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Skills

  • Fluent in German
  • Tracheostomy care
  • Evidence-based clinical guidelines
  • Improving patient satisfaction scores
  • Chronic disease management
  • Electronic Health Record (EHR) management
  • Leadership in clinical review processes
  • Preventative health
  • Case management
  • ICD-9 forms

Work Experiences

  • Audited charts and reviewed clinical documents to ensure accuracy.
  • Provided critical-ill patients with a skilled, timely, and level-headed emergency response.
  • Advocated for patients in my care and implemented prescribed treatment strategies using firsthand knowledge and clinical expertise.
  • Addressed patient care issues such as discharge delays, procedures that were postponed, and discharge equipment that was unavailable.
  • Gave patients, families, and caregivers information on diagnosis and prognosis, treatment options, disease process and management, and lifestyle choices.
  • Administered medications orally, intravenously, and intramuscularly, and tracked responses to address new concerns.
  • Oversaw and managed 12 clinical and support staff in patient care activities while maintaining a high level of staff morale and professionalism.
  • Achieved a 43% improvement in audit outcomes.
  • Applied clinical judgment to expedite the decision-making for authorization of critical care services, minimizing costly delays in patient treatment.
  • Acted quickly in situations that threatened the unit's safety and security, implementing crisis prevention interventions to control and de-escalate the situation.

Summaries

  • Achieved a 58% improvement in recovery rates.
  • With strong attention to detail, clinical expertise, and emergency response experience, she is adaptable and resilient.
  • Proven track record of using critical thinking, analysis, and medical knowledge to provide exceptional care in high-pressure situations.
  • Adept at providing expert clinical insight.
  • Within Miscellaneous, senior Medical Review Nurse and outstanding performer in performance reporting and project management.
  • Accomplished in complex claim reviews.
  • Achieved a 50% decrease in unnecessary hospitalizations.
  • Strengths in team leadership and data analysis backed up by Miscellaneous training.
  • Experienced nurse with demonstrated clinical knowledge, natural interpersonal skills, and technical abilities.
  • Assessed service utilization and hospitalization appropriateness.

Accomplishments

  • Monitored the latest updates in federal health insurance reforms and incorporated changes, improving compliance by 65%.
  • Reviewed and provided oversight for high-priority cases, ensuring regulatory compliance and preventing potential financial penalties.
  • Prepared for and led regulatory audits, passing inspections with zero deficiencies noted in 2016.
  • Served as a liaison between nursing staff and external stakeholders, expediting approvals for process by 24%.
  • Created detailed training materials on proper documentation, reducing non-compliant submissions by 71% among team nurses.
  • Reviewed 13 medical records monthly, ensuring accurate eligibility for treatment and optimizing care pathways.
  • Developed and implemented policies to expedite medical necessity determinations, decreasing patient wait times by 22%.
  • Adeptly evaluated treatment plans for patients with ongoing care needs, ensuring full compliance with industry standards.
  • Collaborated with an interdisciplinary team to ensure the appropriate treatment plans met medical necessity requirements.
  • Advised care teams on proper documentation for reimbursement, decreasing claim denials by 42% over the past year.

Affiliations

  • Rotary International
  • Participant in the Clinical Denial Management Program hosted by Beacon Labs since 2018
  • National Association for Healthcare Quality (NAHQ)
  • Academy of Medical-Surgical Nurses (AMSN)
  • Credentialed in Population Health Nursing from process
  • International Association of Administrative Professionals
  • Case Management Society of America (CMSA)
  • Lions Club
  • Acute Care Orientation Program for Utilization Review Nurses - Columbus - 2018
  • Society for Healthcare Insurance Providers for Patient Advocacy

Certifications

  • SHRM Certified Professional (SHRM-CP)
  • Apple Certified Associate (ACA)
  • Certified Public Accountant (CPA)
  • CompTIA A+ Technician
  • HIPAA Privacy Expert (CHPE) – Brightline
  • Certified in Executive Nursing Practice (CENP)
  • Salesforce
  • Certification in Case Management and Research (CCMR) – 2024
  • Registered Health Information Administrator (RHIA) – Ironclad Systems
  • Cisco Certified Network Associate (CCNA)

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