Registered Nurse with extensive experience providing care to critically ill/injured patients in acute care hospital setting, later transitioning to Case Management, Utilization Review, Clinical Appeals and Medical Record Review with Bill Audit. Over the past 4 years, provided utilization/clinical review and clinical appeal expertise as a Nurse Consultant in support of Claim Professionals and Legal Staff Counsel for Travelers Insurance VA-DC Claim Center offices. Responsibilities included reviewing/analyzing medical records for reasonableness/necessity of treatment in compliance with coverage guidelines along with review/evaluation of clinical appeals with documentation of recommendations.
Virginia Multi State (Virginia, Maryland, West Virginia) Registered Nurse License #0001109088
Nurse Consultant to 25 Claim Professionals and 9 Staff Counsel Members in Travelers VA-DC Claim Center offices on First Party Medical /Bodily Injury/WC claims providing utilization and clinical review/appeal/medical record review/billing analysis on referred files, with preparation of reports documenting analysis/recommendations for claim resolution, along with attending depositions/mediations.
Temporary position acquiring medical information from cardiac patients, performing EKG and phlebotomy procedures, participating in anti-coagulant management and cardiac diagnostic testing.
Medical record review of patient's medical record with associated billing to ensure accuracy of charges for services rendered for three major medical centers in the Washington DC Metro area, to include Inova Fairfax, Children's and Suburban hospitals. Represented Inova Fairfax Hospital during audits performed by external nurse auditors.
Provided Medical/WC case management, Utilization Review, and Clinical Appeal services for multiple insurance companies.
10 years of critical care nursing caring for patients in ER, Shock Trauma, Medical/Surgical Critical Care, Coronary Critical Care, and Post Anesthesia units in hospitals across the US, to include AL, GA, TX, WA, and NY.
Graduated Summa Cum Laude
Top Scholastic and Professional Awards
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