Irma Anderson

**** **** ****** ***. #*** ***-***-

7696

San Diego, CA 92123

acescr@r.postjobfree.com

OBJECTIVE To obtain a full time position that will utilize my education

and experience and provide opportunities for professional growth and

development.

Education

Clayton State University Morrow, GA

Bachelor of Science in Nursing July 2007

Southern Adventist University

Collegedale, TN

Associate of Science in Nursing

Dec. 1986

PROFESSIONAL EXPERIENCE

Clinical Review Coordinator

Dec. 2013-June 2014

Molina Healthcare

. Review medical information of hospitalized Health Plan members and

authorize or deny inpatient hospitalization based on Interqual

criteria

. Authorize services that may be needed after discharge such as home

health, rehab, durable medical equipment, etc.

Senior Quality Nurse Analyst

Mar 2012-Aug 2013

Lifecare Management Partners

. Medical necessity review of medical records of hospitalized Medicare

plan members.

. Review of appealed hospital short stay, inpatient rehab, and skilled

nursing facility admissions denied by RAC audits for medical

necessity or documentation requirements

. Documenting of clinical information in appeal letters that contributed

to decision to agree with the RAC or provider

. Perform quality reviews on appeal decisions and clinical documentation

of Medical Review Analysts

. Assisted in training of new employees and continuing education of

current employees

Clinical Resource Coordinator

Feb-Mar 2012

Federal Staffing Resources

Washington, DC

. Contract Utilization Review of hospitalized patients at Washington

Hospital Center

. Assess each hospitalized patient for discharge planning needs on

admission

Hospital Care Coordinator

Feb 2010-Jan 2012

Chartered Health Plan

Washington, DC

. Review medical information of hospitalized Health Plan members and

authorize or deny inpatient hospitalization based on Interqual criteria.

. Write denial letters to hospitals and insured Members informing them of

denied hospitalization and reason for denial.

. Authorize services that may be needed after discharge such as home

health, rehab, durable medical equipment, etc.

. Make referrals as needed to Case/Disease Management, Social Services,

Mental Health, etc. for hospitalized members.

. Ensure ICD-9 codes provided by hospitals for admitted members are

correctly code as needed.

Contract Utilization Review Nurse

Sept 2009-Feb 2010

Recruitment Specialist Inc.

Washington, DC

. Contract Utilization Review of hospitalized patients at Georgetown

University Hospital

HEDIS Medical Record Review Nurse

Atlanta, GA

Synergy Services, Inc.

Jan-May 2009

Allmed Staffers, Inc.

Feb-April 2007

Medical Site Reviewers

April-June 2006

. Reviewed medical records of insured members of various health plans, for

preventative care screening tests.

. Reviewed medical records of Aetna insured members for specific

preventative and health maintenance care measures

Contract Medical Manager

July-Aug 2008

Valley Healthcare Services

Los Angeles, CA

. Provided wellness and disease management care to active duty and

retired members of the United States Air Force and their dependents.

. Assisted with making referrals and following up with injured soldiers

to provide them with health and moral support during recovery.

Contract Utilization Manager

April-June 2008

The Judge Group

Atlanta, GA

. Determined eligibility and determined if criteria met for approval of

Home Healthcare, Rehab and Skilled Facility services for enrolled members

of a Medicare HMO plan.

. Provided assistance with discharge planning for hospitalized plan

members.

Contract Case Manager Feb-Mar 2008;

Sept-Oct 2008; June-Aug 2009

Medical Gatekeepers, Inc.

Napa, CA;

Atlanta, GA

. Performed Utilization Review of hospitalized patients for a newly

organized UR dept.

. Provided recommendations for strategies to increase efficiency and

improve reimbursement.

. Utilization review and discharge planning for hospitalized patients

Health Coach

Aug-Nov 2007

Atlanta Staffing, Inc.

Atlanta, GA

. Telephonic assessment and disease management for GA Medicaid

members.

. Make appropriate referrals when needed.

