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Case Management Manager Resume Syracuse,...
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Title Case Management Manager
Target Location US-NY-Syracuse
Email Available with paid plan
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E-MAIL: EMAIL AVAILABLEPHONE NUMBER AVAILABLEEXPERIENCE9/2023-currentBinghamton NY, Good Shepherd- HR Wellness RN/Infection PreventionistMaintains employee health program for all employees to ensure all health code requirements and all local, state and federal regulations are met.Performs all employee physicals including tuberculin testing, vaccinations, health assessments and performing respiratory fit testing.Provide general orientation, mandatory in-service, continuing education, and other training to meet all department and facility needs and regulatory requirements.Perform competency skill to assess safety in the work place and annually.Observation of employee med pass/job dutiesWork closely with the HR director and managers to coordinate an employees return to work assignment to include case management and set reasonable accommodations as needed for return to work.Maintain all Employee Health Files and purge as requiredMaintain confidentiality of all records and data.Coordinate Infection Control including tracking statistics and communicating policies and procedure in conjunction with the Director of Human Resources. Work closely with the Health Care Administration on facility infection control manual.Perform competencies to keep skills up to date.Leader of infection controlContribute to management team in such forums as leadership meetings and special meetings and committees; QAPI, Safety/safe Patient handling and corporate compliance.11/2022-9/2023Endwell NY, UHS Endwell Internal Medicine- Registered Nurse (Triage Nurse)Coordinates Clinical training, orientation and ongoing evaluation of new existing clinical staffComplete and submit all clinical competencies at a time of hire and annuallyIn collaboration with the unit coordinator, coordinates clinical schedules, ensuring appropriate clinical supportThe RN provides clinical leadership while overseeing the scope of practice of LPNs and Medical Assistants in the officeTriages and assesses patients for early identification of signs and symptoms to prevent complications and ensure timely interventionEducates patient and family in health promotion and disease management using available resourcesUtilizes a working knowledge of pharmacology and safely administers medicationsMaintains and performs Lab testing and oversees proficiency validation and lab credentialingCollaborates and leads patients, families and all members of the health care team in coordinating patient careIn collaboration with the Unit Coordinator, participates in and facilitates Performance Improvement activitiesCollaborates with the Unit Coordinator to promote and facilitate the compliance and understanding of all regulatory standardsParticipates in educational opportunities and in collaboration with the unit coordinatorActs as a resource for all clinical staffDemonstrate commitment to organizational Values of Compassion, Trust, Respect, Teamwork, and Innovation4/2022- 11/2023Ithaca, NY Franziska Racker Agency- Residential RNComplete nursing evaluationsProvide medical care to individuals and staff as neededMaintain and review medical and health informationProvide initial training of nursing tasks or activities and periodic inspection of the actual act of accomplishing such tasks or activities to unlicensed direct care staffProvide assistance to Licensed Practical NursesConfer with medical professionals with developing and implementing an individual health care program/nursing care planParticipate in individual life plan conferences for medical and/or health related concernsComplete self-medication assessments on assigned individuals and supervise staff in the implementation of self-medication goal plansTrain staff in medication administration and other health and medical skills or techniques (ex. CPR, First Aid, Fire Safety, etc.)Perform or review medication inspections at designated sitesInvestigate incidents/accidents related to medication errors and/or health concernsConform to program changes and regulations and keep abreast of developments in the fieldPerform required duties in a productive and safe mannerAct as role model to individuals receiving services and staff3/2021-4/2022Harford, CT Carecentrix- Nurse LiaisonDetermine the optimal site of care post hospital discharge and develop a discharge planManage and influence the transition of assigned Post-Acute Care patients from acute care setting to the SNF, IRF, LTACH or home settingFacilitate home health physician orders