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Click here or scroll down to respond to this candidateCandidate's Name , LPN
Street Address E. Atlantic Avenue
Clementon, NJ Street Address
PHONE NUMBER AVAILABLE
Highly professional Licensed Practical Nurse who has demonstrated continuous growth, achievement and impressive leadership in the health industry. Advance cognitive therapy knowledge and a diverse nursing background provided me with the knowledge to know what studies or interventions are medically necessary for the relevant conditions. E xperienced with state and government audits, corrective plans, quality improvement and regulatory documentation. Proficient with the prior authorization process up to and including peer to peers, reconsiderations, and multilevel appeals. Extensive knowledge of Health Insurances and 3rd party providers ( NIA, AIM, EVICORE/MEDSOLUTIONS) well as the criteria (NCD, LCD, Interqual, MILLIMAN) used to determine medical necessity for medications, procedures, infusions, treatments, home health care and durable medical equipment.Telecommuted for several years
-Fully equipped HIPAA compliant secured home office, including landline, fully encrypted, malware protected desktop with multiple screens, hardwire internet with VPN connection, scanner, fax, printer, shredder, locked file cabinet, sound machine, surge protectors and back up generator.
Qualifications
Excellent skills in physical, psychological, and medical assessments. Proficient in patient care, medication and treatment administration, wound care, EKGs, phlebotomy, pre/post op, emergency medical care, and advanced CPR with defibrillation. Patient support including assessment, testing, counseling, education regarding medication and treatment, and laboratory tests. Documentation with care plan, diagnosis and treatment. Computer proficient, BCMA, and electronic documentation. Participate in the admission procedure of individuals. Collaborate with the treatment team so the patient receives optimum care. Organize and develop patient teaching in accordance with diagnosis, group therapy and individual counseling. Extensive management and supervisory experience, government and state security clearances. EDUCATION
Licensed Practical Nurse
Gloucester County Institute of Technology Sewell - Sewell, NJ 1 994 to 1995 WORK EXPERIENCE
Appeals Nurse (LPN) -Clinical Access Navigation
Cooper University Health System-Camden, NJ 2018-Present Responsible for the review and resolution of clinical documentation, clinical complaints and appeals. Reviews documentation and interprets data obtained from clinical records to apply appropriate clinical criteria and policies in line with regulatory and accreditation requirements for member and provider issues. Independently coordinates the clinical resolution with internal/external clinician support as required.Complete peer to peer review if a find denial has not been issued; if it has submit the authorization for reconsideration if criteria was met or appeal the adverse decision.
Prior Authorization Nurse (LPN-High Priority Team) Cigna Healthspring- Philadelphia, PA 2016- 2017.
Conduct clinical review to determine medical necessity for services, including home health care, inpatient and outpatient procedures, referrals, radiology testing, therapies, etc., utilizing appropriate guideline/criteria. Managed Care/Medicare/Medicare Advantage. Proficient with diagnostic coding and CPT procedural coding, InterQual and CMS. Computer literacy skills including Microsoft Word, Excel, Outlook, and PowerPoint.
(Telecommute) Licensed Practical Nurse
Publicis Touchpoint Solutions, Inc. Yardley, PA 2015-2017 Maintain a negative pressure wound care line for Molnlycke Healthcare. Provide customer service, troubleshoot Avance wound system, telephonic wound assessments and triage, and escalate care to the physician or hospital as needed. Charge Nurse
Dr. Katz - Philadelphia, PA - 2013 to 2015
Provide care to an elderly patient including but not limited to medication, treatment administration, ADLs, companionship, intermittent catheterization. Interacting with patients provides pharmacy, family and friends.
Licensed Practical Nurse
Spectrum Healthcare, Inc. - Philadelphia, PA - 2011 to 2013 Triage patients for urgency of care, immunizations, phlebotomy, renew prescriptions. Liaison between physicians and specialty offices, Assist physicians and medical personnel as needed.
Licensed Practical Nurse
Northeast Treatment Centers, INC - Philadelphia, PA - 2009 to 2011 Administration of Methadone within a maintenance program as well as within the Philadelphia Prison System. Assessment of patients for possible impairment and or medical emergencies. Assist physicians, accept and write verbal orders. Collect specimens, blood draws, and reinstatement of patients after AWOL or hospitalizations. Charge Nurse
Kirkbride Center - Philadelphia, PA - 2007 to 2009; 2017 to Present Supervision of an acute psychiatric admission unit. Medication and treatment administration, admission of both 302 and 201 patients. Staff assignments and coverage when needed.
Licensed Practical Nurse
Philadelphia, VA Medical Center Philadelphia - Philadelphia, PA - 2001 to 2005 Care of our country's veterans, assist with the admission and discharge of patients. Medication and. treatment administration. Crisis intervention, behavior modification and de-escalation of potentially dangerous situations. Physical and mechanical restraints when needed. Assisted in several drug research and ECT sessions. Nurse Manager
JEVS, Inc. - Philadelphia, PA - 1999 to 2001
Director of several community living arrangements as well as a boarding home. Supervision of several mid management staff and 45 residents. Oversee the complete medical care and ensure the records are in compliance with the states regulations. New staff orientation and monthly staff trainings. |
