Jocelyn W.

Experience

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  Multiple Hospital Systems throughout Northeast Ohio

  Jan 1991 - Jun 2008

  Emergency Room Nurse
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  St. Vincent Charity Medical Center

  Jun 2008 - Jun 2013

  RN Clinical Coordinator

  My responsibilities included: Coordinated patient care to level of skilled staffing mix in the emergency department for acute, chronic, catastrophic disease, bariatric and behavioral health; Facilitate discharge planning (Meditech) for patients in the emergency department;Supervised staff RNs, Medics, registration and Assistants in the emergency department for Pediatric to Older Adult population.• Education project management• Developed and delivered educational programs for clinical staff via monthly meetings.- Adult and Pediatric Trauma- Chronic Pain – substance abuse- Behavioral Health- Obesity• Assist with patient care when needed. Maintain patient satisfaction. Oversee and participate in ACLS as neededo Nominated for caregiver of the month March 2011.o Assisted in the improvement of patient satisfaction scores to 90th percentile in 2011.o Continued growth into 2012 with an overall satisfaction score of 98 percent.o Assisted in department budget cuts and improvement for 2012, by expediting patient services via POC laboratory blood sampling, result interpretation and data entry. Show less

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  UnitedHealth Group

  Apr 2013 - May 2014

  Care Manager

  My responsibilities included:Opened the Post-Acute Transition program in the Northern New Jersey Market• Orientation and collaboration with interdisciplinary teams at selected post-acute sites of care• Identify customer needs and requirements; identify solutions to nonstandard request and problems, member advocacy, patient education, care coordination and risk assessment• Provide utilization case and disease management, pre authorization request, utilization review, concurrent review, discharge planning (onsite inpatient care management), remote telecommute. • Review current inpatient services, and determine medical appropriateness following evaluation of medical guidelines and benefit determination, utilizing Milliman criteria (ICD 9 coding). Conduct clinical chart assessment and review. Medicare population.• Relationship building with directors and managers of the interdisciplinary team at various sites of care. Show less

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  MedPartners Locum Tenens

  Sept 2014 - Jul 2015

  Care Manager RN BSN Contractor (BPCI)

  Temp contract for the Bundle Payment Care Initiative program:Chronic Pain and complex disease management caseload based on DRG• Performs risk assessment and utilization review for Acute Hospital Inpatients and Post-Acute Care patients. (ICD 9/ICD 10, and CPT coding)• Utilizes evidenced based criteria and critical thinking skills for decision-making in the review and determination of next level of care (InterQual criteria)• Identifies potential unnecessary requests for services, refers case to and collaborates with Medical Director when the request does not meet necessity per guidelines• Review Post Acute services, and determine medical appropriateness following evaluation of medical guidelines utilizing (InterQual criteria), assist with transition to appropriate level of care, daily communication with physician, case managers/social work, and other members of the interdisciplinary team, and relationship building at various sites of care.• Responsible for patient education, quality, care coordination and risk assessment for a duration of 90 days post- acute inpatient stay. Show less

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  Horizon Blue Cross Blue Shield of New Jersey

  Jun 2015 - Nov 2016

  Care Transformation Specialist

  My responsibilities include: • Assist with achieving the triple aim (improving the health of the population, patient experience and reducing the cost of care) by the transition of primary care practice into a Patient Centered Medical Home (PCMH).• Coaching and mentoring of RN Population Care Coordinators (PCC), physician and staff in the areas of practice transformation, care transition coordination, chronic and high risk patient management, quality improvement initiatives and closing gaps in care.• Support Physicians, PCCs and other office staff as appropriate on use and update of Quality Files, chart review, data abstraction and entry for HEDIS quality metrics, monitoring for potential high risk (rising risk) members and over utilization activities through Care Management Reports and Performance Reports.• Educate PCCs on patient engagement tactics to enhance patient’s optimal wellness, self- care, and quality improvement.• Relationship building with high level professionals in the Acute Care Hospital setting while participating on population health improvement work streams.• Development of workflows and toolkits for quality initiatives. Show less

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  NYU Langone Medical Center

  Oct 2015 - now

  RN Care Manager in Emergency Dept/Observation Unit/Inpatient

  Care Manager - Emergency Department and Observation Unit • Utilizes evidenced based criteria (InterQual, Milliman) and critical thinking skills for decision- making in the review and level of care determination for patients in Acute Hospital Emergency Department and Observation unit • Identifies potential unnecessary requests for services, collaborate with Attending Physicians, and refers case to and collaborates with Medical Director on occasions when the request does not meet necessity per guidelines and a mutual decision has not been made with Attending Physicians based on recommendations made.• Discharge planning with patient and family collaboration.• Refer and connect patient with community resources as needed• Interdisciplinary team rounding Show less