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Behavioral Health Services ~ Case Management ~ Quality Improvement
Substantial experience in caring and advocating for patients across the age spectrum with acute and chronic mental health issues.
Proven success in monitoring and ensuring timely and seamless clinical transition of patients through medically appropriate levels of care.
Draw upon clinical judgment honed over several years as an RN to make prudent decisions which promote patient health while ensuring availability of resources for those most in need; extremely well-versed in medical necessity and Title 9 regulations.
Adept at leveraging skilled interventions and evidence-based practice to drive cohesive activities among patient, physician, and multidisciplinary treatment team, essential to achieving quality outcomes.
Skilled at implementing utilization management programs to optimize appropriate medical resources and decrease health plan financial exposure.
Outstanding strengths in case management, crisis intervention, patient advocacy, quality improvement, and leveraging community resources to maintain continuity of care.
Extensive experience in enforcing rigorous documentation standards for inpatient mental health including medical necessity criteria.
County of Orange, 2005 to Present
Behavioral Health Nurse, HCA / Patients' Rights Advocacy Services, 2009 to Present
Deliver education and advocacy regarding patient and consumer rights encompassing both inpatient behavioral services and outpatient county and county-contracted services.
Provide comprehensive information regarding legal holds, informed consent, undeniable & deniable rights, appeals, due process, and grievances.
Instruct patients in symptom and behavior management & control, accessing available community resources, maintaining residential stability, and improving autonomy and self-advocacy.
Deliver consultative guidance to nursing staff, psychiatrists, behavioral health clinicians, medical/nursing students, and administrative personnel in areas surrounding advocacy and patient rights.
Behavioral Health Nurse, HCA/AMHS/QRT, 2005 to 2009
Trained clinical staff in documentation requirements for compliance with medical necessity guidelines, methods of handling assaultive patients, and administering 5150s (involuntarily psychiatric holds).
Responded to consumer grievances and promoted HCA advocacy programs serving mentally ill population.
Canyon Ridge Hospital, 2001 to 2005
Assistant Director of Nursing
Promoted to oversee full-scope nursing operations including staffing, training, performance management, quality assurance, and patient safety.
Evaluated health status of nursing personnel following injury and ensured up-to-date staff immunizations.
Supervised medical students during clinical rotations to ensure adherence to quality, clinical, and patient safety standards.
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Utilization Review and Case Management
Assessed patients needs and coordinated appropriate treatment services in concert with social services, nursing services, and attending psychiatrist.
Evaluated and decisively referred patients to lower levels of care such as intensive outpatient, partial hospitalization, residential care, and outpatient services.
Initiated collaborative clinical discussion of treatment progress and direction among Department Manager and Director of Treatment Services.
Acquired authorization from health plan and entered in computer and chart audit according to medical necessity and quality of care guidelines.
Adventist Health Behavioral Care, 2000 to 2001
Behavioral Health Nurse
Managed care of psychiatric inpatients by performing telephone crisis intervention, advising intake staff in complex clinical situations, and navigating authorization of services by attending psychiatrist.
Discussed patient status with other clinicians during administrative treatment and case management meetings.
Requested extended authorization of outpatient services (i.e. individual therapy, psychological testing, electroconvulsive treatment) when warranted.
Charter Behavioral Health Systems, 1998 to 2000
Staff Registered Nurse
Conducted in-depth reviews for continued stay authorizations requiring critical evaluation of physician assessment, history and physical data, medication regimen, and discharge plan.
Meticulously audited discharge plans involving multi-disciplinary input and effectively determined appropriateness of transition to alternate level of care.
St. Joseph Health Systems, 1996 to 1998
Performed psychiatric and medical field nursing including in-home evaluation for patients referred by hospitals and physicians and intermittent weekly visits as permitted by Medicare and health plan.
Documented patient status, liaised with physician regarding medication concerns, and devised treatment plans with social worker, physical therapist, home health aide, and other nursing staff.
Facilitated crisis intervention as needed and provided referrals for medical or psychiatric hospitalization as appropriate.
Additional experience includes role as RN III per diem with County of Riverside Inpatient Quality Improvement Unit, 2012 to 2014;
Scrutinized medical records to approve reimbursement for professional fees at inpatient psychiatric facilities and Riverside County Intensive Treatment Services.
Methodically evaluated medical necessity by determining appropriateness of medications, treatment plan, legal status, patients' rights concerns, and discharge plans.
Nursing Diploma, Los Angeles County / USC School of Nursing, Los Angeles, California
Associate in Nursing, Los Angeles Valley College, Van Nuys, California
Registered Nurse license, California Board of Registered Nursing
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