for home care upon a patients discharge to homeContact referral sources to advise and relay updates to the appropriate individualsPartner closely with the PAC Medical Director in reviewing discharge plans and length of stay status to ensure optimal outcomesCommunicate customer service/provider issues to supervisorEngage and coach the patients/caregivers for performing standard assessments, patient care plans, and document progressWork closely with the home health agency nurse to facilitate education and adherence to establish health care goals and care planAct as a clinical resource for unlicensed staff, to provide clinical expertise and help with referral source directivesParticipate and contribute to ongoing quality assessment/improvement activities, performance, data collection, analysis, operational processesAssist team in implementing and maintain standardized operational processes to ensure compliance to company policies, legal requirements and regulatory mandatesEstablish and maintain professional working relationships with hospital staff and physicians10/2019-3/2021Endicott, NY Ideal Senior Living Center- Reimbursement Coordinator/MDS CoordinatorProvides direct supervision to the Minimum Data Set (MDS) nurse completing all data collection and data entry to the MDSMake determination of Medicare coverage; notifies responsible party and provides requested documentation to support Medicare decisionCoordinates all MDS to assure completion within the time frame mandated by the Department of HealthMaintains the Care Conference schedulesConducts MDS meeting and trains/updates all staff on any new developments and instructions regarding the MDSConducts continuing education for staff to provide clear guidelines for documentation requirements for reimbursementWorks closely with other departments to assure reimbursement issues are addressedRepresent interdisciplinary record keeping and ensures that compliance issues are communicated to the appropriate staffWorks closely with finance department, providing updates on changes in payer sources, submission information and demand billsAttends all mandatory and required number of optional in-service training sessionsMedical Appeals9/2007-10/2019Binghamton, NY Corporate Care Management-Nurse Case ManagerPre certify services requested by providersMedical appeals and completion of medical review for Physician determination of coverageExperimental/Investigational reviewsCosmetic procedure reviewsBilling and coding dispute resolutionPlan interpretationCase managementConcurrent reviewsMedical necessity reviewsNegotiate and secure transplant rates10/2006-9/2007Owego, NY Riverview Manor Nursing Facility Inservice EducatorResponsible for scheduling and conducting state mandated in-servicesProvide re-education to all disciplined staffMonitor all CPR and CNA certification expirations and complete all necessary paperwork for recertificationProvide immunizations to staff and volunteersComplete and maintain all employee health recordsComplete and revise policies and procedures, as necessary7/2006-10/2006Owego, NY Riverview Manor Nursing Facility Nurse ManagerResponsible for all admission and discharge informationComplete daily treatments as ordered by physiciansAdminister mediations when necessaryAct as part of the interdisciplinary care conference teamProvided direct supervision to the LPNs and nurse aidesConduct weekly physician rounding and complete orders as writtenProvide support to the residents and their familiesPatient advocate8/2005-7/2006Owego, NY Riverview Manor Nursing Facility  Assistant Director of NursingPatient advocateProvide help to the director of nursing and complete duties as assignedMonitor scheduling issues and provide coverage as neededMonitor weekly skin program and conduct weekly interdisciplinary skin meetingInfection control nurseCollect data and create monthly reportsAct as primary supervisor during the absence of the Director of NursingMaintain daily censusAct as part of the quality assurance teamCoordinate preadmission screen with the Social WorkerComplete Patient Review Instrument when assignedEDUCATION1998-2002 Tompkins Cortland Community College- Associates Degree in Nursing1987-1989 TST Boces- Early Childhood Education1976-1989 Candor Central School- Local DiplomaLICENSURE & CERTIFICATIONNYS Registered Nurse Licensure received 2002.Case Management Education 2010Case Management Certification received 2011Advance Achievement in Transplant Management 2011CPR Certification 2023REFERENCESLaura Williams, BSN, RN Laurie Crowell Jennifer Zepkowski RNDirector of LHCSA/ALP Intake Coordinator RN/MDS CoordinatorPHONE NUMBER AVAILABLE PHONE NUMBER AVAILABLE PHONE NUMBER AVAILABLEPage 4

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