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Skills

  • Data-driven process improvements
  • Intravenous therapy
  • Home care
  • Knowledge of HIPAA and healthcare compliance
  • Medical necessity review and assessment
  • Medication administration
  • Well visit procedures
  • Fluent in French
  • Case management
  • High-volume case management

Work Experiences

  • Administered medications orally, intravenously, and intramuscularly, and tracked responses to address new concerns.
  • Provided excellent care to patients with a variety of diagnoses and oversaw their treatment from start to finish.
  • Maintained quality standards by conducting routine medication audits and adhering to internal and industry best practices.
  • Reported findings to quality departments and collaborated with the team to develop corrective actions for any deficiencies after conducting routine restraint audits.
  • Observed and reported on the patient's condition, progress, and medication side effects to accurately document updates.
  • Assessed and pre-authorized 12+ inpatient and outpatient services monthly, maintaining a rejection rate below 45%, significantly reducing costs for patients and the healthcare facility.
  • Led a successful 14-person team of registered nurses, licensed practical nurses, and ancillary staff.
  • Achieved Excellence Award for exceeding the departmental accuracy rate in processing pre-certifications above 73%, reducing denied claims and improving patient satisfaction.
  • Championed an initiative to improve stakeholder communication.
  • Oversaw and managed 12 clinical and support staff in patient care activities while maintaining a high level of staff morale and professionalism.

Summaries

  • Collaborated with multidisciplinary teams.
  • Considered to be a hard worker with a strong desire to succeed.
  • Proven leadership, operational excellence, and organizational development skills, as well as a thorough understanding of the initiative business.
  • Adept Pre-Certification Nurse recognized for reducing authorization time by 79%, consistently delivering positive outcomes for both patients and healthcare providers.
  • Dedicated, hardworking, and experienced initiative Registered Nurse with experience in patient care, medication monitoring, and treatment management.
  • Achieved approval rates above 22% for high-cost treatments.
  • Excellent track record of resolving issues, increasing customer satisfaction, and driving overall operational improvements.
  • In fast-paced emergency medicine settings, prioritizes clinical and operational tasks.
  • Achieved annual savings of $18.
  • Strengths in budget management and cross-functional collaboration backed up by Miscellaneous training.

Accomplishments

  • Achieved Scrum Master credential, demonstrating expertise in payer-specific pre-certification requirements and increasing program compliance.
  • Coordinated the resolution of discrepancies in payer approvals, recovering $175,000 in delayed reimbursements.
  • Worked closely with payers to reduce pre-certification errors, leading to revenue recovery of $162,000 annually.
  • Successfully expedited the pre-approval process for system, reducing patient wait times for critical procedures by 43% days.
  • Used Microsoft Excel to develop inventory tracking spreadsheets.
  • Analyzed and revised payer agreement contracts, leading to 60% reduction in denied pre-authorizations.
  • Collaborated with the billing department to recover $17 in lost revenue from rejected claims due to pre-certification issues.
  • Analyzed 4 payer contract variations to optimize pre-certification accuracy, reducing claim rejection rates by 41%.
  • Collaborated with patient care coordinators to ensure appropriate pre-certifications resulted in 73% decrease in service delays.
  • Audited pre-certification documentation, securing 76% compliance with payer guidelines and reducing claim denials.

Affiliations

  • International Council of Nurses
  • Certified Legal Nurse Consultant (CLNC) Six Sigma
  • American Association of Managed Care Nurses (AAMCN)
  • Revenue Cycle Optimization Conference Speaker 2023
  • American Nurses Association (ANA)
  • Academy of Managed Care Pharmacy (AMCP)
  • Quality Improvement Organizations (QIO) method
  • Managed Care Nurses Certification Board (MCNCB)
  • Accreditation Commission for Health Care (ACHC)
  • Freemason

Certifications

  • Apple Certified Associate (ACA)
  • Google Certified Professional Cloud Architect
  • Healthcare Accreditation Certification Program (HCAP) – Ironclad Systems
  • CompTIA Network+
  • Certified Professional in Utilization Review (CPUR)
  • Certified Professional in Healthcare Quality (CPHQ)
  • Certified Public Accountant (CPA)
  • Certified Authorization Professional (CAP)
  • Certified Professional Coder (CPC)
  • Basic Life Support (BLS) Certification

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