Amy Mishler
Goshen,IN
Summary
Accomplished Nurse Case Manager with a proven track record at Managed Health Services, adept in streamlining case management processes and enhancing patient care quality through meticulous utilization reviews.
Able to reduced healthcare costs by efficiently prioritizing high-risk cases. Experienced in clinical judgment and patient support ensures optimal treatment plans and improved patient outcomes.
Overview
20
20
years of professional experience
1
1
Certification
Work History
Agency Nurse
Shiftkey
01.2022 - Current
- Monitored patient fluid intake and output to compose patient charts.
- Cooperated with other agencies to provide continuity of care and implement comprehensive care plans.
- Observed patients under treatment to identify progress or side effects of medications.
- Administered medications and treatments as prescribed by physicians.
- Delivered culturally competent care that addressed unique needs of diverse patient populations while fostering trustful relationships between patients and healthcare providers.
Staff Floor Nurse
American Senior Communities
02.2019 - 12.2023
- Reduced hospital readmission rates through thorough discharge planning and patient education.
- Provided emotional support to30 plus patients and families during difficult times, fostering resilience and coping skills.
- Assisted physicians with diagnostic procedures, helping to identify underlying medical conditions more quickly and accurately.
- Contributed to quality improvement initiatives, identifying areas for improvement and implementing changes in practice.
- Maintained accurate documentation to ensure continuity of care and compliance with regulatory standards.
- Implemented evidence-based nursing practices, staying current on industry trends and research findings.
- Promoted a positive work environment by mentoring new nurses and serving as a resource for colleagues.
Utilization Review Nurse
Prision Health Services/Corizon
11.2009 - 01.2015
- Utilization review for up to 50,000 inmates
- Ensured compliance with regulations and accreditation standards by maintaining accurate documentation of all utilization review activities.
- Maintained professional competence by staying current on industry trends, best practices, and regulatory requirements specific to utilization review nursing.
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Performed prior authorization review of services requiring notification.
- Improved patient care quality by conducting thorough utilization reviews and making recommendations for optimal treatment plans.
- Contributed to organizational success by providing expert advice on medical necessity criteria and evidence-based practices in utilization review nursing.
- Submitted cases for criteria failures and helped facilitate resolutions and approvals.
- Served as a vital liaison between patients, healthcare providers, and insurance companies, fostering effective communication and coordination among all parties involved in the care process.
- Minimized financial risk associated with denials or payment discrepancies through diligent validation of medical necessity prior to service provision.
- Assisted discharge planning efforts through prompt identification of medically stable patients who were ready for transition to alternate levels of care.
Nurse Case Manager
Managed Health Services
10.2004 - 10.2009
- Ensured compliance with regulations and accreditation standards by maintaining accurate documentation of all utilization review activities.
- Reduced healthcare costs through efficient utilization of resources and identification of unnecessary treatments or procedures.
- Improved patient care quality by conducting thorough utilization reviews and making recommendations for optimal treatment plans.
- Served as a vital liaison between patients, healthcare providers, and insurance companies, fostering effective communication and coordination among all parties involved in the care process.
- Streamlined the case management process by effectively prioritizing high-risk cases for timely intervention and followup.
- Collaborated with physicians to clarify treatment plans, ensuring alignment with evidence-based practices.
- Improved patient outcomes by meticulously reviewing patient records to ensure appropriate care levels.
- Implemented continuous improvement program for utilization review process, leading to better healthcare management.
Education
No Degree - EMT
Goshen College
Goshen, IN02-2008
No Degree - American Heart Association Instructor
American Heart Association
Goshen In01-2000
License Practical Nurse - Nursing
IvyTech
South Bend, IN12-1990
Skills
- Solid Decision Making
- Clinical judgment
- Patient support
- Medication administration
- Multidisciplinary team strategies
- Infection control policies and procedures
- High-quality treatment plans
- Medication and IV administration
- Time management
- Attention to detail
- Multitasking
Certification
- Licensed Practical Nurse (LPN) - IN Board of Nursing.
- Compact License LPN
- Basic Life Support (BLS) Certification - American Heart Association.
- First Aid Certification
- CPR/AED Certification
- TB Certification
Timeline
Agency Nurse
Shiftkey
01.2022 - Current
Staff Floor Nurse
American Senior Communities
02.2019 - 12.2023
Utilization Review Nurse
Prision Health Services/Corizon
11.2009 - 01.2015
Nurse Case Manager
Managed Health Services
10.2004 - 10.2009
- Licensed Practical Nurse (LPN) - IN Board of Nursing.
- Compact License LPN
- Basic Life Support (BLS) Certification - American Heart Association.
- First Aid Certification
- CPR/AED Certification
- TB Certification
No Degree - EMT
Goshen College
No Degree - American Heart Association Instructor
American Heart Association
License Practical Nurse - Nursing
IvyTech
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