RN/LVN case management
Resume:
MMANCEL
PARIKIAN
***************@*****.***
WWW: Bold Profile
PATIENT ACCESS NURSE
Guidehouse/MLKCH Los Angeles, CA SEP 2017 - CURRENT CASE COORDINATOR
Methodist Hospital Of Southern
California
2013 - 2017
Dedicated healthcare professional with
extensive experience in patient care and
clinical skills, committed to enhancing
patient outcomes through
compassionate service. Proven ability to
collaborate effectively within
multidisciplinary teams while adapting
seamlessly to dynamic situations.
Strong communication, empathy, and
problem-solving skills contribute to a
reliable, results-driven approach that
ensures the delivery of high-quality care
in a positive and supportive
environment. Passionate about fostering
a culture of excellence in healthcare
delivery while prioritizing patient needs.
WORK HISTORY
Delivered high level of quality care to diverse populations while overseeing patient admission and triaging based on acuity and appropriate department admission.
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Performed accurate documentation of patient assessments, interventions, and outcomes in compliance with regulatory standards using Milliman Guidelines to determine medical necessity.
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Utilized strong clinical judgment in prioritizing patient needs during high-stress situations, ensuring optimal outcomes.
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Collaborated with interdisciplinary teams for optimized patient treatment plans and outcomes.
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Mentored new nursing staff members, fostering teamwork and improving unit efficiency.
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Involved with patients/families and the treatment team to discuss and develop plans for discharge. This included assessing benefits, patient/family support systems and ensuring that patients were accessing the full benefits/services available to them.
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Worked with identifying coverage gaps in order to attempt to identify community resources that could assist or take suggestions back to the team to adjust the treatment plan.
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Coordinated with pharmacists to identify alternate cost-effective medications (medications on formulary, obtaining prior authorizations for coverage of non-formulary meds etc.).
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Completed arrangements for post discharge needs such as coordinating home-health, home IV antibiotics and post discharge
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CASE MANAGER
San Gabriel Medical Center 2009 - 2013
CASE MANAGER
Monrovia Memorial Hospital 2006 - 2009
needs such as follow-up appointments (Anticoagulation clinic, follow up appointments through OPAT clinic, Acute response clinic) Performed utilization reviews utilizing InterQual. Participated in daily IDT (Interdisciplinary Team) meeting.
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• Collaborated with physicians and staff to arrange resources needed for patient to prevent an admission to hospital and to utilize hospital resources appropriately.
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Served as liaison between contractors, third party insurance pay sources, physicians and patients by clarifying information and resolving barriers to healthcare.
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Monitored ongoing cases closely, adjusting case management strategies as needed based on evolving circumstances or new information.
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Conducted thorough assessments of clients'' situations, identifying issues, goals, and necessary interventions. Used InterQual guidelines to help payers and providers determine medical necessity of healthcare services.
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Contributed to team discussions and case conferences actively, sharing insights and expertise with colleagues to optimize client support strategies.
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Maintained accurate documentation on all cases, ensuring compliance with regulations and confidentiality requirements.
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Coordinated services with other agencies, community-based organizations, and healthcare professionals to provide useful benefits to clients.
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Triaged patients for acuity needs to effectively manage disease symptoms/pain levels.
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Received/reviewed, verified appropriate criteria of patients for admission to program.
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Coordinated care w/Physicians/Clinical staff members/patients/families for effective holistic approach.
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• Formulated care plans/ participated in meetings as applicable. Conducted thorough assessments of clients'' situations, identifying issues, goals, and necessary interventions.
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Educated clients on available programs, benefits, and services, empowering them to make informed decisions about their care needs.
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LICENSE:
RN: 95427976
LVN: 168380
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