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Click here or scroll down to respond to this candidateCandidate's Name , FNP - CSKILLS Determine Medical Necessity Medication Side Effect Knowledge Delegation and Motivation Manage Cases Continuous Assessments Community Program Referrals Discharge Planning Coordination Physician Consultations Utilization Review Specialized Healthcare Referrals Contact Management SystemsLANGUAGESEnglishFull ProfessionalSpanishNative or BilingualCERTIFICATIONSAANP BOARD CERTIFIEDREGISTERED NURSEReliable individual bringing 8 years of nursing experience in healthcare environments. Maintains positive relationships with case managers and providers. Remains polished and calm under extreme stress. Detail- oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy. WORK HISTORYNP Clinical Experience Valdez Medical Clinic, Hialeah, FL November 2019 - CurrentUtilization Review Nurse HumanaPrescribed appropriate pharmacologic and non-pharmacologic treatment modalities to support health and comfort of patients.Ordered and interpreted diagnostic tests to develop and implement treatment plans.Assessed patients to determine individual needs and develop care plans in coordination with multidisciplinary healthcare professionals.Performed comprehensive physical examinations and documented patient histories to gather information and identify health issues.Educated patients on treatment options, medical needs, and non- medical options for treatments and therapy.Worked with families, caregivers and patients to determine best options for treatment, diagnosis, and prevention.Participated in multidisciplinary team meetings to discuss patient cases and treatment plans.Administered immunizations and performed other preventive health measures. Provided patient-centered care in variety of clinical settings. Perform timely prospective review for services requiring prior authorization and concurrent review for on-going servicesNotified providers by phone, fax, e-mail, or letter per protocol of authorization determinationWorked on a variety of special projects and assumed other duties as assigned Reviewed and evaluated requests for completeness Coordinated care and benefits across settings and providers for certain servicesContacted provider(s) to obtain the necessary information to make a coverage determinationSubmitted cases for criteria failures and helped facilitate resolutions and approvals.Evaluated medical guidelines and benefit coverage to determine appropriateness of services.Performed admission reviews based for medical necessity based upon CMS specification.Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.CONTACTMiami, Florida 33032PHONE NUMBER AVAILABLEEMAIL AVAILABLEOctober 2018 - November 2019Case Manager HumanaJuly 2016 - December 2017RN Case Manager One Home Care SolutionsJune 2013 - December 2014LPN Palmetto Sub-Acute Rehab CenterCollaborated with leadership to devise initiatives for improving nursing satisfaction, retention and morale.Completes comprehensive assessments of members per regulated timelines and determines who may qualify for case management based on clinical judgment, changes in member's health or psychosocial wellness, and triggers identified in the assessmentDevelops and implements a case management plan in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals and member's support network to address the member needs and goalsPerforms ongoing monitoring of the care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordinglyPerforms ongoing monitoring of the care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordinglyAssesses for barriers to care, provides care coordination and assistance to member to address concerns.Screen clients for healthcare needs, and develop client-focused case management plans, implement and document on-going activities Identify and address clients' risk factors and any obstacles to healthcare Coordinate daily case management and clinical care including initial assessment, benefits management, continued stay review and denial/appeal managementDelegate, direct and supervise implementation of care plan to LPN, PCT or other health care workers.Demonstrate knowledge and respect patient, service provider and organizational confidentialityprocedures and protocols under the HIPAA Privacy Policies and follow those procedures when using ordisclosing protected health informationAble to communicate with patients regarding their condition, and therefore should have goodinterpersonal.Assessed patient's conditions by thoroughly going through their records and medical historiesTook vitals, administered medications as ordered by physician, and prepared Monitored patient safety and fall precautionsFostered and cultivated open and collaborative lines of communication with physicians on the development and execution of comprehensive treatment plans Evaluated patient knowledge and provided education as needed Provided emotional and psychological support to patients and families Focused on ensuring all patient records were complete and maintained HIPAA complianceDocumented patient care services by making sure that all conditions, medications, responses and observations were properly recorded.EDUCATIONBachelor's DegreeChamberlain UniversityAssociate DegreeSABER CollegeMSN - Family Nurse PractitionerChamberlain University |
