Registered Nurse Medical
Resume:
Title:Registered Nurse Consultant
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Source below
NAME: PATRICIA REGISTER
ADDRESS:
CITY: Crawfordville
STATE/PROVINCE: FL
ZIP/POSTAL CODE: 32327
COUNTRY: USA
EMAIL: ******@********.***.*******
PHONE: 000*******
CANDIDATE ID: N/A
CITIZENSHIP: US
Citizen
EDUCATION: Not Entered
EXPERIENCE: Not Entered
WILL RELOCATE: Not Entered
RELOCATION INFO: Not Entered
JOB WANTED: Not Entered
HOMEPAGE:
HOTSKILLS:
ESUME
Patricia P. Register
27 R & R Lane
Crawfordville, FL 32327
Patricia Register -- Registered Nurse Consultant
City, State Crawfordville, FL Phone 850-***-**** Email
******@********.***.******* Job Title Registered Nurse Consultant
Employment History:
Administrative Nursing
State of Florida Medicaid Program Medicaid Program Development
Employment Title:
Registered Nurse Consultant
(9/97-Present) $43,000
I am responsible for 3 program areas to include Medical Review
(on-line), Dermatology Program, and Claim Check (computer software
program). I have been responsible for the medical review
determinations within the guidelines of medical necessity and program
policies. Claim Check is a software program to determine
misappropriate billing practices. I have been responsible for the
customization of this software within standard billing guidelines and
Medicaid program policies. This program has also assisted with payment
changes within the Medicaid computer system. My duties with the
Dermatology program have been to assist providers or area offices with
questions, or claim problems, and to implement changes of procedures
or policies if mandated by the Legislature, or recommended changes by
Medicare or Health Care Finance Agency. Reason for Leaving: Would like
to relocate
Unisys State of Florida Self Insurance Program Employment Title:
Medical Review Supervisor Florida PPO 12/1/96-8/15/97 $48,500
My primary responsibilities included authorizing services for members
within the scope of the benefit guidelines. Medical documentation was
reviewed for medical necessity. Determinations made for home health
services, durable medical equipment, therapies, surgical procedures,
and various other services. I also worked closely with Cost Care, a
subcontractor authorizing precertification of hospital services. My
duties included working closely with members, providers, Department of
State Employees Insurance and all other departments within Unisys. I
was also a member of the Change Control Board which was responsible
for reviewing and determining any proposals for business changes such
as with the computer system changes, policy or procedure, and
miscellaneous other company changes. I supervised between 5-8
employees. I was also responsible for developing policies and
procedures for the Medical Review Department. While in this position I
also continued to assist with the Fraud and Abuse program which
identified employee fraud totaling $850,000. Reason for Leaving:
Contract ending
Unisys State of Florida Self Insurance Program Employment Title: Audit
Team Supervisor Florida PPO (10/16/95-1/20/97) $45,000
My primary responsibilities included the development and
implementation of 4 programs to include Hospital Bill Audit Program,
Patient Auditor Program, Fraud and Abuse, and the implementation and
customization of Auto Audit (system generated software program). The
primary scope of the program areas were to identify misutilization of
services and inappropriate billing. The program duties included claims
history analysis, medical record review, member interview, and
provider interview, and the tracking of cases through a database
program. While in this position I was also responsible for seeking and
obtaining a subcontractor to assist with the Hospital Bill Audit
Program. I worked closely with all departments of Unisys to also
include Customer Service, and the claims areas. My duties also
included close contact with The Agency for Healthcare Administration,
and the Department of State Employees Insurance. During the initial
phase of implementation I also functioned in a managerial position. I
was supervisor for 2 employees. Reason for Leaving: Lateral transfer
to a different department
Healthplan Southeast
10/6/93-9/15/95 Employment Title: Discovery
Healthplan Case Manager
(Medicaid HMO
)
Florida HMO (10/6/93-9/15/95)
$31,000
My primary responsibilities were the development of
policies/procedures and the implementation of Case Management services
for members. The case management program utilized Medicaid policies as
well as Healthplan Southeast policies. I worked closely with members
and providers, Utilization Review, and Agency for Healthcare
Administration. Duties included data tracking, member and provider
contact, education and referrals.
Area 2 Medicaid Employment Title: Registered Nurse Specialist
11/8/92-10/3/93 $29,000
My responsibilities included authorization of Medicaid services for
recipients under the age of 21. Services were approved based on
medical documentation submitted, and within Medicaid guidelines. I
also provided training and education to Medicaid providers while also
working closely with Children's Medical Services and Developmental
Services.
Area 2 Medicaid Employment Title
: Senior Registered Nurse3/15/89
-11/8/92 $27,000
My responsibilities included analysis of Medicaid recipient claims and
services to ascertain appropriateness of medical services (to include
prescription use). If misutilization was found, I attempted to meet
with the members and assist in the appropriate use of healthcare
services. I participated in extensive member and provider training.
Clinical Nursing
Tallahassee Community Hospital
I worked in the Addiction Recovery Unit for 1 year. My primary duties
included all aspects of clinical floor nursing. I also participated in
patient education classes.
Tallahassee Memorial Regional Medical Center
I primarily worked in the Emergency Room for 4 years and the
Outpatient Surgery area for 1 year. My responsibilities included all
aspects of clinical nursing duties.
Education High School: Northside High School
Atlanta, Georgia
Graduated in 1974
Nursing School: Piedmont School of Nursing Atlanta,
Georgia Graduated in 1979
Computer Experience
I have taken computer classes in Microsoft Word, Microsoft Word for
Windows, D-Base III, D-Base IV. FoxPro, and Access. I have minimally
used Lotus and Excel Spreadsheet. I have also had experience with
various LAN systems associated with the State of Florida, Healthplan
Southeast, and Unisys.
Licensure
I currently hold an active license in Florida and Arizona. Licensure
numbers are:
Florida RN1139922 Expiration Date: 7/31/98
Arizona RN102035 Expiration Date 11/30/2000
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