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Click here or scroll down to respond to this candidateCandidate's Name , R.N, BSN,MSNPhone #:PHONE NUMBER AVAILABLEE-mail:EMAIL AVAILABLEProfessional Registered Nurse (RN), passionate to work as "UM Nurse" where I can utilize my knowledge and experience to improve patient's and member's healthcare experience. My "Professional Summary" includes:Experience working with multidisciplinary team of doctors, nurses, and clinicians to provide excellent care to patients and their families in multiple health care settings.Experience in assessment of patients health, psychosocial needs, and support systems and consider their cultural preferences.Experience in EPIC implementation, upgrades, and enhancements and responsible for facilitating delivery of quality patient care with electronic health record and financial systems.Experience working as Nursing Instructor to provide optimal learning experiences.Experienced registered nurse to assess, develop, implement, monitor, and evaluate care plans designed to optimize the members health across the care continuum using Cognizants'Care Advance' and related digital tools and apps.Knowledge to serve as a liaison for clinicians to facilitate a common understanding of information system needs end user processes.Knowledge and skill in collecting, analyzing, organizing, structuring, and exchanging various data in healthcare settings.Deep understanding to implement socio technical approach towards the development, deployment, and maintenance of health information technologies.Team player and a demonstrated self-starter needing minimal supervision.Knowledge to assess and recommend new and emerging technologies in terms of their impact and potential strategic value to an organization.Knowledge in HIPAA regulations and working experience with Medicare, Medicaid, Medicare Advantage patients.Knowledge and understanding about the Health Insurance Industry, Standards, Referrals, Pre-Auths.Able to maintain a professional and ethical behavior at all times.Excellent communication and presentation skills to deliver both clinical and economic data.Able to connect patients with social and community support systems for continuation of care and building a great relationship with the patients and families in person and via telephonic conversations.Education Qualification:Master of Science in Nursing (MSN) with major in Nursing Informatics: University of Michigan, Ann Arbor. CGPA 3.5Bachelor of Science in Nursing (BSN): Combined Institute of Medical Sciences and Research & College of Nursing, Dehradun, India (Graduated in December 2009). CGPA 4.0Technical Skills:Microsoft Office Package: MS-Word, Excel, Outlook, Power-Point,Visio, OneNote, TeamsElectronic Health Record System's: EPIC, Cerner, Practice Fusion, DeVero, PyxisMedical Claims Processing Software's: Facets (claim processing software)Database Management System's: Sybase, SQL(Application to query the database to find data as needed)Statistical Analysis System's: SASCare Management Tools: Care Advance, Blue Cross Coordinated App, True CareClinical Skills:-> NICU experience -> Medical Surgical experience-> Behavioral Health experience -> Emergency response-> Superior clinical abilities ->Teaching/Instructor/Educator experience-> Excellent interpersonal skills ->Critical thinker-> Patient assessment ->Time management->Empathetic, supportive, and a good listener ->Health Insurance Industry Understanding-> Strong problem-solving skills -> Telemetry monitoring-> Team player -> Verbal de-escalation-> Excellent communication/documentation skills ->HIPAA/Referrals/Pre-Auths/Medicare/Medicaid-> Preventive care experience -> Managed Care experience->Chronic care experience -> Knowledge of HEDIS-> Homecare experience -> Knowledge of CMS and MCG guidelines->Health Plan experience -> Medicare/Medicaid Experience->Proficient in using electronic health record systems->Ability to work flexible work schedule.Affiliations and Registrations:2013-Present: Registered Nurse (RN), Michigan Board of Nursing (Permanent ID # 4704297430)North Carolina Board of Nursing license # 3422692010-Present: Nepal Nurses Associations, MemberRegistered Nurse (RN), Nepal Nursing Council (Registration # 13801)2010-Present: Indian Nurses Associations, MemberRegistered Nurse (RN), Indian Nursing Council-Uttarakhand (Registration # 1127)Member of Honor Society (http://honorssociety.org/)Basic Life Support (BLS) Certification from American Heart AssociationCMC (Case Manager Certification)-In ProcessCertification in Chronic Care Professional (CCP)- In ProcessProfessional Experience:Meridian/Centene Health, Detroit, MI March 2022-Oct 2023Position: Case Manager, RN, BSN, MSNAs a Registered Nurse 'Case Manager' working for Meridian Health/Centene Corp. my roles, responsibilities and experience include but not limited to:Coordinate and provide care that is safe, timely, effective, efficient, equitable, and client centered.Handle case assignments, draft service plans, prepare care plans, review case progress, and determine case closure.Help clients achieve wellness and autonomy.Facilitate multiple care aspects (case coordination, information sharing, etc).Help patients make informed decisions by acting as their advocate regarding their clinical status and treatment options.Develop, assess, and adjust, as necessary, the care plan and promote desired outcomeAssess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short- and long-term goals, treatment, and provider options.Coordinate services between Primary Care Physician (PCP), specialists, medical providers, and non-medical staff as necessary to meet the complete medical socio-economic needs of clientsDevelop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needsAbility to work independently and efficiently in a remote environment.Provide patient and provider education and Facilitate member access to community-based servicesDevelop effective working relations and cooperate with medical team throughout the entire case management process.Arrange abeyances with social services, health, and governmental agencies.Take the extra mile and interact with patients to keep track of their progress and to ensure satisfaction.Record cases information, complete accurately all necessary forms and produce statistical reports.Promote quality and cost-effective interventions and outcomes.Assess and address motivational and psychosocial issues.Adhere to professional standards as outlined by protocols, rules, and regulations.Blue Cross Blue Shield, Detroit, MI June 21-Feb 22Position: Care Manager, RN, BSN, MSNAs a Registered Nurse 'Care Manager' working for my client, my roles, responsibilities and experience include but not limited to:Coordinate with multidisciplinary team to provide holistic, person-centric care to a diverse health