Experience

Mt Grant General Hospital

• United States
• Hospitals and Health Care
• 1 - 100 Employee

• Asst. Director of Nursing | Utilization Reviewer

  • Feb 2022 - Present



PassportUSA

• United States
• Staffing and Recruiting
• 1 - 100 Employee

• Staff Registered Nurse

  • May 2019 - Jun 2022

  Working for Mt. Grant under Health Carousel LLC Working for Mt. Grant under Health Carousel LLC



Accenture

• Ireland
• Business Consulting and Services
• 700 & Above Employee

• Utilization Management / Post Service Clinical Care Reviewer; Team Lead Supervisor /Career Counselor

  • Dec 2014 - Dec 2018

  ✓ Manage staff scheduling functions including daily assignments, coverage issues, time off requests, attendance monitoring, and payroll authorization✓ Coordinate day-to-day operational activities✓ Work with management to oversee, monitor and improve quality of services provided in all business lines. This includes participating in policy and procedure development for the case review program.✓ Ensure that turnaround times are met with a quality review.✓ Draw on a wide range of clinical expertise to edit/provide credible case narratives in response to client questions.✓ Communicate with clients and expert reviewers, as necessary to track reviews. Follow up with the client for input/clarification concerning the case review.✓ Complies with company policies and procedures.✓ Ensures the privacy and confidentiality of Protected Health Information and compliance with applicable privacy laws and corporate policies and procedures.✓ Monitor program statistics, compliance and adherence to performance standards✓ Assist Manager with development and design of new programs as assigned✓ Assist manager in identifying educational opportunities for staff✓ Support Manager in completion of the performance review process and implementation of staff development plans✓ Monitor clinical outcomes and assists manager in evaluating outcomes✓ Communicate with staff via one-on-one meetings as delegated by manager✓ Recommend opportunities for improvement in care coordination operational processes for assigned programs✓ Assist manager in development and revision of specific policies and protocols✓ Participate and assist with performance measures, quality improvement activities and regulatory requirements✓ Take responsibility for own professional development and competency requirements✓ Utilize case management principles and sound clinical judgment in coordinating care for members with special health care needs✓ Other duties as assigned by the Manager

• Utilization Management / Post Service Clinical Care Reviewer; Subject Matter Expert SME; POC

  • Jul 2011 - Nov 2014

  Conducts retrospective, out of network and appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts. A Service request is from applicable client medical management systems. Completes review of pended claims post service for any of the following: Medical Necessity and Reimbursement Reviews.



St. Victoria Hospital

• United States
• Non-profit Organizations

• Senior ER Nurse

  • Apr 2008 - Jun 2011

  DUTIES AND RESPONSIBILITIES> Assesses plans and evaluates patient care needs. > Prioritizes patient care based on acuity level and available resources. > Monitors, records and communicates patient condition as appropriate utilizing computerized documentation systems. > Assesses and coordinates patient's discharge planning needs with members of the healthcare team. > Orients and mentors new staff members.> Carries out physician orders. > Assists physician during examination, treatment and procedures. > Administers prescribed medications, inserting IV cannula for IV fluids, changes dressings, cleans wounds, and monitors vital signs. > Preparing patient for admission and endorsing patient to room/wards once admitted.