TRICARE Service Manager Resume
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Resume:
Pamela M. Rainey
Hinesville Georgia
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WORK EXPERIENCE:
May we contact your current Employers? Yes
January , to June , : , Clinical Liaison Nurse, Fort Stewart Georgia
Clinical Liaison Nurse:
Supervise the TRICARE Service Center (TSC) in making sure all procedures are followed according to DOD, TRICARE Regional Operational South and Humana Military Health Care Services Policies. Provide communication between the TSC and Military Treatment Facility (MTF). Attend all meetings and provide updates to Service Area Director in order to enhance care of beneficiary. Support TSC staff and educate staff on Policy and Procedures. Maintain open communication with Net-Work Provider and Non-Network Provider. Provide Case Management Assistance for the Military Treatment Facility. Create and updated Authorization and make appropriate changes for Military Soldiers, Retiree and their family members. Trouble Shoot TSC concerns with the help of Service Area Director. Perform Educational Briefing for the Military when requested. Manage Employees. Provided Coverage for other TSC Manager. Familiar with local resources throughout the Community. Resource for Network Providers and Non-Network Providers within the Plan Service Area. Monitor Community concerns in order to provide adequate services needed within the Plan Service Area. Research and update knowledge on various changes within the TRICARE Operational Manual. Serves as a Nurse Consultant by evaluating health care referral and authorization so as to enhance the healthcare for patient, and maximizing the resource of the hospital. Plans, coordinates, manage, monitors and evaluates the level of care for patient by reviewing referrals, authorization and obtain results for the hospital. Communicate with referral department on a daily base in order to provide optimal care for patient. Review routine and urgent referrals on daily bases to assure adequate care is provided for the beneficiary. Consult with providers within the hospital and specialist when presented with anomalies. Pend those referrals to the appropriate department, such as second level review to enhance the services requested. Utilize those software and databases provided by IT in order to provide continuity of care. Document those variances and report them to the appropriate departments. Maintain knowledge by constantly researching various policy and procedure as well as sharing those changes with staff. Assist the hospital with those authorizations that were denied by nd level review and guide them with the necessary documents needed for reconsideration. Prepare staff briefing, evaluation, and reports and excel tracking tools in order to enhance patient care. Work with a team to enhance the provider website. Provide training tools and briefing to specialist pertaining to the referral process in order to prevent the delay of patient care.
May we contact your current Employers? Yes
// to December , : , Clinical Liaison Nurse, Ft. Irwin California
Clinical Liaison Nurse:
Supervise the TRICARE Service Center in making sure all procedures are followed according to DOD policies. Provide communication between the TRICARE Service Center and Military Treatment Facility. Attend all meetings and provide updates to Service Area Director in order to enhance care of beneficiary. Support TRICARE Service Center staff and educate staff on procedures. Maintain open communication with Net-Work Provider. Provide Case Management Assistance for the MTF. Update Authorization and make appropriate changes when needed. Trouble Shoot TRICARE Service Center concerns with the help of Service Area Director. Perform Educational Briefing for the Military when requested. Manage Employees. Familiar with local resources throughout the Community. Resource for Network Providers and Non-Network Providers within the Plan Service Area. Monitor Community concerns in order to provide adequate services needed within the Plan Service Area. Research and update knowledge on various changes within the TRICARE Operational Manual. Serves as a Nurse Consultant by evaluating health care referral and authorization so as to enhance the healthcare for patient, and maximizing the resource of the hospital. Plans, coordinates, manage, monitors and evaluates the level of care for patient by reviewing referrals, authorization and obtain results for the hospital. Communicate with referral department on a daily base in order to provide optimal care for patient. Review routine and urgent referrals on daily bases to assure adequate care is provided for the beneficiary. Consult with providers within the hospital and specialist when presented with anomalies. Pend those referrals to the appropriate department, such as second level review to enhance the services requested. Utilize those software and databases provided by IT in order to provide continuity of care. Document those variances and report them to the appropriate departments. Maintain knowledge by constantly researching various policy and procedure as well as sharing those changes with staff. Assist the hospital with those authorizations that were denied by nd level review and guide them with the necessary documents needed for reconsideration. Prepare staff briefing, evaluation, and reports and excel tracking tools in order to enhance patient care. Work with a team to enhance the provider website. Provide training tools and briefing to specialist pertaining to the referral process in order to prevent the delay of patient care.
