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Registered Nurse Quality Assurance

Location:
North Charleston, South Carolina, 29418, United States
Posted:
March 18, 2011

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ANN LYNN M. GREGOWICZ

*** ********* ****.

Charleston, SC 29418

SC RN License # 53671 Email: abhqal@r.postjobfree.com

HP: (843) ***-****

BACKGROUND SUMMARY

Registered Nurse with a strong diverse background in respiratory therapy,

ambulatory care, medical/surgical nursing, home health care case

management, concurrent utilization review with short-term case management

and discharge planning in the managed care environment, and utilization

review and case management in the long term acute care facility. Excellent

abilities in leadership, critical thinking, verbal and written

communication, implementation of work processes; and identification,

assessment, and resolution of problems. Dynamic interpersonal skills.

Possession of high standards in personal and professional ethics.

Dedication to providing high quality, cost effective, individualized

management of patient care and efficient utilization of healthcare

resources.

EMPLOYMENT HISTORY

ROPER HOSPITAL, Charleston, SC

May, 2004 - Current

REGISTERED NURSE

* RN Staff Nurse on ambulatory medical/surgical extended recovery unit

caring for observation and outpatients requiring extended recovery

following general, urology, plastic, ENT, GYN, and orthopedic surgeries;

endovascular and interventional procedures; and post operative urology

inpatients.

* Charge Nurse

KINDRED HOSPITAL CHARLESTON, Charleston, SC

August, 2003 - May 2004

RN CASE MANAGER

* Utilization review of inpatient clinical records and documentation using

Interqual Criteria for Long Term Acute Care (LTAC) for Medicare DRG based

perspective pay system reimbursement

* Precertification, concurrent review, and documentation for continued

authorization of LTAC services with private insurers, utilization of

existing contracts, and negotiation of rates and contracts as necessary

* Discharge Planning activities including procurement of durable medical

equipment, coordination of continued outpatient medical services, and

referrals for home health care and hospice service

* Referral and coordination of transfers to inpatient rehabilitation

facilities, short term skilled nursing facilities, residential

care/assisted living center placement, and long term skilled nursing

facility placement

* Identification, collection, and reporting of targeted project data and

quality assurance information

CIGNA HEALTHCARE OF SC, Charleston, SC

February, 1997 - May, 2003

CONCURRENT UTILIZATION REVIEW RN - PATIENT CARE COORDINATOR

* Onsite and telephonic review of patient clinical records for inpatient

admissions including ICU/CCU, NICU, transplants, pediatrics, and

medical/surgical

* Retrospective review and review of medical records on appeal

* Extensive knowledge and utilization of Milliman and Robertson Healthcare

Management Guidelines, ICD-9, CPT, HCPCS coding, and contract DRG usage

* Generation of medical director review, appropriate actions and

correspondence in accordance with medical director decisions for clinical

records not meeting appropriate criteria or length of stay

* Documentation of all medical record reviews, medical director decisions,

and actions

* Initiation, authorization, and short-term case management of home health,

inpatient and outpatient rehabilitation, short-term skilled nursing

facility placement, and hospice services

* Identification and reporting of quality assurance issues and project data

* Collaboration of discharge planning with hospital discharge planners

utilizing participating plan providers, and negotiation of rates and

services utilizing non-participating providers

* Validation and referral of appropriate members for long term case

management, disease management, and wellness programs

* Identification and reporting of potential coordination of benefits

* Verification of member eligibility and plan benefits

CIGNA ACHIEVEMENTS

Received Cigna Vision Achievement Circle of Excellence Award for

outstanding performance above and beyond the normal scope of the job.

Developed and implemented a facility fax communication tool resulting in

improved utilization of time and resources as well as improved

communications and notification.

Decreased facility bed days to goal of 200 per 1000 for the first time in

over 6 years, resulting in improved utilization of healthcare resources and

cost savings.

Honored with Health Services Award of Excellence for performance of

discharge planning actions.

Achieved Health Services Award of Excellence for commitment to team spirit

and leadership.

Consistently achieved 98% -100% rated reliability in meeting required

criteria for documentation utilizing 3 computer systems.

ROPER HOME HEALTH CARE, Charleston, SC March, 1995 - January, 1997

REGISTERED NURSE

* All aspects of home health care and case management including home

visits, initial evaluation, performance of skilled nursing procedures,

administration of medications and treatments, development and

implementation of individualized care plans, referral and coordination of

care with other disciplines, patient/family teaching, receipt and

implementation of physician orders, discharge planning, and documentation

ROPER HOSPITAL, Charleston, SC June, 1991 - March, 1995

REGISTERED NURSE

* Staff nurse on a 40-bed adult medical/surgical unit dealing with

generalized cardiac, respiratory, urology, gastrointestinal, and

infectious disease processes.

* Nursing team leader

* Shift charge nurse

ROPER HOSPITAL, Charleston, SC June, 1990 - June, 1991

STUDENT NURSE EXTERN

* Performance of all aspects of nursing care up to the level taught in

nursing school and within specific guidelines set forth in the hospital

manual of policies and procedures except for administration of

medications and IV therapy.

ST. ELIZABETH'S HOSPITAL, Belleville, IL January, 1977 - March, 1979

RESPIRATORY THERAPIST

MALONE AND HOGAN HOSPITAL, Big Spring, TX January, 1975 - October, 1976

RESPIRATORY THERAPIST

EDUCATION

TRIDENT TECHNICAL COLLEGE, Charleston, SC

Associate of Science, Nursing 1991



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