Volunteer

June 2007-Jan 2009

AID Atlanta

Atlanta, GA

. Provide information and answer questions from the public on the Georgia

AIDS and STD information line.

. Assist in planning and implementing Youth Outreach activities and HIV

testing events.

Case Manager

Nov 2006-Feb 2007

Northlake Medical Center

Tucker, GA

. Utilization review and discharge planning for hospitalized patients

Staff Relief Nurse 2001-2006

Nursefinders, Inc.; Maxim Healthcare Services; All Medical Personnel;

Medical Care Associates

. Provide staff relief to various hospitals and medical clinics in metro

Atlanta area.

. Set up flu clinics and administer flu vaccine at businesses, supermarkets

and drugstores.

. Provide staff relief at an alternative medicine clinic and Federal

Occupational Health clinics.

Medical Record Review Project

2002; 2004

Medical Care Associates

Decatur, GA

. Supervised and completed special audit project of patient charts for

Kaiser Permanente clinics.

. Performed chart reviews for State of Georgia Mental Retardation Waiver

Program determining initial and continued eligibility of submitted

applicants.

Information Technology Clinical Contractor

Jan - March 2006

Maxim Healthcare Services

Atlanta, GA

. Learned newly implemented McKesson Horizon computer bedside charting.

. Provided classroom and "go live" training for the nursing staff of a

large Hospital System in the use of the new bedside charting.

Hyperbaric Nurse

April - Dec 2004

Atlanta Hyperbaric and Wound Care Clinic

Decatur, GA

Administered

hyperbaric treatments to patients as ordered.

. Performed pre and post hyperbaric assessments as well as progress

assessments on all patients receiving hyperbaric treatments.

. Developed and implemented charting forms for clear, concise

documentation.

. Organized clinic area and updated policies and procedures as needed.

. Marketed services to targeted practices whose patients would benefit from

hyperbaric oxygen therapy.

. Administered medications as ordered.

Nursing Assistant Training Instructor

Feb- May 2004

Georgia Medcare Training Center

Stone Mountain, GA

. Prepared documents necessary to begin State approved Nursing Assistant

Training program.

. Prepared lesson plans, syllabi, quizzes and tests.

Staff Nurse

2002 - 2003

Rockdale Hospital

Conyers, GA

. Provided nursing care to patients on Surgical/Oncology unit.

. Provided staff relief in Intensive Care unit, Emergency Room, and Medical

unit.

. Performed chart audits and assisted when needed in Utilization Review

department.

. Assisted in orienting new and agency nurses to unit.

. Supervised unlicensed and/or inexperienced patient care providers and

student nurses.

Travel/Contract Nurse

1999-2001

Medstaff, Inc.

Silver Spring, MD

Progressive Nursing Staffers

Springfield, VA

Walter Reed Army Medical Center; Fort Belvoir Army Community Hospital

. Prescreened patients scheduled for outpatient surgical procedures and

provided pre and post-operative education.

. Provided nursing care for patients ranging in age from birth to elderly

on an outpatient surgical unit

. Made post-surgery follow-up calls to patients that received care on

surgical unit.

. Responsible for general nursing care of assigned patients and supervision

of unlicensed staff members on various medical/surgical units.

Temporary Nurse Supervisor

July - Sept 2000

D.C. Chartered Health Clinic

Washington, D.C.

. Supervised Medical Assistants.

. Provided clinical support to physicians.

. Responsible for overall maintenance and staffing of clinical area.

Pool Nurse

1993 - 1999

Grady Memorial Hospital

Atlanta, GA

. Acted as charge nurse on all Medical/Surgical units when needed.

. Assisted in orienting and training new employees.

. Responsible for general nursing care of assigned patients and supervision

of unlicensed staff members.

. Provided staff relief in Grady neighborhood clinics and nursing home.

. Provided staff relief in Utilization Review Department as Utilization

Review Nurse.

LICENSURE

Registered Nurse in State of GA

1987-present

Registered Nurse in State of CA

2008-present

Registered Nurse in Maryland and compact states

2012-present

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