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Title Quality Assurance Case Management
Target Location US-FL-New Port Richey
Email Available with paid plan
Phone Available with paid plan
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Candidate's Name , RN, HCM-C, NM-CSpStreet Address  C: PHONE NUMBER AVAILABLE EMAIL AVAILABLEPROFESSIONAL EXPERIENCE:Regency Oaks Senior Living Community, Clearwater, FLDirector/Administrator of Innovative Services April 2018 - PresentAdministrator of Innovative Home Services (IHS) which includes implementing policies of the agency and supervising provisions of direct care servicesParticipate in Strategic Planning that reflects the agencys mission and evaluation of internal and external environments effecting agency viability, growth and financial stabilityCoordinate services, including alternative resources, as needed, within professional and state guidelinesComplete Case management for clients, families, and additional care takers that are involved with the continuum of careMarket the Home Service program to appropriate internal and external audiencesPerform budgeting within the accounting system that promotes the health and safety of the clients and associatesPrepare annual budget for approval by Governing BodyReview financial statements, operating results, and performance evaluations on an on-going basisOversee the recruiting, hiring, orientation and training of areas associates.Provide education to families, clients and staff membersManage staffing coverage for the provision of services on a day-to-day basisComplete preparation for regulatory and independent reviews including, Community Health Accreditation Partner (CHAP) and Department of Health (DOH).Complete Quality Assurance (QA) and Performance Improvement (PI), Risk Management, Comprehensive Emergency Management Plan (CEMP), and other routine and/or ad-hoc reporting.Participate in Patient Safety Committee.MAOS and Provider educationLong Term Care insurance filing and prequalification, ICD 10 CodingAngelina Theresa Bucci Eye Surgery Center, Inc., Wilkes-Barre Twp, PADirector of Surgical Services March 2015  January 2018Supervise daily clinical operations of the surgery center and manage the clinical and clerical staff.Direct patient care (including circulating) and oversee patient activities in preoperative, postoperative, and intraoperative areas.Systematically monitor the nursing standards of practice, standards of care, standards of performance, and consumer satisfactionWrite and/or update polices in accordance with DOH, Joint Commission, Center for Medicare and Medicaid Services (CMS), and Accreditation Association for Ambulatory Health Care (AAAHC) guidelinesEnsure compliance with regulatory agencies and accreditation standards.Responsible for Quality Assessment, Risk Management, Peer Review, Utilization Review, Patient Safety andPerformance Improvement initiativesMember of the Strategic Planning(Lead), Peer Review, Therapeutic, Medical Advisory, Utilization Review, and Quality Assurance/ Performance Improvement Committee.Responsible for all staff development, education, orientation, appraisals, and discipline.Wound Healing Center at Wilkes-Barre General Hospital, Wilkes-Barre, PAClinical Manager March 2008  March 2015Assist with wound related procedures including biopsies, debridements, graft applications, and hematoma evacuationsResponsible for staff education on wound care staging, assessment, and treatment, debridement procedures, nutritional needs, and patient safetyAdministering of Hyperbaric treatment to patients.Case Management, including but not limited to, nutritional risk assessment, screening with care planning, fall risk, national patient safety evaluations, and collaboration of carePerform and/or participate in compliance related auditsExperience and Familiarity with ICD 10 Coding, Pre authorizations,MAOS and provider educationPart Time/Per Diem WorkCeltic Home Health Agency, Kingston, PAHome Health Registered Nurse/Consultant July 2012  December 2015Geisinger Health System, Wilkes-Barre, PAQuality Data Specialist Performance Improvement February 2007  July 2008SkillsCase Management, Risk Management, Infection Control, Wound Care, Quality Assurance, Performance Improvement, Audit/Compliance, EMR Systems, Utilization Review, Data Abstraction, ICD coding, Pre Authorization, Insurance ClaimsLICENSE/CERTIFICATIONS:Registered Nurse (RN)oFlorida (Multistate)oPennsylvaniaCertified Wound Care AssociateCertified Health Care Manager (HCM-C)Certified Specialist in Nursing Management (NM-CSp)Advanced Care Life Support (ACLS)Basic Life Support (BLS)EDUCATION:Excelsior College, Albany, NYAssociate of Science in Nursing January 2012Wilkes-Barre Area Career & Technical Center, Wilkes-Barre, PALicensed Practical Nursing Program (LPN) December 2003

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