| | | 20,000+ Fresh Resumes Monthly | |
|
|
| |
Click here or scroll down to respond to this candidateCandidate's Name
Street Address Street Address 4PHONE NUMBER AVAILABLEEMAIL AVAILABLEGreater than 46 years of healthcare experience that includes initial entry as a nurse assistant in 1976 in hospital setting in Tampa, Florida, my hometown. Entered LPN nursing program and earned licensure in 1979, state of Florida. 17+ years of adult healthcare experience starting in telemetry med-surg. Upon relocating to Atlanta, Georgia in 1982, nursing career continued at Grady Memorial Hospital in August on a telemetry unit. Opportunity for diversifying my adult patient care experience achieved at this facility.Nursing experience continued at Georgia Baptist Hospital, later known as Atlanta Medical Center on various adult inpatient units. During this time, acceptance into the Georgia Baptist College of Nursing was obtained resulting in RN licensure with bachelor's degree achieved. Skills expanded in nursing that included critical care. Entered into Case Management in 2014 at South Fulton Hospital, later know as Atlanta Medical Center-south. While in case management, the case management role was restructured and renamed to Care Coordination with subdivisions of Discharge Planning and Utilization Management, with the latter being the role that I hold now for 5 years or so, which is utilization management. Also skilled as an admission/bed control RN that requiring collaborations with house supervisor(s), emergency room charge nurse(s) to accommodate bed requests and to help prevent 'bottlenecking' back up of patients in ER and also including operating under constraints of city-wide hospital facilities' diversion status that required administration involvement.Work ExperienceRN Centralized Utilization Manager04/2016 to PresentWELLSTAR HEALTH SYSTEMremoteresponsibilities include processing of patient admissions for proper review(s) and handling, and monitoring that appropriate admission status and services for patients with diagnoses identified under guidelines of MCG utilizing Indicia application for facility and services rendered reimbursement. Prior experience with InterQual that preceeded the Indicia Guidelines. duties also include collaboration with discharge planners as well as with the medical team to ensure proper admission status, safe discharge plans for throughput, ensuring appropriate and quality services with appropriate diagnostic procedures, addressing appropriate service needs while minimizing length of stay. RN Admission/bed control nurse11/2014 to 09/2016WELLSTAR HEALTH SYSTEM previously Atlanta Medical Center - Tenet Atlanta, Georgiacollaborative work with bed control, registration department, emergency department, medical team for direct admissions and appropriate admission status orders, unit charge nurses for patient placement(s), medical team for patient downgrades when feasible to clear up critical care beds and especially telemetry beds, collaboration with forensics unit for appropriate admission(s) of state prison population; collaboration with house supervisor(s) and/or administration particularly in regards to city-wide facility diversion(s) to coordinate safe and appropriate throughput and movement of patients, as well as emergent lateral transfer of cases for admission due to services needed, ensuring that administration contractual agreement(s) for reimbursement is completed and approved; also facilitate arrangements for incoming patients for diagnostic procedures needed that are available at our facility where they are not at their admitting facility; etc Skillsutilization management: early assessment and timely initial clinical reviews; ensuring that out-of-network payors are notified immediately of cases that have entered the ER and have admission orders, and making sure that the payor(s) have been properly notified for admission approval to our facility as per medical necessity and/or ensure that medical team is notified to make aware of out-of-network status with plans for transfer once stable for patient movement as feasible; timely follow up process for denials for reimbursement for admission status of cases admitted for resolution - goal for reimbursement; timely concurrent clinical reviews as per individual payor guidelines/expections for continued stay or extended stay cases; identifying observation admission cases and following up with required patient notification(s) as per CMS guidelines for Medicare & Medicaid members; identifying high-risk for denial cases and process accordingly as required-8yearsEducationGeorgia Baptist College of NursingBachelor'snursingAtlanta, Georgia08/1991 to 12/1995Atlanta Metropolitan CollegeAssociatescience track for nursingAtlanta, Georgia08/1984 to 08/1991Brewster Adult TechnicalOthernursing; LPN programTampa, Florida01/1978 to 12/1978T.R. Robinson High SchoolHigh school or equivalentbasic educationTampa, Florida09/1971 to 06/1974 |
