Manager Registered Nurse
Resume:
Rondine Gordon
Mountain view Pass
Stone Mountain,
Georgia 30087
*******@*******.***
Dedicated RN Case Manager
Dedicated, skilled Registered Nurse (RN) and certified case manager (CCM) with more than fifteen years of relevant experience. Broad range of healthcare experience providing excellent patient care while ensuring smooth nursing operations and regulatory compliance. Recognized as an exceptional team member always willing to ensure quality of care, appropriate utilization, effective discharge planning and evaluation of risk areas with timely and appropriate management.
Areas of expertise
. Quality medical record review . Quality Management
. Quality assessment . Compliance reporting
. Regulatory compliance . Efficient extraction of pertinent medical
. Proficient in electronic charting information.
Work Experience
Utilization Review Nurse United Healthcare 1/11/10 to Date
Work in the commercial and Medicare market providing utilization review for inpatient rehab, long term care and skilled nursing facilities.
.Reviewed benefits to verify appropriateness of patient stay and level of care, reviewing
.Extracted clinical information as provided by facilities and approving inpatient stays
using Milliman guidelines.
.Communication with case managers, therapists and physicians to facilitate
discharge planning, safe and timely discharge of patients to the next level of care.
Case Manager 6/2007 – 1/10/10 United Healthcare, Dunwoody, GA
.Worked on a designated account providing case management to members for assigned
cases .
. Provided telephonic care to members with multiple disease conditions.
.Provided health care teaching, educate member on their insurance benefits as it relates
to their insurance plan, encouraged members to take full advantage of their health
insurance benefits especially well visits.
.Assisted members in locating in network physicians and facilities to decrease members
out of pocket expenses.
.Communicated with physicians to obtain pertinent info to assist with members care
with member’s permission, refer members to other support services example
behavioral health, MSW, disease management and customer service in order to provide
total care. .Communicated all relevant info to team lead and manager, participate in
medical review case conferences sharing interesting cases with entire team for
discussion and new ideas.
.Preceptor new staff members providing feedback to manager and continue to provide
guidance as needed.
Sedgwick CMS December 2006- June 2007, Dunwoody, GA.
Analyze reported claims, determine benefits due and make timely payments and adjustments.
. Medically manage disability claims specializing in claimants with mental nervous
conditions, claimant with workman compensation claim and other medically
complicated claims.
. Coordinated investigative efforts by contacting the claimant, supervisor and physician
to gather info to determine eligibility of the claim. Thoroughly review contested
claims, evaluate and arrange appropriate referral of claims to outside vendors, and
negotiate settlement of claims up to the designated authority level.
. Triaged claims to the appropriate disability specialists in a timely manner make
appropriate referral to the relevant support network based on diagnosis.
United Home Care 4/2006 – 12/2006 Decatur
Worked in the home care field provided case management.
. Responsible for admission of patients with completion of oasis, following patients
through their certification period providing wound care (including using wound vac),
care of Picc lines and administration of intravenous medications.
. General assessment of patients, provision of medication and disease process teaching
to patient and family.
. Communicated with physicians and other members of the health care team to provide
total care for patient at home and reduce or eliminate rehospitalisation and promote a
safe environment for patient and care giver to promote comfort while providing care
through education and teaching.
. Performed venipuncture for labs, performing Coumadin teaching and management.
.Recommendation and supervision of home health aides to ensure following of care
plan.
.Priortorising and coding of disease conditions to ensure proper care of patient.
.Documentation on patient’s condition and contact with other disciplines for care
coordination.
RN12/2004 - 4/2006 DEKALB MEDICAL CENTER, Decatur, GA.
Worked as RN on an ortho, neuro, gynae unit.
.Assessed patients, medication administration both oral and intravenously, teaching
patients about medications effects and side effects and the importance of reporting
adverse effects.
. Administration of blood and blood products, performing wound care according to
protocol, execution of physicians orders in a timely manner, communicating with
clinical coordinators, physicians, colleagues and all other members of the health care
team to provide patient with total care.
.Performed pre and postoperative care for patients. Communicated with patient’s
relatives about their progress without HIPPA violations, documentation of care
provided. Prepared patients for discharge from hospital promoting wellness for home
with regards to diet, disease processes and the importance of completing medications
and following up with physicians.
.Educating family members while preparing them for discharge on steps that can be
taken to promote patients wellness at home.
.Supervision of nursing assistants.
RN6/2001 - 8/2004 Bermuda Hospital Board, Paget, and Hamilton
. Provided care for patients post surgery and with medical conditions.
. General assessment of patients, wound care, enteral feeding, and medication
administration.
.Supervision of staff, making staff assignments, resolving problem as they arise on unit
with regards to patient care and staffing. Reported on total unit activities to
Supervisor in charge, maintained census records to accept the appropriate admissions
when bed was available.
.Assisting with the smooth running of unit activities by coordinating care with
physicians, colleagues and other members of the health care team.
RN/ Office Supervisor 5/1998 - 9/2001 Eureka Medical center, Road town, Road town
Worked in an internist office/ medical clinic
. Assessed patients, prenatal monitoring, and assisting physicians with procedures,
insurance verification and obtaining pre-certification prior to some procedures.
.Accounts receivable, coding and billing insurance companies. Assisted physician with
conscious sedation for patient undergoing endoscopies, pre and postoperative teaching,
following up with patients at home for continued care.
.Supervision of all office staff, maintenance of patient’s records and filing.
RN 9/2000 - 6/2001 Peebles Hospital, Road town, Road town
.Worked in all areas emergency, pediatrics, meds/ surge, ICU and Gynae. Provided
general nursing care for patients, triaging, assisting physicians with procedures, and
communicated with all disciplines to ensure care coordination.
.Supervision of staff on different shifts. Ordering of supplies and maintaining inventory.
Education and Honors
.Chamberlain college Of Nursing
Bachelors of Science in Nursing with President’s Honor 10/24/2010
.New Amsterdam School Of Nursing
Diploma In General Nursing 9/15/2006
. University Of Guyana
Certificate in Supervisory Management
. Kaplan University
Certificate in coding(in progress)
. Certification
CCM Certified
.License
State of Georgia(active)
.References available upon requests.
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