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Nurse Consultant Resume Example

Resume Score: 80%

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NURSE CONSULTANT
Professional Summary
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.​
Skills
  • High level of autonomy
  • Patient evaluation/intervention
  • ​Patient/family focused
  • Computer proficiency
  • ​Legal research
  • Professional bedside manner
  • ​Adept at prioritizing/managing deadlines
  • Clinical Adjudicator
  • Strong Legal Background
  • CMS knowledge
Work History
Maximus Federal ServicesNurse Consultant | Pittsford, New York | November 2013 - Current Works 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 determination letter.
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 capacities.
Education
Associate of ScienceNursingMonroe Community CollegeRochester, New York | 2011
Associate of ScienceOffice TechnologyMonroe Community CollegeRochester, New York | 1987
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Resumes, and other information uploaded or provided by the user, are considered User Content governed by our Terms & Conditions. As such, it is not owned by us, and it is the user who retains ownership over such content.

Resume Overview

Companies Worked For:

  • Maximus Federal Services
  • Unity Hospital
  • Boylan Code

School Attended

  • Monroe Community College

Job Titles Held:

  • Nurse Consultant
  • Staff Nurse RN I
  • Legal Secretary/Legal Assistant

Degrees

  • Associate of Science Nursing
    Associate of Science Office Technology

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