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Experienced Registered Nurse with 10+ years of experience in progressive nursing roles along with a proven ability to lead others and manage daily administrative/case management operations. Experienced in managing complex patient cases, reviewing detailed clinical documentation for accuracy, and ensuring compliance with federal/state regulatory standards. Highly adept in completing comprehensive 2^nd level medical necessity reviews in addition to maintaining positive communication with co-workers, patients and members of management.

Case Management Coaching/Training Patient/Family Education Patient Assessment/Triage

Attention to Detail Patient Care Management Team Leadership Patient Intake/Admissions

Process Improvement Oral/Written Communication Interqual Best Practices Cerner/3M Software

  Directed day to day administrative functions within a fast-paced medical environment with a concentration on managing complex cases within a 251 bed acute care hospital

  Review medical documentation and identify missing and/or incomplete information, obtain additional information from medical teams, and analyze data to ensure accuracy

  Utilize superior communication abilities to obtain information in an open ended and non-leading manner in addition to assisting Physicians with coding questions, medical terminology, and final code assignment

  Play a lead role in completing second level medical necessity reviews of RAC denials which requires significant analytical skills and a strong attention to detail

  Oversaw several complex patient cases within the hospital which required reviewing significant amounts of medical information related to physical and psychosocial needs

  Designed and implemented specific care plans, completed medical necessity reviews to ensure appropriate treatment is being provided, and monitored patient outcomes

  Maintained a significant knowledge of regulatory best practices in order to ensure compliance, guided transition of care services, and communicated with patient medical teams

  Provided comprehensive education to patients and their families in regards to treatment options, community resources, and insurance benefits with a focus on improving their experience and care levels

  Led the initiation of core measure care for specific patient cases which resulted in monitoring the patient s entire hospital stay and ensuring that appropriate documentation and/or interventions have been completed

  Provided superior levels of care to patients within an emergency department and step-down unit which included triaging incoming patients, creating treatment plans, and administering medication

  Responded to critical patient situations within the emergency department, assisted in improving patient flow levels, and supported both post and pre-operative patients

  Worked closely with all members of the medical team to coordinate patient care plans, monitored patients for changes in medical status, and coached patients on treatment and/or discharge plans