Director of Client Care

• May 2023 - Present

Behavioral Health Complex Case Manager

• Jan 2021 - May 2023

• Conduct behavioral and clinical assessments to identify an individual’s behavioral and clinical needs and develop tailored care plans. • Educate individuals on appropriate care and settings for their behavioral healthcare needs. • Coordinate care with providers to ensure all members collaborate on the care plan. • Assist individuals in understanding diagnostic tests, test alternatives, costs, risks, and treatment options, preparing for hospital admissions, inpatient stays, and discharge • Interface with members’ health plans to facilitate coverage and care decisions and direct individuals to facilities, agencies, and specialists for care; work with member-appointed delegates and interface with providers to coordinate care. • Educate and empower our members so they can navigate the healthcare system confidently. Show less

Registered Nurse case manager

• Mar 2019 - Jun 2020

Case Management• Applies accepted admission criteria to screen referrals before admission to determine medical necessity and level of care• Assess patient needs, goals, and barriers to the patient’s clinical condition, psychosocial environment, and socioeconomic resources• Conduct concurrent reviews and apply InterQual criteria to screen for medical necessity• Monitor length of stay, referral sources, and readmissions• Evaluates the effectiveness of care, systems, and environment and patients’ progress toward outcome to minimize avoidable days.Quality Improvement and Compliance• Establish best practices for the behavioral health utilization review process • Perform periodic audits to ensure provider compliance • Perform monthly audits to ensure clinical staff compliance• Monitors compliance in staff who perform utilization review activities and reeducate as necessaryEducation• Conduct annual mandatory education in a 4-hour class to staff on the Care of the Aggressive Patient • Conduct annual mandatory education in a 3-hour class for staff on Suicide Prevention• Conduct policy review with new hires regarding 1:1 observation, environmental rounding, and restraints• Provided one on one education updates to providers. Show less

Registered Nurse

• Nov 2018 - Mar 2019

• Making and reviewing work assignments for lower-level nursing personnel • Medication administration according to doctors’ orders• Documentation using an EMR system (Meditech)• Admissions and discharges• Providing a safe environment and diversional activities when needed• Administering STAT and PRN medications• Develop care plans based on individual medical and therapeutic needs• Assessing and recording physical and psychological status• Build positive relationships with patients, families, and members of the multidisciplinary team Show less

Utilization Review Nurse

• Feb 2018 - Nov 2018

• Review of admissions and concurrent records of patients for medical necessity and appropriateness using established guidelines • Assessing the patient’s needs, goals, and barriers to the patient’s clinical condition, psychosocial environment, and socioeconomic resources• Review InterQual Criteria to screen the patient’s condition• Assures compliance with regulatory and payor source requirements regarding patient status and case management• Acts as a liaison between the hospital, the attending physician, and third-party physician advisors.• Collaborates with the multidisciplinary team to plan, implement and evaluate the patient’s plan of care via daily rounds• Manages length of stay by proactively identifying and mitigating issues and barriers to care and a successful discharge plan• Actively addresses and monitors resource utilization using evidence-based standards during the patient’s stay Show less

Registered Nurse

• Apr 2015 - Feb 2018

• Served as a multidisciplinary team member providing direct patient care for geriatric patients suffering from behavioral health issues.• Medication administration according to doctors’ orders• Documentation using an EMR system (Cerner, Epic)• Admissions and discharges• Providing a safe environment and diversional activities when needed• Administering STAT and PRN medications• Develop care plans based on individual medical and therapeutic needs• Assessing and recording physical and psychological status• Build positive relationships with patients, families, and members of the multidisciplinary team Show less