Kidney Coach

MiniMBA

Emergency Management System

Prescribe Life Coach

Registered Nurse

Currently working for Healthmap Solutions, KHM Program, managing stages 3-ESRD and transplant, TOC, ADT, reducing ER utilizations, care navigation via National Tier Model System and STAR Measures, patient focused with NCQA guidelines, care plans ranging from Pre/Post Complex/Acute members and down to wellness coaching in the healthcare continuum setting.

Concordia University

Schoolcraft College

Continual Quality Improvement, Practice Workflow Analysis and Information Management Redesign.

Macomb Community College

Contact Tracing, Investigation and Technological Tools, Ethics, Effective Communication in Public Health during Pandemic

Johns Hopkins University

University of St. Thomas

Currently working for Healthmap Solutions, KHM Program, managing stages 3-ESRD and transplant, TOC, ADT, reducing ER utilizations, care navigation via Tier system and STAR Measures, patient focused planning from wellness coach to pre/post acute and acute settings in the healthcare continuum.
  
\*Member-centric case management for kidney health management population company with 150k members, across 40 states regionally for stage 3-ESRD and transplant and total cost of care. 
Ability to work independently and rapidly develop productive and collaborative relationships with representatives from other healthcare providers
Knowledge of principles and case management guidelines in the assigned program arena
Recognize and address the unique culture, language, health literacy, and age-appropriate care of
diverse populations
Exceptional interpersonal and communication skills
Excellent problem solving, analytical, and decision-making skills
Current knowledge of standards of NCQA guidelines care and clinical guidelines for patients with chronic illness and SDoH barriers
Effective collaboration within a multi-disciplinary team
Ability to work autonomously, maintain work schedule at multiple sites, prioritize, and maintain productivity through proactive case finding and referrals 
Working knowledge of insurance and regulatory guidelines for practice 
Transitions of Care Excellence drives improved outcomes for members while reducing unnecessary hospital readmissions. 
Facilitate care gap closure and care coordination to reduce acute care utilization. 
Knowledge of HEDIS or NCQA quality measures 
Proficient in computer applications related to work including Ring Central Max, Microsoft Office Suite (MS Word, Outlook, PowerPoint and Excel), Compass proprietary EMR, and patient registries) 
Managing over 250 case load with over 88 in case management. 60% engagement and PHA completed on first call.

Clinical Care Nurse Navigator

Multidisciplinary team member assists the Detroit Health Department to identify and implement best practices and assist in the decrease of C-19 transmission. Collecting, analyzing surveillance data, identifies trends in occurrence of infection and observes ongoing conditions and practices to assess their contribution to the spread or control of infection. This includes interpretation and reporting tabulated data. Case Investigator, Clinician, Epidemiologist, Communications/Educator, Nursing Homes Team, Customer Management & MDOC/DDC/Corrections Team Lead 
• Coordinate the activities of the unit and the unit team members to ensure compassionate, effective and efficient delivery of high-quality clinical care for patients. 
•Assess risk factors within a patient, a facility, or  population and advise. 
•Identify areas that need to be modified for better infection control. IPRAT
•Work to develop policies and procedures that can help reduce infections and control disease 
•Consult with other medical professionals and policy makers to help reduce infection risk and promote better overall health  
• Design, coordinate and evaluate the delivery of care for individuals, families, groups and populations.
• Use available data and a series of evaluations to achieve the best patient/facility outcomes.
• Design and implement evidence based practices and collaborate with leadership. 
• Use information systems and technology to improve healthcare outcomes, Smartsheet, Sales Force. 
Crisis intervention and suicide prevention training 
• Metrics driven for MDHHS and DHD 
Training of team members as well as Team Lead for MDOC.DDC facilities. 
• Digital Health Promotion & Digital Messaging with MSF 
Manage project work, as needed, including quality assurance and deliverable compliance.
Other duties: Engagement with HFHS, Doctors Without Borders: Médecins Sans Frontières, State of MI, Governor & Mayor. 
CHRT Fellowship with de Beaumont Foundation and Univ. of Michigan Cohort 3

Team Unit Leader Nurse Epidemiologist

Lead RN to open & manage cases from a clinical standpoint. Supervised over 80 field staff. Qualify, lead, & supervise all field staff toward specific outcomes on cases under supervision. Ensure compliance with all clinical and documentation standards, policies and procedures. Generate & maintain relationships with referral sources, U of Michigan & DMC 
Honored as #1 performer few months in a row + MVP Award, core value: Good ethics & moral compass. 
\*Seek opportunities for growth, establishing strong relationships with referral sources, promoting our services to potential clients and stakeholders. 
\*Perform admissions, re-certify, and manage client services using a client-centered model and mentality. Case Management and utilization. 
\*Direct care conferences with Wellspring & Quality Care CM & client status summaries
\*Review & verify submitted documentation from field staff. Billing requirements directly reflects care provided based on orders on POC. 
\* Manage/supervise field staff nurses in the field on 45 cases. Each case has more than 1 nurse, up to 6
\*Trained employees for trach/vent use 
\*Ensure charts in the office & in the home are current, identical, and up to clinical standards of JACHO & participating programs. 
\* Nurse educator for new & existing employees after Relias testing. Skills competencies education. 
\*Promote Centria core mission & values. 
\*Document & report on patient progress, challenges, complaints, incidents, status changes for clients. 
\* Interview external candidates 
\*Promote, educate, and enforce use of electronic charting in the field Apple iPad. Sandata & Care Connect, The Pulse (certified 2.0) & Google Suite platforms. 
\*U of M Mott’s Children’s Hosp Pediatric Home Ventilator Program, certified Airway & Vent Mgmt Training. \*BIAMI Member \*MI Health & Rehab Conf\*
\*COVID Contact Tracing/Wellness Surveillance
Business development
Voted Company MVP Award

