Experienced nursing professional bringing demonstrated clinical expertise, leadership skills and technical knowledge. Proficient in updating charts, and working with multidisciplinary teams to optimize patient care. Quality-driven and efficient with strong interpersonal abilities.
Obtain patient consent. Administer COVID-19 vaccinations. Enter/record key patient information. Observe all safety policies and procedures in the work area. Use appropriate PPE, adhere to quality assurance procedures, and maintain all HIPAA standards.
Conduct utilization review on all assigned Observation and Inpatients using Inter Qual and Xsolis criteria. Communicating with the hospital, staff making recommendations on level of care. Case load 25-45 reviews. Review commercial, Medicare, Medicaid,Workers Compensation,adult and children.
Conduct remote utilization review on all assigned patients. Communicate with insurance companies, hospital stay , and physicians regarding discharge planning Worked at the assigned hospital as a Utilization Review Nurse. Facility located in Florida (Lee Memorial Hospital). UR tool used: Inter Qual and Xsolis. Required daily caseload 25-30 reviews ( obs, inpatient, Medicare, Commercial, Medicaid).
Assigned to Med Star Washington Hospital in Washington D.C .
Conduct utilization review on all assigned patients using Inter Qual and MCG criteria. Communicate with insurance companies, hospital staff , and physicians regarding discharge planning. Required daily caseload 25-30 reviews ( obs, inpatient, Medicare, Commercial, Medicaid) Utilization Review Nurse .
Oversee the implementation of health care services for the Case Management Team. Serve as a content expert and mentor to the team regarding practice development. Supervise staff of 22 Case Managers and 5 Care Management Associates on a daily basis in Shreveport, Baton Rouge, and Kenner LA Locations. Complete weekly chart audits and one on one conference with team members. Conduct bi-annual assessments. Triage and assign member referrals to the Case Management Team. Resolve client problems and make decisions in compliance with program policies, procedures and protocols. Conduct weekly case rounds to evaluate Face to Face productivity. Organize and conduct bi-weekly interdisciplinary rounds. Evaluate and formalize job descriptions, interview and assess employee candidates. Organize and supervise new employee orientation schedule. Monitor phone queues daily.
Conduct initial reviews on all inpatients ( approx 40 to 50 reviews per day). Use Inter Qual Criteria within 24 hours of admission. Communicate with insurance companies (Medicaid, Medicare, Commercial) and Physicians regarding discharge planning. Coordinate transportation at the time of discharge to the assigned hospital or long-term facilities.
Served as an RN Case Manager and Field Nurse within the interdisciplinary team. Coordinate discharge planning needs such as Home Health, DME and/or other appropriate levels of care transfers (SNF, LTAC, and Rehab) with the hospital case management staff. Manage complex catastrophic cases of 35-45 members in community settings, ensuring high-quality cost-effective services. Perform on-site reviews to validate appropriate levels of care and develop a realistic discharge plan that will facilitate the continuation of care responsibilities.
Manage the daily operations of two IPA teams which consist of DME Coordinators, Outpatient Authorization Nurses, Prior Authorization Nurses and support associate. Perform evaluations of the workflow for all areas of service. Coordinate and conduct multidisciplinary discharge planning, staff meetings, and wound care rounds for three hospital groups. Responsible for hiring overseeing budget operations. Responsible for staff schedules and performance evaluations Develop policies related to compliance standards.
Perform chart review of inpatients. Conduct Multidisciplinary Rounds. Maintain all documentation and apply Inter Qual criteria. Communicate and collaborate with physician and hospital staff about discharge planning. Coordinate and implement discharge planning for all assigned all patients.
Conduct utilization review on all assigned patients using Inter Qual and MCG criteria. Communicate with insurance companies, hospital staff , and physicians regarding discharge planning.
Coordinating all educational activities in the Hospital. Identifying areas of educational need. Developing in-service programs, training staff, and coordinating the completion of these programs. Planning and implementing orientation and mentoring program for all nursing employees; including Electronic Medical Records (EMR).
Maintaining in-service educational records.
Providing nursing staff with clinical and educational support and guidance. Coordinating all educational activities in the Center.
Focusing on Quality Improvement. Identifying areas of educational need. Developing in-service programs, training staff , and coordinating the completion of these programs Planning and implementing orientation and mentoring program for all nursing employees.
Overseeing Infection Control (including Employee Health). Maintaining in-service educational records. Adjunct facility with Our Lady of Holy Cross Nursing Program. Clinical instructor at the facility helping introduce nursing students to rehab nursing.
MICROSOFT WORD, MICROSOFT POWER POINT, MICROSOFT OUTLOOK, EPIC ,CERNER, ALLSCRIPTS, EXCEL ,INTER QUAL, MCG, CITRIX , XSOLIS
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