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Candidate's Name , RNElgin, IL Street Address  PHONE NUMBER AVAILABLE EMAIL AVAILABLEAll About Childcare Health, McHenry, IL (hybrid) October Street Address   currentNurse ConsultantProvide onsite health assessments, medication audit, review health forms/vaccination records, etc.Observe staff/teachers interaction with children, childrens behavior/health e.g. infectious diseases, behavioral health.Inspect/survey and create reports on safety/infection control settings in compliance with the Department of Children and Family Services (DCFS) Rule 407 & Illinois Department of Public Health (IDPH) infection control precaution guidelines.Guidehealth (formerly Arcadia.io), Rockford, IL (remote) December 2022  April 2024Nurse Case ManagerTelephonically outreached members with complex/chronic conditions and post hospitalized members within 48 hours to assess which ones are in critical condition to prevent re-admissions and identify any barriers in achieving their health goals.Collected and reviewed medical records daily for members with managed care insurance from utilization review depts database, hospitals EMR/reporting system or via calling/faxing hospitals/physicians offices to identify which member needs case management e.g. cardiac diseases, respiratory, diabetes, cancer, CKD, behavioral / mental health.Collaborated with utilization management nurses to resolve issues within BCBSs policy and guidelines.Coordinated members medical care with physicians, hospitals, dme companies, pharmacies, DME and local resources etc. to resolve members medical issues within BCBS policies and guidelines.Created care plans using the nursing process using SMART goals.Collaborated with multiple hospital network I.T. staff to set up EMR and reporting systems.iPlace agency (Molina Healthcare Insurance), Oakbrook, IL (remote) May 2022  November 2022Nurse Case ManagerPerformed daily outreach to qualified members to determine qualification for case management based on clinical judgment, changes in member's health or psychosocial wellness, & triggers from the assessment.Developed members care plans in collaboration with their physicians, other healthcare professionals; including community resources, Department of Aging, Division of Rehab Services, etc. to resolve members barriers to health care.Collected/reviewed medical records daily for members with MCO from utilization review, hospital/physicians offices to identify which member needs case management e.g. Cardiac, pulmonary, mental health problems.Collaborated with utilization management nurses to resolve issues within BCBSs policy and guidelines.Crescent (formerly Citadel) Rehabilitation/ Skilled Nursing Facility, Elgin, IL and March 2017  March 2020 ProMedica (formerly ManorCare) Rehabilitation/ Skilled Nursing Center, Arlington Heights, IL March 2017  March 2020Floor Staff Nurse SupervisorPerformed direct bedside nursing care: administered medications for patients with complex chronic medical history, hospice/palliative; triaged patients new or any medical changes; kept doctors/patients & patients families informed of illnesses (acute or follow-up), laboratory/radiology results, new medication orders/adjustments, etc. Facilitated admissions & discharge of patients.Collaborated with clinicians/ case management team to ensure completeness of medical documentation for discharge planning and create care plan to follow CMS policy guidelines Medicare/ Medicaid/ managed care/ and other insurance companies billing policy/ requirements.Centrad DME Healthcare, Compliance Dept., Naperville, IL September 2012  October 2015Utilization Review NursePerformed medical records review for completeness in response to Medicares requirements for prior authorizations/ audits/ appeals including cases to present to Medicares Administrative Law Judge (ALJ).Helped educate staff of required medical records to submit with claims to justify medical severity of illness; purpose of clinical forms/doctors orders; use of equipment; basic diagnostic lab results, drug indications; & composed letters daily to justify medical necessity of medical supplies/ equipment.Neighborhood Family Healthcare, Chicago, IL January 2003  December 2008Administrator/Clinic AssistantProcessed medical claims, financial contracts for self-pays, insurance contracts, medical/legal paperwork for occupational health, workers comp, disability cases, including managed care/Medicare utilization reviews in preparation for audits/ appeals.Triaged walk-ins, scheduled appointments, prepared meds & labs/radiology forms/results, and medical supplies/equipment.Coordinated procedures/surgeries with specialists, hospital depts., insurance companies with required documentations (referrals, history & physicals, authorizations, etc.).Swedish Covenant Hospital, Family Practice Department, Chicago, IL September 1994  December 2002Outpatient Clinic SecretaryAssigned patients to appropriate physicians/hospital depts.; answered phone calls for appointments & registered patients.Coordinated surgeries with insurance companies, hospital depts., & physicians with required documentation (referrals/authorizations; H&P; test results, etc.).Reviewed medical records daily for accurate physicians documentation in accordance with clinic policies for proper billing and assignment of ICD / CPT.Education:Elgin Community College, Elgin, IL  Associates in Nursing, Registered Nurse License# 041-404507.EMR/Computer Applications:EPIC, Cerner, Powerchart, Meditech, MXO, Point Click Care, Brickell, Microsoft Office Suite, CCA, QNXT, M360, Bamboo/Ping, Winscp.