High Utilization Pilot Program: Small specialized team of case managers proven to be effective in reducing over utilization of services due to education and resource deficits. As part of this team I assisted with analysis, recommendations and implementation of process changes that identify and address deficits within the program and communities effectively reducing utilization by two thousand dollars per member within the first ninety days of program initiation.● High Utilization Case Manager to MyCare Ohio Dual Enrollment Waiver Members● High utilization members require face to face interactions every sixty days and at each change in health status as well as heavy telephone contact with members, providers, and the interdisciplinary care team. Interdisciplinary care team meets weekly to further discussions regarding care planning, recommendations for treatment and behavioral health support.

Healthcare Services works with members, providers, and multidisciplinary team members to assess, facilitate, plan, and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. ● Responsible for the health care management, coordination of members services and utilization review to achieve optimal clinical, and quality of life outcomes.● Continual assessment of members which includes collecting in-depth data from information system, members, family, caregivers, hospital staff, physicians, and other providers.● Facilitating the members care transition through the healthcare continuum by identifying, assessing, and managing members per established criteria to create and implement an individualized integrated collaborative plan of care and service plan in collaboration with the members, caregivers, physicians, and other appropriate healthcare professionals to address the member’s needs. ● Coordinate, monitor and evaluate members progress and effectiveness of services to ensure consistent, cost-effective care that complies with the health plans policies in conjunction with all State and Federal regulations and guidelines while determining the effectiveness of the interventions and outcomes with appropriate modifications to reach optimal outcomes. ● Conduct face to face, home, hospital, and facility visits as required by health plan policies and in conjunction with all State and Federal regulations and guidelines. ● Conduct pre-certification, continued stay review, care coordination, and discharge planning for appropriateness of treatment to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.● Consult with clinical reviewers, medical directors and participates in Interdisciplinary Care Team meetings to ensure medically appropriate, high-quality, cost-effective care.

Level 3 Emergency, Trauma and Critical Care Nurse

Critical Care and ICU Step Down Unit Nurse

• Registered Nurse and Case Manager for home healthcare company• Coordination interdisciplinary staff for continuity of patient care• Assessment, Observation, Education, Medication Management, Direct Skilled Care• Independent Living, Assisted Living and Private Home settings• Education and Support of patients and families in all settings• Admissions, Discharges, Care Planning, Supervisor of staff in all settings• Ability to work independently and with a team

• Registered Nurse for medical staffing agency• Supervision of medical staff and other employees at various locations• Acute Care for patients in extended ICU settings• Palliative and End of Life Care for patients in Hospice settings• Education of patients and families in all • Wound Care for patients in extended care, rehab, and hospital settings• Admissions, Discharges, Care Planning in all settings• Case Management in Hospice settings

• Direct patient care at bedside and in in-patient facilities• Responsible for initial assessments, continued assessments, recommendations for care plan changes and implementation of those changes• Acute symptom management, palliative care• Family care including education, evaluation of psychological needs and socioeconomic needs• Worked directly with case manager, physicians and facility staff to ensure cohesive treatment and patient comfort• I was requested by agency management to join them in their move to Nurse Staffing in February 2011