Occupational Health Case Management RN

Tawanda Smith

Owings Mills, *****, United States, +1-667-***-****, **************@*****.***,

SUMMARY Detail-oriented Case Manager with over 10 years of experience in acute care, transitional care, and utilization management. Proven ability to facilitate patient discharge planning, coordinate community resources, and manage complex care needs. Proficient with EMR systems including Telligen, Kaiser Anna, and Careport/Wellsky. Possesses CCM and WCCM certifications, demonstrating a commitment to patient advocacy and efficient healthcare delivery. Seeking to leverage extensive clinical and case management expertise to enhance patient outcomes at your organization.

WORK EXPERIENCE

Inpatient/Acute Care Case Manager

Ascension-Baltimore

11/2024 – Present Baltimore

Facilitated transitional care and discharge planning for patients with post- acute care needs, covering inpatient and observation statuses. Utilized Telligen, Kaiser Anna, and Careport/Wellsky applications for daily workflow management.

Secured and documented Medicaid and Medicare discharge services, adhering to cost-effective Managed Care Organization (MCO) and fee-for- service guidelines.

Coordinated referrals for Peer Recovery Care, housing assistance, and other community support services.

Managed patient transitions to Acute Inpatient Rehabilitation, Subacute Rehabilitation, and Long Term Care facilities.

Arranged essential services including transportation, home health care, and durable medical equipment.

Independent Contractor

T. A. Smith Consulting dba Covenant Care

03/2015 – Present Baltimore

Operated as Owner/Independent Contractor.

Delivered comprehensive case management, HEDIS & Utilization Management services, Adult Day Care oversight, and Delegating Nurse supervision for Assisted Living Facilities (ALF), Long Term Care (LTC), and Developmentally Disabled Adults (DDA) with psychiatric impairments in Maryland and the District of Columbia.

Senior Pastor

Rapha Ministries of Baltimore

01/2015 – Present Baltimore

Led Rapha Ministries of Baltimore.

Directed The Walk At RMOB Outreach initiatives.

Engaged in community collaboration with the Baltimore City Police Department.

Workers Compensation Nurse Medical Field Case Manager Aetna, a CVS Health Company

04/2014 – 05/2019 Baltimore

Provided complete medical case management for injured workers across Maryland, Virginia, and the District of Columbia.

Liaised with interdisciplinary providers, vendors, employers, and attorneys to facilitate safe and timely return to work, operating within jurisdictional rules. Served as a Utilization Management Nurse Consultant, conducting daily reviews of provider requests for medical necessity, including prior authorization, outpatient procedures, inpatient stays, retrospective reviews, and appeals.

Executed special projects as assigned by department leadership. Weekend Admissions Case Manager

Professional Healthcare Resources

07/2017 – 02/2018 Baltimore

Managed weekend admissions as a nurse, utilizing OASIS measures across various insurance products.

Developed comprehensive plans of care for diverse disease processes, serving adolescent to older adult patients.

Demonstrated proficiency in IV therapy, wound management, psychiatric care, and the completion of SOC (Start of Care), ROC (Recertification of Care), REC (Resumption of Care), and RV (Revoked) documentation. Discharge Planner/Utilization Reviewer/Special Project Manager Amerihealth Caritas District of Columbia

05/2013 – 05/2014 Washington

Executed daily investigations and special projects as assigned. Functioned as the Discharge Planner for the entire DC line of business, cultivating established relationships with participating and non-participating providers.

Reviewed and interpreted clinical data to authorize services and determine placement criteria for inpatient and outpatient stays, durable medical equipment (DME), home health care, and hospice services for plan members.

Utilized InterQual Criteria, Microsoft Office Suite, and various IT products proficiently.

Discharge Care Utilization Manager

UnitedHealthcare

01/2012 – 05/2013 Elkridge

Managed transitional care for community and state products

(Medicaid/Commercial) in Maryland and the District of Columbia. Conducted daily clinical reviews of acute/post-acute inpatient stays utilizing Milliman criteria.

Assessed and evaluated complex inpatient care issues impeding discharge processes.

Provided referrals and assistance for social and behavioral health needs. Facilitated placement to post-acute services, including but not limited to Skilled Nursing Facilities (SNF), Subacute Residential Facilities (SAR), Long Term Acute Care Hospitals (LTACH), and Acute Inpatient Rehabilitation

(AIR).

Managed Single Case Agreements and Third-Party Liability (TPL) regulations.

Agency Registered Nurse

FlexRN

01/2009 – 06/2012 Stafford County

Provided Per Diem (PRN) nursing services in Emergency Room, ICU, Telemetry, Perioperative, and Occupational Health settings. (Now American Medical Staffing)

Employee Health Coordinator

Bon Secours Baltimore Health Systems

06/2010 – 10/2011 Baltimore

EDUCATION

Western Governors University

Master's degree, Nursing

2024 – Present Utah

Concentration in Leadership & Management, Public and Community Health. Baltimore City Community College

A.A., Surgical Technology

01/1990 – 05/1991 Baltimore, MD

Eastern Senior High

high school diploma, College Preparatory /Accounting 09/1982 – 06/1986 Baltimore

SKILLS Medical coding EMR Systems

Laboratory experience HEDIS

Workers' compensation law ICD-9

Product demos Medical Terminology

Hospital Experience CPT Coding

Home Care Phlebotomy

ICD-10 NCQA standards

Sales Microsoft Excel

MCG Cerified Medical Necessity Review

Managed Care Acute care

Epic Clinical research

Utilization Management Medical records

Nursing Workers' compensation

Critical care experience ICU Experience

Microsoft Office Interqual

Long term care Anatomy Knowledge

Vital Signs Adobe Acrobat

Cerner Triage

Geriatrics Teaching

Hospice Care Medical Billing

Anatomy knowledge Medical terminology

Orthopedics Windows

Medication Administration ICU experience

Critical Care Clinical documentation improvement

Medical Records Computer skills

Nurse Management Delegating Nurse

Analysis skills Leadership

Vital signs Perioperative Care

Benefits administration Management

Microsoft Word Medical Management

Crisis Intervention Worker's Compensation

DRG Primary care

Community Health ODG certified

Home Health Care plans

Occupational Health Public relations

Behavioral Health Vendor management

Emergency Care Employee Orientation

Customer service Discharge Planning

Motivational interviewing Supervising experience

Training & development Public relations

Presentation skills Communication skills

Research

BLS, ACLS

American Heart

CCM #4252704

CCMC

02/2021

Certified Case Manager 12/2020

WCCM-Maryland #G0826

State of Maryland Workman's Compensation

11/2018

BLS Certification

CPR Certification

AED Certification

Compact State Nurse License

RN License 08/2000

CERTIFICATES

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