| Candidate Information | | Title | Registered Nurse Case Manager | | Target Location | US-TN-Elizabethton | | Phone | Available with paid plan |
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Click here or scroll down to respond to this candidate502 South Watauga AveElizabethton, TennesseeStreet Address
PHONE NUMBER AVAILABLEQualificationsRegistered Nurse with a Bachelors Degree in Health Administration combined with over 30 years experience providing and/or coordinating medical and non-medical support to individuals and their families. Empowering individuals to function the best way possible within their environment, deal with interpersonal relationships, and address personal and family healthcare issues. Proven ability to help clients identify concerns, consider effective solutions, and determine reliable resources. Aptitude for quickly adapting to new situations, ensuring ability to promptly become an asset to my employer and co-workers.EducationAssociate of Applied Science, Nursing, East Tennessee State University, Johnson City, TN May 1992Bachelor of Science, Health Administration, East Tennessee State University, Johnson City, TN August 1986Relevant ExperienceElevance Health/Anthem, Knoxville, TNBehavioral Health Case Manager II, May 2023 present Remote position with 50% Field Work in assigned geographical location and 50% Work from Home. Field visits to member's homes, provider's offices, or other locations in the community as permitted. Responsible for performing case management telephonically and/or by home visits within the scope of licensure for members with behavioral health and substance abuse or substance abuse disorder needs.RN Care Coordinator TNCARE CHOICES Program, October 2016 June 2017Provide care coordination for CHOICES members: physical health, mental health, and long-term care needs. Perform comprehensive, individual assessment of health and long-term care needs and determine the services most appropriate to meet individual member needs. Develop plan of care, in collaboration with member and caregiver, to ensure that member is receiving the right kind of long-term care services in the right setting: home and community-based services versus nursing facility. Ensure that plan of care is pertinent to member and updated appropriately to reflect changing needs.Ballad Health/Mountain States Health Alliance, Johnson City, TNRN Physician Office BHMA Pediatric Specialty, October 2022 May 2023Provide nursing care in physician office setting. Nursing assessment and delivery of care appropriate to age and developmental level of assigned patients. Documentation in EMR. Integral part of care teamPediatric Care Navigator - Niswonger Childrens Network, March 2022 October 2022Assist parents of Children with Medical Complexities to navigator the healthcare system. Act as a liaison between doctors, medical groups, insurance companies and patient care giver. Act as an advocate on patients behalf. Responsible for development and reassessment of individualized Care Plan, Care Map and a Care Notebook to meet the individuals needs.RN Physician Office/Prior Authorization Nurse BHMA Pediatric Specialty, October 2020 March 2022Provide nursing care to pediatric patients in the office setting. Float to clinical areas when a need is identified. Work with providers, patients, vendors, and insurance to obtain prior authorizations for needed medical care.Charge Nurse, Gero-Psych Unit, Sycamore Shoals Hospital, Elizabethton, TN June 2017 October 2020Ensure the effective and efficient delivery of nursing care and operation of the nursing unit consistent with hospital policies and procedure. Make nursing assignments based on patient acuity, the skill, experience, and competencies of the nursing staff. Evaluate and modify patient care assignments as needed. Promote patient-center culture of safety, teamwork, accountability, communication, and efficiency. Orient, evaluate and supervise temporary staff, new nurses, and other staff as needed. Preceptor for senior management practicum students for local university. Provide effective communication between nursing and other hospital staff, physicians, patients, their families, and visitors as appropriate.PCMH Patient Care Coordinator, May 2012 January 2013Collaboratively worked with patients, physicians, practice teams and health plan to integrate patients into the medical home. Engage patient in an active role in the management of their disease or medical condition and promote patient education and self-management skills. Assist in the identification of appropriate providers, facilities, and community resources to improve or maintain the patients social, emotional, functional, and physical health status. Promote whole person health support with the patient with emphasis on establishment of routine contact with the primary care physician and facilitate specialist referrals and other care as appropriated per physician orders. Work to coordinate diseases registry activities, performance reporting, and regular meetings with stakeholders regarding success or improvements within the medical home. Infection Prevention Practitioner, Oct 2008 - July 2011Implementation of the Infection Control Plan based on current, sound, and published epidemiological principles. Develop plan into policy and assure accessibility to team members. Surveillance and reporting of healthcare acquired infections to the facility and reporting of diseases required by the Tennessee Department of Public Health. Report conditions that warrant immediate action to prevent illness or injury. Coordinating compliance with The Joint Commission Standards for Surveillance, Prevention, and Control of Infection, the TOSHA Bloodborne Pathogen Ruling and applicable local, Tennessee State and Federal Guidelines addressing infection control or infectious diseases. Close working relationships with the Laboratory, Pharmacy, and all areas performing invasive procedures. Work collaboratively with Team Member Health, Organizational Development, Patient Safety and Quality. Active member of Value Analysis Team, Safety Committee, Clinical Policy and Procedure Committee, and Shared Governance committees. Conduct routine infection prevention classes for all team members. Community education and