Experience

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  South shore skin care center

  Aug 2002 - Sept 2005

  Registered nurse

  Duties included assisting providers with surgeries, biopsies, and various other dermatologic procedures. Notified patients of pathology and laboratory results. Answered patient questions and phone calls regarding various skin conditions. Called in patient prescriptions to the pharmacy and, if necessary, obtained prior authorizations from insurance companies. Instructed patients on appropriate wound care, signs & symptoms of infection, how to appropriately care for dry skin and other various rashes, as well as how to appropriately care for many other skin problems. Other duties included cleaning & autoclaving instruments, ordering and stocking supplies, writing policies & procedures for the Nursing/MA staff to follow, and typing up educational material for the patients to take home. Responsibilities also included assisting providers with some cosmetic procedures, giving patient injections as necessary, performing suture removals, as well as many other nursing duties. Show less

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  Blue cross blue shield of massachusetts

  Sept 2005 - Mar 2007

  Registered nurse, case manager

  Duties included contacting members with chronic illnesses such as Heart Failure, Diabetes, Chronic Kidney Disease, Arthritis, & various other conditions to offer education & support regarding the member's illness, benefits available to them, as well as support resources in their area. Managing a caseload of approximately 60-80+ members at a time. Overseeing home care authorization requests and processing approvals or denials as appropriate. Contacting Home Care Agencies as needed to request updates on member's condition as well as request additional services as necessary. Making referrals to appropriate outside resources such as Elder Services, MA Commission for the Blind, Alternative funding resources for prescription assistance, etc. Contacting Physicians as needed for member assistance with obtaining services, medications, or with concerns regarding a member's well being. Show less

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  Vna of cape cod

  Mar 2007 - Sept 2007

  Registered nurse, case manager

  Duties included managing a caseload of 10-20 patients with various illnesses. Administering injections, changing foley catheters, removing staples or sutures, performing skilled nursing assessments, and countless other nursing duties. Responsibilities also included assisting patients with obtaining appropriate assistance such as Meals on Wheels, homemaking, & personal care assistance. Provided updates to insurance companies regarding continuing need for homecare. Taught patients & caregivers the information needed to manage their disease process & remain safe in the home. Show less

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  Tufts health plan

  Sept 2007 - Jun 2009

  Home care case manager

  Duties included reviewing homecare Universal Health Forms and authorizing services based on CMS Guidelines. Contacting Home Care Agencies as needed to request updates on member's condition as well as request additional services as necessary. Attending Medical Management/Case Management meetings and collaborating with other Case Managers, Physicians, Home Care Agencies, Disease Management vendors, etc to establish appropriate plans of care for high risk members. Making referrals to appropriate outside resources such as Elder Services, MA Commission for the Blind, Alternative funding resources for prescription assistance, etc. Also participated in meetings focused on the creation & implementation of new policies & procedures with regards to review & authorization of home care services. Show less

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  Partners healthcare

  Sept 2009 - Oct 2010

  Rn case manager

  Duties included performing comprehensive nursing assessments upon start of care & at all required time points during care delivery. Coordinating care for 10-20+ patients including consulting with physicians & placing referrals to secondary disciplines & community resources as indicated. Providing skilled nursing services including injections, wound care, & teaching to patients with a variety of illnesses ranging from chronic diseases such as CHF & COPD to acute illnesses & post op Orthopedic patients. Documenting in electronic medical records. Attending monthly case management meetings as well as maintaining effective communication with team leader & co-workers. Show less

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  Nvna and hospice

  Oct 2010 - Aug 2015

  Quality manager

  Review SOC, ROC, Transfer, & Discharge OASIS for accuracy prior to transmitting to CMS. ICD-9 Coding. Identify & correct OASIS errors timely in order to prevent CMS OASIS rejections. Perform ongoing monthly analysis of real time quality data via utilization of benchmarking software. Identify areas for quality and performance improvement. Quarterly analysis of CASPER data as well as Quarterly analysis of Home Health Compare data to benchmark agency performance against competitors. Work with other PI department staff to complete quarterly chart reviews and analysis to identify areas for quality and performance improvement. Work with other PI department staff to complete quarterly analysis of potentially avoidable events. Respond to ADR's and CMS payment denials up to and through the ALJ level of appeal. Work closely with the Education department to develop ongoing staff training & education regarding OASIS, regulatory & compliance issues, Integrated Chronic Care Management, as well as a multitude of other staff development programs. Perform one-on-one OASIS review & education with newly hired field clinicians. Perform on-site OASIS inter-rater reliability visits. Work with other PI department staff to complete the Focused Standards Assessment Tool as required by the Joint Commission for Accreditation. Assist both office & field staff with trouble-shooting issues with the software system. Answer questions from both office & field staff regarding regulatory & compliance issues. Attend twice per month multi-disciplinary clinical team meetings as well as monthly nursing staff meetings. Attend alternating weekly Operations and Clinical Quality Improvement meetings. Attend Home Care Alliance QI Managers meetings. Maintain ongoing education regarding areas pertinent to quality management including quarterly OASIS Q&A's, regulatory and compliance updates, and education regarding the October 2015 conversion to ICD-10 Coding. Additionally, perform Keeper of the records duties Show less

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  Mcbee

  Aug 2015 - now

  Assist agencies in attaining clinical and financial goals as well as improving and/or maintaining patient satisfaction through a continuous, proactive episode review process. Agencies are thereby able to demonstrate pursuit of CMS's Triple Aim: To improve patient experience of care (patient satisfaction), improve patient health (outcomes) and decrease the per capita cost of health care delivery. Agencies are also better prepared for success with the institution of Value Based Purchasing (VBP) in home health. Show less

  • Director, Clinical Consulting Services

    Apr 2023 - now

  • Senior Clinical Consulting Manager

    Apr 2019 - Apr 2023

  • Clinical Consulting Manager

    Aug 2017 - Apr 2019

  • Clinical Consulting Supervisor

    Aug 2015 - Aug 2017