Clinical Quality Analyst

• Oct 2022 - Present

Nurse Case Manager

• Nov 2019 - Oct 2022

• Assess, plan and implement care management interventions • Appropriate use of clinical criteria and policies to meet company standards • Identify and initiate referrals for both healthcare and community based services • Coordinate care needs for the Dual Special Needs Population (DSNP) member, ensure compliance with the Special Needs Model of Care (SNP MOC) criteria • Perform field and virtual visits with members in homes and other settings to assess for PCS/PDN needs. Transition of Care duties including medication reconciliation to prevent readmissions Show less

Medicare Field Nurse Case Manager

• Jun 2013 - Nov 2019

• Telephonic and field visits to assess, plan, implement and coordinate care with members to evaluate needs reduce readmissions and address STARs gaps • Evaluate members’ records, completes assessments and individualized care plans (ICPs) within the required timeframes with a focus on safety and quality of care • Conduct current reviews and authorizations of Home health requests • Applied appropriate clinical criteria and policies to meet NCQA and company requirements. Monthly self/team audits of documentation to ensure quality and compliance Show less

Transitional Case Manager/Behavioral Health Case Manager

• Mar 2012 - Jun 2013

• Care Management of NC Medicaid Access II and dually covered Medicaid II/Medicare population. Embedded in hospital to perform care coordination, discharge planning, community resource linkage and referrals to admitted mbrs. • Enhanced transitional care to reduce hospital readmissions to include med teaching and chronic disease education using motivational interviewing. • Care Management of NC Medicaid Access II and dually covered Medicaid II/Medicare population. Embedded in hospital to perform care coordination, discharge planning, community resource linkage and referrals to admitted mbrs. • Enhanced transitional care to reduce hospital readmissions to include med teaching and chronic disease education using motivational interviewing.

Home Health Nurse

• Nov 2009 - Mar 2012

• Case Management of high acuity patient population, care coordination, Education • Provide hands on care and assessment to include IV therapy, TPN, tube feedings, wound care and medication management • Assess patient safety and reporting of adverse events • Case Management of high acuity patient population, care coordination, Education • Provide hands on care and assessment to include IV therapy, TPN, tube feedings, wound care and medication management • Assess patient safety and reporting of adverse events

Psychiatric Registered Nurse

• Oct 2008 - Nov 2009

Care of Psychiatric adult and pediatric emergencies Administer medications and prescribed treatments as directed by ED physician Conducted assessments and applied clinical criteria and policy to documentation and hand offs to comply with company and regulatory requirements Charge Nurse duties Care of Psychiatric adult and pediatric emergencies Administer medications and prescribed treatments as directed by ED physician Conducted assessments and applied clinical criteria and policy to documentation and hand offs to comply with company and regulatory requirements Charge Nurse duties

Licensed P&C Agent

• Jun 2000 - Apr 2007