• Conducted functional assessments and annual reassessments to determine eligibility and the appropriate level of care and services necessary, based on the person’s health and daily living needs.• Actively listened to member needs and addressed concerns promptly. • Educated individuals, their families, and caregivers about available services and assisted them in making informed decisions about care.• Developed, implemented, modified, and supervised the execution of an individual service plan (ISP) to deliver appropriate services. This involves collaboration with the individual, their family, caregivers, and healthcare providers.• Monitored the services provided to individuals to ensure they are effective, appropriate, and of high quality.• Followed state, federal, and organizational regulations for documentation. • Achieved over all yearly audit of 98.7%. • Demonstrated strong teamwork skills by actively seeking out opportunities to collaborate with other team members.• Precepted and mentored new colleagues, resulting in building positive relationships with colleagues and improved work processes.

• Maintained competency with the state and federal survey process. • Achieved Deficiency Free status on 2022 Home Health Agency Medicare Conditions of Participation State survey.• Maintained a positive, supportive and team-centered customer service approach in every interaction.• Assisted patients and their families to obtain the appropriate level and type of health, medical, financial and psychosocial care, as needed.• Managed day-to-day operations, ensuring effective scheduling and smooth service delivery.• Provided regular reports and updates to senior management on the branch’s performance, challenges and opportunities. • Maintained home health Star Rating of 3.5.• Ensured proper documentation is completed by all staff in all situations. • Conducted quality assurance and performance improvement processes including internal audit reviews, corrective action plan development, and completing QAPI meetings and forms. • Implemented corrective action plan as needed. • Reviewed evaluation packets, Oasis, and 485's for completion and accuracy, as well as accurate start of care date and episode date range according to physician orders. • Reviewed Oasis coding for completion and accuracy; ensure frequency of visits align with scoring. • Implemented patient plan of care; coordinated and monitored all services the patient required to determine effectiveness and make modifications as needed. • Managed and led case conference meetings weekly to discuss patient care and issues. • Led the recruitment, training, supervision, and performance evaluation of branch staff, optimizing efficiency and workplace morale.• Engaged in community outreach to establish strong relationships with other healthcare providers and organizations, thereby expanding branch visibility.

• Promoted communication between sales team and clinical staff, resulting in improved Timely Initiation Care to 95%.• Collaborated with Quality Audit Specialist and Coding Team and improved Oasis accuracy to 90%.• Mentored field staff on policies and procedures, standards of care, defensible documentation and order entry.• Minimized risk and incidents by daily communication with appropriate medical team regarding coordination notes, vital signs alert, lab results, wound score deviations. • Led weekly case conference and approved case conference notes submitted. • Completed field staff annual onsite performance reviews. • Acted as advocate and resource for patients assigned to Team A.

• Created a Culture of Safety that improved issues related to discipline, compliance and quality improvement within the home care nursing team.• Collaborated with Regency Healthcare in providing continuity of care.• Implemented programs as follows: home safety and fall prevention, disease management, medication education to homebound patients.• Provided services in the following territories: Houston, Sugarland, Pearland, Missouri City, Spring, Conroe, The Woodlands, Magnolia, Crosby, Wharton.

• Provided leadership and direction to staff members, including nurses, therapists, administrative staff and other professionals. • Ensured agency complied with all relevant regulations, laws and accreditation standards, including maintaining appropriate licensure, certifications, and documentations as well as staying up to date with changes in regulations. • Improved Star Rating from 2.5 to 3.5 • Achieved Condition of Participation State Survey results below the state average since 2015.• Gained and maintained Joint Commission accreditation since 2015. • Updated and implemented policies and procedures in accordance with current CMS Conditions of Participation.• Developed and implemented policies and procedures to minimize risks and ensure compliance with best practices. • Implemented Home Health Quality Initiative Programs within the average census of 120 patients in the Dallas/Fort Worth and East Texas areas. a. Emergency Management program in cooperation with various local agencies, increased patient awareness and disaster readiness by 84% b. Infection Control Program, reduced infections to an average of 5% quarterly c. Medication Reconciliation Project, led to an increase in medication safety to 99% and improved pain levels to 85% d. Fall Prevention Program, reduced incident of falls to an average of 6% quarterly

• Utilized nursing theories, skills and techniques with decreased length of stay by one episode.• Coordinated with multidisciplinary healthcare teams, including doctors, nurses and therapists, to efficiently implement individualized care plans, resulting in increased ambulation outcomes.• Coordinated with social workers and local community resources causing alleviated anxiety and financial burden on patients.• Conducted comprehensive initial and ongoing assessments of patients' medical, social, and emotional needs to develop tailored care plans.• Coordinated with multidisciplinary healthcare teams, including doctors, nurses and therapists, to efficiently implement individualized care plans, resulting in increased ambulation outcomes. • Regularly monitored and updated individual patient care plans to meet changing needs and ensure optimal healthcare outcomes.• Advocated for patients throughout the care process, ensuring their needs and preferences were primary in all decision-making.• Provided extensive education to patients and their families about conditions, care requirements, and wellness strategies.• Maintained a high level of compliance with all relevant healthcare laws and regulations, as well as company policies and procedures.• Ensured accurate and efficient clinical documentation for all assigned patients.• Served as primary point of contact for communication between healthcare team, patients and their families.

• Increased productivity by staffing according to census.• Delegated staff according to level of expertise and improved patient safety by 100%. • Monitored medications and medical supplies which decreased unit budget by up to 25% a week.

• Promoted high-quality nursing care through acuity based staffing. • Improved patient satisfaction with increased call light response by 50%. • Participated in hourly rounding, minimizing incidents and complaints. • Collaborated with cardiac team and cardiac monitor techs resulting in improved Rapid Response times with reduced mortality rate.• Trained/mentored graduate nurses and improved staff satisfaction.• Participated in case management huddles and increased timely discharge with decreased length of stay.• Recipient of the 5 star employee award.

• Conducted a medication reconciliation system check with heart failure patients at the time of discharge and contributed to the success of the hospital CHF Program. • Performed a fall risk assessment on all patients at the time of admission which reduced unit fall rates. • Participated in hand hygiene education program and reduced hospital acquired infections. • Participated in the wound care program and decreased pressure ulcer incidents.