plan population with a variety of health and social needs.Prepare and use the case management process to assess, develop, implement, monitor, and evaluate care plans designed to optimize the members health across the care continuum.Experience in engaging and managing members/patients telephonically to provide coordination of care.Expert in using 'Care Advance' application and various digital channels like 'Blues Coordinated Care app' to prepare individualize plan of care and communicate with members back and forth.Assess the member's health, psychosocial needs, support systems and consider their cultural preferences.Coordinate patient/members care delivery and support with providers, community-based agencies, home health care and families.Prepare member and or caregiver for discharge from a facility to home or another healthcare facility to support continuity of care.Educated the member and/or caregiver about post-transition care and needed follow-up.Maintain or exceeded established compliances, audit and met required deadlines.Beaumont Health System (Farmington Hills, MI) Sept 2017-Dec 2017Position: Informatics Nurse, RN, MSNDuring my work in Beaumont Health, my roles/responsibilities include but not limited to:Worked with Informatics Nurse Director, Nursing Informatics team, project teams, external vendors, department's directors during planning and implementation of new EPIC Rover System(A bar code equipped device/system that enhances patient safety to prevent medication errors hence improve the quality and safety of medication administration.)Worked with the project team to review, finalize and communicate the implementation plan to department and nursing staffs.Advocated how the technology integration on the existing nursing workflow be beneficial to all areas of healthcare (Nurses, Doctors, Patients, Families and Healthcare Administrations)Worked with nursing staffs to provide necessary communication, training, handout, about the new technology prior go live.Worked with team to analyze the data from the Rover system and collected the feedback and experience from nursing staff to measure whether the technology has improved patient outcomes.Worked closely with project team and operational stakeholders.Worked with multidisciplinary team to understand and suggest the optimal methods in nursing process, practice, relevant regulatory mandates, and principles of quality/safety improvement.Henry Ford Kingswood Hospital (Ferndale, Michigan) July 2013-July 2015Position: Registered Nurse (RN)As a Registered Nurse (RN) working in Henry Ford Kingswood hospital, my roles, responsibilities include but not limited to:Worked as a Registered Nurse in management and supervision of child and adolescent in acute care behavioral unit.Worked directly with doctors, nurses, and healthcare administrators to care and make treatment plans for patients.Worked to improve patient outcomes by integrating evidence-based practice and standards of excellence into clinical practice.Designed, directed, and implemented teaching plans to patients and their parents to meet specific needs in relation to the diseases, process, and treatment regimen.Prepared medical records, involved in team meeting to provide nursing consultation and support in matters of clinical care.Prepared discharge plans and involved patients and family in the discharge process and followed up on the care plan regularly using telephonic calls.Worked extensively as a super user during EPIC an 'Electronic Medical Record System implementation, upgrades, and enhancements as well as to suffice the daily needs as that relates to customers, patient, and hospital.Coordinating critical activities across the design, test, train, and go-live phases of EPIC implementations.Deliver education to patients and their members, which include health education, self-management skills, medication plans, nutrition, and weight management during the hospital stay and included relevant information during discharge plan.Worked on a team to develop learning modules, prepared training materials and handouts for existing and new users about the software use within the department.Nobel Nursing College (Pokhara, Nepal) Jan 2011- Aug 2011Position: Lecturer/Nursing InstructorAs a lecturer/Nursing Instructor, my core responsibilities included but not limited to:Teach students per the curriculum which included lecture, laboratory, and clinical skills training.Review lesson plans and prepare for class instructions and electronically record assignments, actively promote student retention, support Clinical as applicable, and perform related work as required.Provide clinical instruction and evaluation to students in a clinical setting.Meeting all agency requirements as required by the clinical site.Assessing student work and performance, working with lead faculty to provide optimal learning experiences.Assigning and submitting grades in accordance with established Nobel Nursing College schedules.Gandaki Medical College/Teaching Hospital (Pokhara, Nepal) June 2010- Jan 2011Position: Registered Nurse (RN)As a Registered Nurse working as part of level 3 and 4 Neonatal Intensive Care Unit (NICU), my core responsibilities included but not limited to:Provided expert care of the neonate, endangered through premature birth, birth defects, neurologic, renal, cardiac concerns, infants requiring advanced ventilation and extracorporeal membrane oxygenation.Prepared infants for surgical procedure and monitored post-operativelyResponsible for managing both peripheral and central lines along with drawing blood sample, administrating medications for neonates.Provided emotional support, encouragement to family during hospital stay and prepared discharge plan.Miteri Hospital and Research Center (Kathmandu, Nepal) Dec 2009-June 2010Position: Registered Nurse (RN)As a Registered Nurse working for Medical Surgical Unit, my primary duties and responsibilities included:Provided individualized patient care by assessing the patient, identifying/analyzing potential problems, developing, and implementing a nursing plan of care and evaluating the care of the assigned patient under limited supervision.Utilized clinical expertise to remove sutures, administer medications, IV therapy, test glucose level, perform veni puncture and provide wound care.Closely worked with pre- and post-surgery of patients with acute health conditions which require some form of surgical interventions such as tracheotomy, feeding tube and IV unit.Worked as a wound care clinician to identify wound types, select treatment plans, and prevent infection to patients dealing with chronic and acute wounds.Developed fine skills on various nursing procedures like Foleys catheter, IV therapy, dressing, administering medicines, charting, admission of patients and discharge.References:Upon Inquiry. |
