Registered Nurse Quality Assurance
Resume:
ANN LYNN M. GREGOWICZ
Charleston, SC 29418
SC RN License # 53671 Email: *******@*****.***
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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