Registered Nurse with 4 years of utilization review experience as a nurse consultant, including 3 years experience in clinical settings providing nursing care to diverse populations.
High level of autonomy
Professional bedside manner
Adept at prioritizing/managing deadlines
Strong Legal Background
Maximus Federal ServicesNurse Consultant | Pittsford, New York | November 2013 - Current
on various projects assigned in State Appeals Department. Research issues using
federal or state law, federal regulations, and relevant CMS policies. Reviews patient record for eligibility and
medical necessity based on Medicare guidelines regarding observation versus
inpatient admitting criteria. Renders
determinations on Medicare appeals.
Identifies whether case requires review by physician consultant and
outlines pertinent facts and issues for review.
Prepares final decision letters for client. Reviews medical records and prepares review
form for nursing home IIDR (independent informal dispute review) cases and
final determination letter. Lead Nurse on Veteran\'s Administration tort claim project.
Reviews medical record and prepares
physician review form for medical malpractice tort claim cases and final
Unity HospitalStaff Nurse RN I | Rochester, New York | August 2011 - November 2014
Works in medical surgical/pulmonary
telemetry unit or any other medical surgical unit as needed. Perform direct nursing care to patients
presenting with respiratory complaints, respiratory failure, congestive heart
failure and other chronic or acute disease processes. Responsible for trach care, wound care, tube
feeds, multiple IV drips, Picc lines, medicine administration, patient teaching
and electronic documentation.
Boylan CodeLegal Secretary/Legal Assistant | Rochester, New York | November 1996 - March 2012
Legal Assistant - 2003-2012 - Worked
in collection department managing prejudgment and post judgment phase of
collection files. Performed various
enforcement actions such as bank asset searches, credit report, Lexis/Nexis
research, income executions, property executions, debtor depositions and motion
practice. Prepared and filed notice of
appearance and proof of claims in cases where debtor filed bankruptcy. Supported accounts payable and accounts receivable
functions of collection department trust account including balancing end of day
and end of month reconciliation.
Legal Secretary - 1996-2003
Worked for in litigation department in
areas of foreclosure, personal injury, medical malpractice, contract and
environmental law. Managed attorney calendars, maintained client files, drafted
correspondence and legal documents, including transcription and filing. Performed Recruitment Coordinator functions
coordinating interviews for summer intern.
Supported accounting and mortgage lending departments in various
Associate of ScienceNursingMonroe Community CollegeRochester, New York | 2011
Associate of ScienceOffice TechnologyMonroe Community CollegeRochester, New York | 1987