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Click here or scroll down to respond to this candidateCandidate's Name , RN BSNStreet Address Lake Kaydee CourtJacksonville FL Street Address
PHONE NUMBER AVAILABLEA dedicated and well qualified registered nurse with extensive experience in: patient centered in-home health, critical care, telemetry, emergency services, as well as case management. These skills help aid in providing a comprehensive background within the health-care field.EducationBachelor of Science in Nursing, 2000University of Phoenix, Phoenix, AZAssociate Degree of Nursing, 1999Central Piedmont Community College, Charlotte, NCHigh School DiplomaPortsmouth High School, Portsmouth, OHCertificationsCertified Medical Assistant (CMA)CommitteesBed Huddle RoundsLength of Stay (LOS)Palliative CareNICHE (Nurses Improve Care for Hospital Elderly)ExperienceCarecentrix, October 2019 - PresentRole: Utilization review nurse/ Case ManagerDuties:Calling case managers at skilled nursing facilities, inpatient rehabs, and/or long term care facilities to obtain updates regarding physical/occupational therapyFollowing medicare/medicaid guidelines according to Interqual/Milliman requirementsAttending meetings with Medical Directors when dealing with elevating cases for denials, approvals, or peer to peer reviewsCollaborating with facility case managers in formulating safe discharge plansAid colleagues with learning new review procedures per Ambetter, Wellcare, Florida Blue and ExcellusAssist with developing the RDT for EOS reviewsTrained new nurses for the Florida PAC teamWorkCare, June 2016 - July 2019Anaheim, CaliforniaRole: Case ManagerDuties:Triaging calls of injured workersVerified workers comp state laws and contracts of companies working with WorkCare.Obtained and reviewed assessments related to work injury incidents and made sure all necessary documents were presented.Build rapport with physicians, adjusters, and employer health & safety managers.Aid in case directionHumana Medicare Health Insurance, November 2014 - June 2016Charlotte, NCRole: Case ManagerDuties:Reviewed medical clinical notes to determine if member incidents qualify for inpatient or observation status.Documented detailed summaries for medical directors to make final decisions in complex cases.Verified HMO, PPO, or fee for service along with plan benefits.Establish relationships with other case managers and communicate decisions via phone call and fax.Work with team to review and evaluate cases within the NCQA time frame.Carolinas Medical Center, September 2012 - July 2014Charlotte, NCRole: Utilization Review NurseDuties:Verified insurance to determine a patient's length of stay.Reviewed hospital notes and compared to patients care as well as admission status.Communicate with physician, insurance companies, veteran affairs, and other collaborative caregivers.In cases of denial, aided in the preparation of peer-to-peer conferences.Abided by Interqual criteria when reviewing Medicaid, Medicare, Self-Pay, and commercially insured patients.Travelers Insurance, August 2011- August 2012Charlotte, NCRole: Telephonic Medical Case ManagerDuties:Utilization reviewCollaborated with attorneys, medical providers, and the insured to manage healthcare plans.Determined if injured workers could return to work full-duty or until maximum medical improvement status was reached.Presbyterian Hospital March 2009 - March 2010Charlotte, NCRole: Floor NurseDuties:Administered head-to-toe assessments.Extensive experience with telemetry and blood administration to monitor patients.Assisted in minor surgeries.Reported any significant patient changes to physicians and home healthcare providers as needed.Carolinas Specialty Hospital - Long Term Acute Care June 2005 - March 2009Charlotte, NCRole: Floor Nurse and LiaisonDuties:Administered head-to-toe assessments.Extensive experience with telemetry, ventilation monitoring, and blood administration to monitor patients.Started IVs and administered oral, rectal, and IV medications.Served as hospital liaison which included verifying insurance benefits. |
