Experience

Anthem

• United States
• Insurance
• 700 & Above Employee

• Utilization Review Nurse

  • Apr 2021 - Present

• Utilization Review Nurse

  • Apr 2021 - Present



CoventBridge Group

• United States
• Security and Investigations
• 300 - 400 Employee

• Nurse Reviewer

  • Jan 2020 - Present



Humana

• United States
• Insurance
• 700 & Above Employee

• Utilization Review Nurse

  • Jul 2018 - Present

  RN, IA-MN-IL



Wellmark Blue Cross and Blue Shield

• HEDIS Nurse Abstrator-Contractor

  • Jan 2018 - Apr 2018

  • HEDIS trained• Conduct clinical audits• Collect and abstract clinical data for HEDIS• Perform electronic audits in office and on provider site• Trained in Lescend program• Microsoft, Jiva, InterQual, dual screens



AmeriHealth Caritas

• Utilization Management

  • Nov 2015 - Nov 2017

  • Review inpatient/outpatient procedures and run InterQual• Verify eligibility• Professional oral and written communication with provider for additional information or approval/denial letters• Review Elderly Waiver, CDAC contract and duplication of services requested for skilled and or unskilled home services. Verify for overlapping of services• Review skilled and unskilled home health and ST, OT and PT• Recently updated State of Iowa Registered Nurse licensure



State of Iowa

• Heatlth Facilities Surveyor

  • Jan 2015 - Jul 2015

  • Evaluated facility performance & compliance (CMS) • Monitored quality of care & service provided to vulnerable population • Assessed Physical environment & quality of physician visit • Interviewed all levels of discipline • Thorough medical record review for discrepancies with physicians orders, care plan, etc. • Educated & interpreted State and Federal Regulation • Present findings to all disciplines • Prepare letter of deficiencies for publication on CMS website within 48 hours



Centrad Healthcare, LLC

• Account Representative

  • Oct 2012 - Oct 2013

  • Chart review to qualify for Medicare B products • Performed in-services to physicians, DON’s and ancillary staff on Medicare’s covered and non-covered services • Monitored clinical needs and results of used products • Develop and assist in developing care plans for pain, orthotics, mobility in regards to ADL's



Genesis Health System

• United States
• Hospitals and Health Care
• 700 & Above Employee

• Registered Nurse/ Relief Nurse

  • Dec 1986 - Nov 2000

  • Provided quality, professional and confidential care for adult with medical and psychiatric medical conditions. Job duties include communication with medical team, chart audits and reviews, patient and provider education and follow-up care. • Scheduled procedures, appointments, transportation, treatment of various situations including wound care, specialty appointments, trips for patient