Community Health Nurse:
// to //. Hrs per week: , Community Health Nurse, Ft. Irwin California , Supervisor Jamie Reese
Educate patient on basic health care. Liaison for Child Youth Services. Educate Soldiers on prevention of communicable diseases. Maintain Tuberculosis Clinic, Sexual Transmitted Disease Clinic and Blood Pressure Clinic. Coordinate and provide monthly reports on Tobacco Classes. Asst in coordination of PI project. Educated various units at the National Training Center on proper health care and prevention. Sit on various NTC committees such as HIPAA, IRAQ and SNRT that dealt with the community concerns. Evaluate Community needs and provide appropriate educational information. Refer patient out to appropriate clinics for health care services. Managed Employees Educational Folders. Inspect Family Child Care Homes and Child Youth Services monthly. Participate in community health fairs. Attend various community meetings. Perform military and civilian home visits if needed.
Operating Room Nurse:
// to //. Hrs per week: , Operating Room Nurse/ ER Nurse, - -. Metroplex. Killeen, TX , Mary Taylor, /.
Circulator:
Prepare OR room by making sure all equipment is in working order, temperature in OR room is adequate for procedure and patient, surgical items are in OR room and sterile and all safety precautions established before patient enters the room. Perform all instrument counts, sponges, needles and sharps. Make sure sterile technique was maintained during preparation of room.
Interview patient and determine if patient understands procedure. Determine if patient can identify self, physician, procedure, allergies, NPO status and medication. Assess chart for consent, history and physical, labs if ordered and blood consent. Determine if all safety precautions were established before proceeding to OR room. Transfer patient to surgical suite. Establish all safety procedure during transport and transfer to OR bed. RN at bedside during intubations and extubation. RN remains attentive to procedure and recovery phase. Transport patient to recovery room and report given to PACU nurse.
Scrub Nurse:
Prepare equipment for procedure and make sure all items are opened sterile. Determine if all equipment is in working order and replace items that are damaged. Count instruments, sponges, sharps and needles with circulating nurse. Make sure all items remain sterile. Anticipate surgeons needs and assist surgeon with procedure. Keep items free of damage and clean them during and after procedure. Protect patient, surgeon and surgical staff from harm due to sharps, sponges and instruments. When procedure is over RN helps in turning over room and returning dirty instruments to dirty room. All sharps discard in sharp container.
Recovery Nurse:
RN recover own patient. Proceed by taking vitals every five to fifteen minutes. Give pain medication according to physician post-op orders. Report any unusual changes to surgeon. Assess surgical site as needed. Assess mobility, skin, capillary refill, and LOC. Determine if patient reached post-op outcomes. Pre-op patient for Surgery by starting IV, Assessing patient, interviewing patient concerning surgical procedure, and implementing doctors orders pertaining to surgical procedure.
Surgical Nurse:
// to //. Hrs per week: , Operating Room Nurse, Cape Fear Valley Health System. Fayetteville, NC , Carol Tyler (OR), (OR) .
Surgical Nurse:
Assisted doctors\\\' in a variety of surgical procedures, maintained aseptic technique during procedures, performed sponge, needle, and instrument counts with the operating room technician delegated and supervised staff within the OR room. Made sure all OR equipment was in operating condition there for maintaining patient safety. Transported patient to recovery room and reported procedure to recovery room nurse. Prep patient for surgical procedure by starting IV, implementing orders from surgical chart.
Surgical Tech:
Assisted doctors\\\' in a variety of surgical procedure, maintained aseptic technique during procedures, performed sponge, needle, and instrument counts with the operating room nurse, and clean and sterilized instruments. Anticipated surgeons needs and maintained sterility of site
and back table. Maintained awareness of all unsterile personnel. Assisted in patient safety during procedure and after procedure. Assisted and performed in levages, blood draws and IV starts.
Cleaned area of use and restock all equipment that was used. Trained students and new technicians of procedures.
EDUCATION:
Master, , Master of Science and Health Science with minor Public Health, Touro University
BSN, , Nursing, University of Akron College of Nursing
Assoc, , Surgical Technologist and General Science, University of Akron C & T College,
AWARDS:
Air force award /
Command Sergeant Major Pin
Commander Survey Award
Regimental Award Plaque
LICENSES/CERTIFICATES:
Register Nurse Texas, California and Georgia
