seamless care coordination.
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Conducted initial OASIS assessments and admissions, provided wound care, and developed care plans for home care patients.
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Developed individualized plans of care and provided specialized wound care management, enhancing patient outcomes and satisfaction.
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• Sigma Theta Tau International Honor Society, Omega Gamma Chapter
• The National Society of Leadership and Success, Sigma Alpha Pi
Contact this candidate