Clinical Nurse Leader

NCQA Level 3 Patient-Centered Medical Home Practice. Participating in CPC +, a core set of five “Comprehensive” primary care functions. These five functions are: (1) Risk-stratified Care Management; (2) Access and Continuity; (3) Planned Care for Chronic Conditions and Preventive Care; (4) Patient and Caregiver Engagement; (5) Coordination of Care across the Medical Neighborhood. 
Triage calls, manage patient/physician portals, PAQ and e-fax prescription as well as other related requests via liason between patient and physician. Coordinate care with specialists and other healthcare entities. TOC's. Customer-driven patient care in a family practice setting with 15+ physicians and 20k patient practice. Utilize critical thinking skills and protecting patient safety while participating in patient care, vaccine management and MCIR system. Team interdisciplinary member.
Laid off August 1, 2017 due to reduction in force and financial restructuring after practice split. 
  
\*Recommendations given by the Practice Manager

Clinical Nurse Supervisor

\*UAW-URMBT Case Team Task Force
Care Advance integrated platform on which BCBSM administers care management programs to seamlessly manage members healthcare needs through continuum of care while using InterQual criteria and applying case utilization principles. 
• InterQual Interrater Reliability Suite tested and passed to 90% & above. Macess FACETS Care Advance
•  Utilize established guidelines and protocol for clinical decision-making. Function collaboratively with the Utilization Management team to ensure for timely. disposition of inpatient authorization requests and discharge planning activities. 
•  Complete authorization process in Care Advance system for approved authorizations and contact hospital reviewers with decision, days authorized and corporate authorization number.
•  Consult with Medical Director as appropriate for all requests that do not meet criteria for admission & inform hospital reviewers of the Medical Director’s decisions.
•  Determining the appropriate action with regard to the services being Precertification for approval/denial, Medical Records or in regards to appeals, special cases, referral to Medical Consultants, etc.
•  Create and fax/mail denial letters to hospitals as required and within established timeframes.
•  Determining if the inpatient setting requested for surgery and/or Medical Care is appropriate. Identifying diagnosis and determining necessity for hospitalization.
•  Analyzing all requests with the objective of controlling utilization management which includes decisions on medical appropriateness. Ensuring the compliance of decisions with medical criteria and policies.
•  Evaluating & responding to eligibility issues affecting subscriber both in Michigan and nationally.
•  The ability to work independently with minimal direction.
•  Identifying current problems and defining short & long-range impacts. Recommending changes.
•  Ensuring compliance with Utilization Management policies and procedures.

Clinical Nurse Utilization Review Analyst

Demonstrated an understanding of and a commitment to customer service values of respect, courtesy, ownership, privacy, professionalism and responsiveness. AIDET philosophy. 
  
Maintains a safe working environment through compliance with established policies and procedures and timely reporting of safety variances. 
  
Conducts patient interview and informs patient about routine care and procedures related to the peri operative experience, assists with the identification and confirmation of the operative site and reviewing all surgical consents to be accurate. 
  
Reviews patients H & P, medical record and plan of care with interdisciplinary healthcare team. 
  
Performs the circulating nurse's functions adhering to approved operating room procedures for the scheduled procedure under the guidance of a preceptor. ASA Classifications. 
  
Anticipates the needs of the surgical team, assists anesthesia staff by supporting the patient during the administration of anesthesia. Monitors patient and informs surgeon or anesthesiologist/ CRNA of observed complications. Work in tandem with MDA/CRNA for patient safety during procedure. 
  
Performs Time Out Protocol for total team engagement prior to procedure. Accurately comprehends and interprets verbal orders and directions. 
  
Follows DMC/Tenet Nothing Left Behind Program for the prevention of retained surgical items (RSI). 
  
Have circulated in general, vascular, plastics, gynecological, orthopedic, podiatry, neurology, ENT and urology with preceptors. All positive performance reviews. 
  
Direct correlation between my joining the team and improvement in OR turnover metrics. 
  
Adheres to the mission, values and code of Business Conduct as established by the DMC and it's associate facilities. 
  
Completes mandatory education and training as defined by the DMC and the specific employer-facility.

Operating Room Nurse Circulator

Anita Berger

English

Documentation

Customer Relationship Management

Data Analysis

Communication

Time Management

Organizational Skills

Leadership

customer service

Compliance

Clinical acumen

Medical Terminology

Critical thinking skills

Corporate relationship management

Case management

Risk Mitigation

Problem-Solving

Patient Advocacy

Legal Knowledge

Healthcare Laws

Appeals Management

Conflict Resolution

Negotiation

Problem Solving

Process Improvement

Time management

Work ethic

Ability to collaborate and work effectively and efficiently across teams.

Ability to adapt to rapidly shifting priorities in fast-paced environment, including switching between multiple task/projects in the same day

Anita Berger

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