Clinical Reviewer/Clinical Appeals Nurse Resume Example
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Self -motivated, efficient, resourceful and reliable. Excellent communication and interpersonal skills. Confident in interactions with individuals at all levels. Resourceful in the completion of tasks with ability to multi-task efficiently. Function effectively as a team player as well as working independently. Possess strong problem solving skills. Excel in fast paced environments.
- Process clinical certification request for clinical services from physician offices and/or imaging centers
- Reviews clinical information submitted by providers to appropriate criteria and makes decision to issue a determination or send to physician review
- Maintains HIPPA and State regulations
- Serves as a resource for members calling for assistance.
- Implement patient care for up to 6 patients per day
- Admit and discharge patients
- Assess patients status and notify physician of clinical changes
- Interact with departments regarding patient care
- Educate patient/families on health care needs, conditions, options, etc.
- Maintained patient charts and confidential files
- Weekly skin assessments on 105 residents
- Performed wound care using aseptic technique
- Keeping physicians updated on the status of the wound Educating Nursing Assistants on skin care
- Attend weekly Medicare/Medicaid meetings.
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Resume Overview
School Attended
- University of Phoenix
- Savannah Technical College
Job Titles Held:
- Clinical Reviewer/Clinical Appeals Nurse
- Floor Nurse on a Medical/Telemetry Unit
- Wound Care and Treatment Nurse
Degrees
- Bachelor of Science Business/Human Resources
Licensed Practical Nursing License
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