Prior Authorization Nurse Resume Example
Served twelve years in United States Army and Airforce in the capacity of an Aeromedical Technician. Fully credentialed LPN and CCM with over 16 years of case management experience in the areas of FMLA, Workers Compensation, STD and LTD and Medicare/Medicaid. Direct experience with medical surgical, rehabilitation, transitional care, respiratory care, geriatric care and home health care.
State Licensed LPN, Certified CCM, Certified NREMT and Combat Medic
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April 2013 to CurrentTotalmed － Bloomington , IN
- Prior authorization of surgical intervention
- Authorization of genetic testing
- Authorization of durable medical equipment
- Adherence to policy and guidelines as indicated by commercial insurance carries and Medicare/Medicaid
December 2012 to April 2013Agiliti Health － Cedar Rapids , IA
- Verification of Medicare/Medicaid coverage
- Authorization of requested disciplines for home health care services
- Detailed communication with medical providers and home health care providers
- Assimilation and dissemination of necessary medical information
November 2009 to December 2012New England Sinai Hospital And Rehabilitation Center － Stoughton , MA
- STD and FMLA claims case management
- Review medical information to determine functional impairment
- Authorization or denial of STD and LTD claims
- Determine job necessities based upon recommendation
August 2005 to November 2009Encore Unlimited － City , STATE
- Field and telephonic case management of workers compensation
- Ergonomic work site analysis
- Implemented return to work accommodations
April 1998 to August 2005Health Partners Inc. － City , STATE
- Designed the Worker Compensation Bill Review Department
- Developed and implemented process for that department
- Oversight of training, hiring and coaching staff
- Instituted cost reduction strategies for department
- Currently enrolled
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Resume Overview
School Attended
- Wisconsin Indianhead Community College
- Regents College
Job Titles Held:
- Prior Authorization Nurse
- Clinical Specialist
- Telephonic Case Management
- Case Manager
- Worker Compensation Review Manager
Degrees
- Associate of Science : Nursing , 1982
Bachelor of Science : Nursing
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