patients and family education relative to Infection Prevention.United Health Care, Kingsport, TNRN Care Coordinator TNCARE CHOICES Program, January 2016 October 2016Provide care coordination for CHOICES members: physical health, mental health, and long-term care needs. Perform comprehensive, individual assessment of health and long-term care needs and determine the services most appropriate to meet individual member needs. Develop plan of care, in collaboration with member and caregiver, to ensure that member is receiving the right kind of long-term care services in the right setting: home and community-based services versus nursing facility. Ensure that plan of care is pertinent to member and updated appropriately to reflect changing needs. Actively participate in the care planning process of nursing facility members. Conduct quarterly face to face visits with home/community-based members and semi-annual visit with nursing facility members. Utilization Management Nurse, United HealthCare (formally John Deere Health), 2002 2008Medical Review Unit - Post service medical review of inpatient and outpatient records for retro authorization/denial utilizing Milliman Care Guidelines and physician directive for medical appropriateness of services received. Inpatient Care Manager - Concurrent telephonic and onsite review of case-specific information for medical necessity of hospital admissions and continued stay using InterQual Criteria, Milliman Care Guidelines and/or physician directives. Electronic documentation of pertinent clinical information for individual reviews. Prepare cases, including preparation of clinical information and correspondences for physician review. Telephonic/face-to-face discussions with health care providers and members to explain medical necessity determinations and to obtain additional clinical information. Function as unit contact for Medicare appeals filed through CMS.Blue Cross Blue Shield of Tennessee, Chattanooga, TNDual Special Needs Program RN Care Coordinator, February 2015 October 2015Provide person-centered care planning, service coordination, and support services for DSNP members: promote interdependent collaboration for members care with the member, physician, family, and members of the care coordination team. Perform assessments of the members health care needs and implementation, monitoring, and evaluation of available resources to promote quality, cost effective outcomes while meeting the individuals healthcare needs. Assist members in the identification of appropriate providers and facilitate authorized services to improve or maintain the social, emotional, functional, and physical health status of the member. CHOICES RN Care Coordinator, January 2013 January 2015 and July 2011 April 2012Provide care coordination for CHOICES members: physical health, mental health, and long-term care needs. Perform comprehensive, individual assessment of health and long-term care needs and determine the services most appropriate to meet individual member needs. Develop plan of care, in collaboration with member and caregiver, to ensure that member is receiving the right kind of long-term care services in the right setting: home and community-based services versus nursing facility. Ensure that plan of care is pertinent to member and updated appropriately to reflect changing needs. Actively participate in the care planning process of nursing facility members. Conduct quarterly face to face visits with home/community-based members and semi-annual visit with nursing facility members.Sullivan County Regional Health Department, Blountville, TNCare Coordinator, Childrens Special Services, 1998 2002Assisted families of special-needs children (0 - 21) to obtain individualized medical and non-medical services, DME, and modification of home/community to attain the highest level of independence for each child. Empowered families to become effective managers of their childs care. Supported families in coordinating services regarding insurance/managed health care, obtaining and implementing referrals for medical care.House Call Home Health, Johnson City, TNRegister Nurse Home Health, 1995 1998 (PRN)Home visits of adult population for physical and psychiatric assessments and care. Private duty home care for pediatric population with traumatic brain injuries.Sycamore Shoals Hospital, Elizabethton. TNRegistered Nurse, 1997 - 1998Assessed and provided care to medical, surgical, and pediatric clients. Supervised LPNs and CNAs when assuming duties of charge nurse. Performed duties as required for client care.Greystone HealthCare, Blountville, TNStaff Development Coordinator, 1997Provided staff education and in service to all staff, CNA training, and orientation to all new employees. CPR Instructor certified by American Heart Association. Actively participated in administrative meeting and development/revisions of policy and procedures.North Side Hospital, Johnson City, TNRegistered Nurse, 1987 - 1997 (began nursing tenure in 1992)Assessed and provided care to medical, surgical, intensive care, and psychiatric/substance abuse clients. Performed client and family teaching, chart audits, admission pre-certification, admission evaluations, crisis intervention, and other duties as required for client care. Supervised LPNs and CNAs while acting as charge nurse. (Began tenure as registration clerk and transferred to nursing services while attending nursing school.)Woodridge Psychiatric Hospital, Johnson City, TNHouse Supervisor, 1995Supervised RNs, LPNs, and mental health technicians as house supervisor. Assured adequate staffing for oncoming shift. Performed admission nursing assessments, obtained insurance certification for afterhours admissions, obtained medications from pharmacy after hours, provided crisis intervention both in house and via telephone.Licenses/CertificationsRegistered Nurse State of Tennessee, License No. RN0000091845, Issued Date: 8/1992, Expiration Date: 5/31/2025.Case Management Certification, Certification Number: 00099422, Issue Date: 10/28/2006, Expiration Date: 11/30/2026American Heart Association BLS ProviderReferencesDeborah Myers, RN MSN: PHONE NUMBER AVAILABLEDawn Fullagar, RN: PHONE NUMBER AVAILABLEVictoria Mitchell, RN: PHONE NUMBER AVAILABLE/pre> |
