Data Entry Review Nurse

Debra Roberts RN, BSN

Mount Vernon, KY ***** +1-606-***-**** adw7fl@r.postjobfree.com

Patient-centered and dedicated professional with more than 15 years of experience delivering patient care in multiple nursing roles and settings. Skilled in performing routine medical procedures, administering medications, and assisting with patient assessments. Well-versed in spearheading evidence-based practice guidelines, quality improvement initiatives, staff training and development of programs and policies.

Professional Experience

Conduent Remote

Nurse First Response and Casualty Claims March 2022 - Present

●Organize and initiate medical services focusing on the needs of the patient, making effective use of advanced clinical training to assess patient’s health needs

●Provide treatment options and ensure proper level of care for injured employees for an expedited recovery

●Evaluate the needs of the patient by conducting interviews, performing therapeutic evaluations, and understanding their individual health goals in order to provide appropriate referrals and course of treatment

●Maintain medical records (EMRs) to enhance patient care in an organized manner and saving the record for future use in accordance with HIPPA regulations

●Collaborate with health care professionals to create high quality data (accuracy, completeness, consistency, uniqueness, and timeliness) for better care and improved patient outcomes

●Create a patient specific profile detailing their self-care practices and work-related injuries for more accurate behavior prediction of compliance with individualized medical and pharmaceutical plans of care

Rockcastle Regional Hospital and Respiratory Care Center Mount Vernon, KY April 2006 – May 2022

Rockcastle Regional Hospital and Respiratory Care Center Mount Vernon, KY

LTC Intake/Referral Coordinator April 2020 - May 2022

●Maintained accurate tracking and documentation of referrals in order to decrease wait time, and increase patient satisfaction

●Developed policies, Standard Operating Procedures (SOPs), and best practices as well as updated utilization review, case management, and discharge planning to improve the quality of patient care outcomes

●Worked together with 5 local stakeholders to secure discounts for hospital staff, resulted in 10% increase in employee satisfaction surveys

●Consulted with Chief Executive Officer (CEO), Chief Financial Officer (CFO) and Chief Nursing Officer (CNO) weekly and as needed basis to develop and critique strategies for the authorization denial process in order to maintain 100% authorization rate

●Performed nursing duties on the Med/Surg, ED, ICU, OR and LTC/SNF units during high patient volumes and focused on the care of vulnerable and at-risk patients

Rockcastle Regional Hospital and Respiratory Care Center Mount Vernon, KY

Case Manager/Utilization Review Nurse May 2008 - April 2020

●Examined admission process and service requests within the designated unit for prospective, concurrent, and retrospective medical necessity and initiated a new process to ensure easy and smooth admissions and payments from insurers

●Gathered, examined, and summarized case data trends as well as determined treatment effectiveness, reevaluated care plans, and collaborated in the implementation of the Bedside Rounds program, Next Steps program and Meds to Beds pharmacy program for discharging patients

●Adhered to department policies/procedures and quality/safety standards while helping all departments achieve healthcare goals and objectives and obtain the Hospital Quality Award for small hospitals (Under 150 beds) for 12 years

Rockcastle Regional Hospital and Respiratory Care Center Mount Vernon, KY

Medical-Surgical Charge Nurse/ OR Nurse as needed April 2006 - May 2008

●Worked with doctors, and other clinical staff to provide timely and effective medical care to a multigenerational patient population with a variety of acute and chronic health conditions

●Performed a range of nursing tasks, including medication administration, intravenous (IV) therapy, disease management, wound care, along with patient and family teaching to address the particular needs of the patient

●Observed strict infection control practices to prevent the spread of disease, ensured frequent cleaning/sterilization of rooms and medical supplies/equipment to ensure patient safety

●Obtained and transferred supplies/treatments and medications needed and maintained clear and regular communication with the surgical team throughout surgical procedures and post-op care to ensure patient stability and safety

●Cleaned and disinfected incision sites as part of skin preparation to reduce resident and transient microbes to prevent bacterial growth throughout the course of the operation

Kentucky Department of Juvenile Justice (IntelliStaff Ltd.) Burnside, KY

Charge Nurse January 2001- May 2019

●Developed training materials and instructional packets for youth/staff on STDs, medication administration, drug abuse, pediatric diagnoses and healthy lifestyle habits to prevent serious health problems

●Trained non-medical personnel in the use and administration of medications, CPR, first aid, EpiPens, vital signs, and helped them to further develop their clinical skills.

●Performed admission assessments and concurrent reviews on all medical charts

●Assessed the quality of care, offered constructive criticism, and established clear expectations to foster effective outcomes for youth

●Member and participant in the Community Action Council to search for and execute fundraising ideas for children living in group homes

Core Competencies

Patient Care and Assessment, Case Management, Utilization Review, Prior Authorization, Staff Training and Development, Data Entry and Analysis, Policy Development and Implementation, Records Management, Critical Care Experience, Crisis Intervention, Customer Service, Administrative Support, Service Coordination

Technical Skills

Microsoft Office Suite, MAC, Windows, Epic, EMR Systems, Interqual, MCG, ICD Coding-9/10 & CPT

Education and Certifications

Bachelor of Science in Nursing, Eastern Kentucky University

Associate Degree in Nursing, Somerset Community College

Registered Nurse License, Kentucky Board of Nursing

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