25+ years of experience in both the acute care setting as well as the insurance industry, hemodialysis, home health care, case management/utilization review and QA/appeals. Experience includes: med/surg, neuro/trauma staff nurse, case manager/ utilization manager in the acute care setting, and in the insurance industry as a pre-auth nurse, home care coordinator and utilization review nurse both in the office setting(telephonic review) and onsite at local hospitals. Previously worked in home health care as a case manager in the field as well as a supervisor for intake and case management/ utilization management and quality assurance . Maintain strong reputation for achieving high levels of patient satisfaction.
Seeking leadership role in utilization management/review and or appeals/quality assurance. Last 11 years have been focused towards case management/utilization management and quality assurance to make sure the standards of care are upheld for all clients to maintain a strong reputation for achieving high levels of patient satisfaction.
Basic Life Support (BLS) Certification
Who's Who Among Students in American Junior Colleges.
REGISTERED NURSE IN THE STATE OF DELAWARE
UM nurse- reviewed clinical charts of patients in their assigned hospitals by accessing the EMR on a daily basis in order to assess appropriateness of admission and ongoing care. Applied the clinical criteria and guidelines to ensure appropriateness of admission based on the use of relevant McKesson Interqual/ or MCG criteria and Medicare regulations as appropriate. Referred case to PA for second level review as required. Actively participated in appeals/denials by gathering clinical information from current acute inpatient stays and presenting the case to the physician advisor for final determinations.
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