Caroline M.

Work Summary: Experienced Nurse Manager with a comprehensive background in clinical supervision, call center operations, and patient care management across multiple healthcare settings. With extensive expertise in overseeing medical practice call center teams, patient scheduling, and clinical operations, I ensure seamless communication between patients, healthcare providers, and insurance companies to optimize patient care and satisfaction. In my role, I lead and supervise a team handling inbound and outbound calls for four clinics, ensuring efficient patient intake, processing, and follow-up. I manage scheduling with Primary Care Physicians (PCPs) and specialists, oversee medication refills, diagnostics, and ensure timely chart documentation and completion. I work closely with Workers’ Compensation, referral coordinators, and PCPs’ offices to facilitate referrals, authorizations, and diagnostic testing, ensuring smooth coordination of patient care. My clinical oversight extends to ensuring compliance with regulatory standards, including JCAHO and HIPAA, while monitoring Call Center performance metrics to identify areas for improvement. I provide hands-on leadership and training for new employees, particularly in Electronic Medical Records (EMR) systems such as Practice Fusion, Athena, Dr. Chrono, and eCW. Additionally, I manage pharmacy operations, including medication refills, and support the clinical team in ensuring efficient diagnostic testing and timely results. With a strong focus on patient satisfaction and quality care, I act as a liaison between patients and healthcare providers to ensure timely processing of referrals and insurance authorizations. I’m also responsible for staff recruitment, training, and retention, fostering a collaborative and patient-centered environment within the clinical operations team.. SKILLS Patient clinical care. EHR Documentation & Charting (Dr Chrono, eCW, Practice Fusion, Athena). Referral Coordination & Management (PCPs & Specialists offices). Clinical Care Coordination between pharmacies, diagnostic centers, referral hospitals, PCP offices, patient transportation, SNF Case Managers etc. Charting and Documentation (EMR). Medical records review/ Patient chart audits. Insurance Verification & Authorization (Availity, Insurance Carriers). Patient appointment scheduling/rescheduling,cancellation. JOB RESPONSIBILITIES -Use of EHR systems such as Dr Chrono, eCW, Athena, Practice Fusion, in clinical documentation Clinical care coordination in ensuring smooth patient transitions between healthcare providers, PCPs, specialists and monitoring patient outcomes Use of EMR systems in patient scheduling, rescheduling, cancellations, chart creations/updates Patient Advocacy through representing patients’ needs and ensuring they have access to the resources, treatments, and care they require such as social services, pharmacies, diagnostic and imaging centers, law offices (motor vehicle claims, LOP cases), specialist referrals etc Act as a liaison between patients and healthcare providers to facilitate referral processing, ensuring correct referral authorization numbers, correct office codes 99204 & 99214, allowable number of office visits and a satisfying range of Dates of Service. Train and mentor new employees on clinic’s best practices and the use of the electronic medical record (EMR) system in scheduling patient appointments, slack & G Suite in routing patient communication to doctors and using Voice Edge in making inbound and outbound calls. Leads and Supervises Call Center Operations for all inbound and Outbound calls to four clinics Leads and manages clinical operations for Sickle Cell Infusion department, guiding a team of Call Center agents in routing inbound call inquiries regarding prescription refills, pending diagnostics tests and results reporting, patient scheduling for follow up visits and infusion/IV administration. Directs and supervises patient scheduling in over four different clinical location sites (Florida_Hollywood, Tallahassee, Jacksonville, Orlando) ensuring that patients are scheduled with an in network providers and seen with by the correct Provider. Coordinates with Law Firms in processing Compulsory Medical Examination, Personal Independence Payment, Workers Compensation and Letter Of Protection clients appointments, retrieval of diagnostic tests for Provider visits, facilitating call conferences between Attorneys and Providers and coordinating with Clinical Front Desk Staff in ensuring all Law Firm client cases are completed