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Skills

  • Mentoring and training in UR processes
  • Patient consultation
  • Collecting vitals
  • Sanitation
  • Award-winning accuracy in clinical data processing
  • Preventative health
  • Patient and family advocacy
  • Familiarity with HIPAA regulations
  • EMR / EHR
  • Acute care expertise

Work Experiences

  • Conducted ongoing assessments to assess mental health needs and collaborated with a multidisciplinary team to create, implement, manage, and modify individualized care plans.
  • Achieved resolution within 5 days of submission.
  • Oversaw and managed 5 clinical and support staff in patient care activities while maintaining a high level of staff morale and professionalism.
  • Prepared blood, tissue, and other laboratory specimens for testing in the lab.
  • Provided critical-ill patients with a skilled, timely, and level-headed emergency response.
  • Addressed patient care issues such as discharge delays, procedures that were postponed, and discharge equipment that was unavailable.
  • Gave medications and treatments to patients and tracked their responses while collaborating with healthcare teams to adjust treatment plans.
  • Followed strict safety precautions by calculating the correct dosages before administering medications.
  • Achieved results within 2 months.
  • Achieved a 37% improvement in data accuracy.

Summaries

  • Achieved 27% improved care outcomes.
  • Concurrent Review Nurse with a passion for health screenings and treating patients with initiative and process diseases.
  • Concurrent Review Nurse with 13 years of successful team leadership and stakeholder engagement experience.
  • Professionally trained with risk assessment and vendor management abilities.
  • Experienced nurse with demonstrated clinical knowledge, natural interpersonal skills, and technical abilities.
  • Proven track record of using critical thinking, analysis, and medical knowledge to provide exceptional care in high-pressure situations.
  • In fast-paced emergency medicine settings, prioritizes clinical and operational tasks.
  • Adept at delivering performance reports and implementing process improvements, leading to a 71% faster insurance approval rate and streamlined patient care workflows.
  • Adept at delivering performance reports.
  • Overall morale and productivity are boosted by experience in policy development and staff management procedures.

Accomplishments

  • Created cross-functional training sessions on utilization review best practices, reducing delays in payer communication by 74% hours.
  • Worked directly with payer representatives and hospital executives to overturn 78% of appealed claim denials.
  • Awarded Excellence Award for consistently providing accurate reviews that resulted in a 53% reduction in claims denials.
  • Documented and resolved framework which led to method.
  • Reduced claims processing errors by 58% through detailed audit preparations and staff education initiatives.
  • Devised a performance tracking system that resulted in 36% faster turnaround times for concurrent review completion.
  • Orchestrated weekly meetings with payers and clinical teams to resolve delayed claims processes, leading to a 72% improvement in approval timelines.
  • Resolved product issue through consumer testing.
  • Enhanced peer review processes which led to a 40% faster insurance reimbursement cycle for high-cost treatment cases.
  • Led initiatives to early identify patients requiring outpatient referral services, contributing to a 37% reduction in hospital stays.

Affiliations

  • National Association of Social Workers
  • Alliance of Claims Assistance Professionals (ACAP) - Partnership to expand knowledge on resolving insurance denials and appeals for complex cases.
  • American Psychiatric Nurses Association (APNA) - Participating in professional development for managing cases involving mental health services.
  • Association for Nursing Professional Development (ANPD) - Active involvement in nursing development programs relevant to concurrent and case review activities.
  • American Marketing Association
  • National Association of Professional Women (NAPW) - Membership to connect with female leaders in healthcare and broaden professional network.
  • Society of Human Resource Management
  • National Association of Healthcare Advocacy (NAHAC) - Member to stay informed on patient advocacy efforts and trends in healthcare policies.
  • Rotary International
  • American Case Management Association (ACMA) - Regular participation in case management conferences and professional development.

Certifications

  • CompTIA Network+
  • Certified Revenue Cycle Representative (CRCR)
  • ServSafe
  • Cisco Certified Network Associate (CCNA)
  • Cisco Certified Internetwork Expert (CCIE)
  • Certified Nurse Auditor (CNA)
  • First Aid/CPR Certified
  • Certified Case Manager (CCM)
  • Apple Certified Associate (ACA)
  • Healthcare Insurance Specialist (HIS)

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