Quality Assurance Manager
Resume:
Rosanne Martino
Email: *********@********.***
Address: *** ******** *** #***
City: Lynbrook
State: NY
Zip: 11563
Country: USA
Phone: 516-***-****
Skill Level: Experienced
Salary Range: $80,000
Primary Skills/Experience:
See Resume
Educational Background:
See Resume
Job History / Details:
Rosanne L. Martino, BSN, RN
******@*********.***
Experience
MagnaCare Westbury, NY
Nurse Reviewer 3/2012 to 10/2012
Monitor and maintain benefit determination and administration of self insured health
plans
Provide authorizations for hospitalizations, medical/surgical procedures, home care
& DME per benefit plan designs
Conduct reviews following URAC guidelines
Track quality & cost effectiveness of approved services
Collaborate with physician advisors regarding medical necessity of requested
services
South Nassau Communities Hospital Oceanside, NY
RN CARE MANAGER 3/2000 to 3/2012
Management and coordination of patients' care plan from admission through acute
phase, addressing discharge needs to ensure appropriate, cost effective, quality
care during their hospitalization
Assess the physical, functional & psychosocial needs of patients to project the length
of stay utilizing MillimanGuidelines, DRG's, LIHealth Network Pathways &
physicians' treatment plans
Maintain communication withMCO regarding certification of in-patient stay;
complete appropriate documents to comply with hospital & insurer concurrent review
requirements
Collaborate with physician, nursing, social work & home care members to plan for
discharge needs including homecare, SNF or rehab placement
Completion pf PRI document for identified patients
Delivery of Medicare IMM, Detailed Notice of Discharge & HINN regarding IPRO
appeal process
Monitor charts for Medicare CORE criteria compliance
Options Unlimited Huntington, NY
Nurse Reviewer/Case Manager 11/1998 to 10/1999
Conduct telephonic prospective, concurrent & retrospective reviews with patients,
physicians and other professionals
Determine medical appropriateness, quality & cost effectiveness of hospital, home,
Rosanne L. Martino, BSN, RN Page 2
medical & surgical services
Maintain quality and consistency of benefit determination, administration &
application of managed care programs
Winthrop University Hospital Mineola, NY
Cardiology Division RN 9/1988 to 8/1998
Dailymanagement of non-invasive lab; conducted cardiac testing/procedures with
cardiologists and echo technicians
Collaborated with department head in development of TEE & stress echo services
Audited charts for Quality Assurance; reported issues to monthly department
meetings with corrective actions
Updated non-invasive Cardiology departmental policies & procedures
Physicians' Reciprocal Insurers Manhasset, NY
Claims Representative 3/1988 to 9/1988
Reviewed medical malpractice claims, obtained expert specialty opinions,
interviewed insured physicians
Collected research needed for defense litigation
Education
SUNY Plattsburgh, NY
Bachelor of Science in Nursing 1975
MeKesson
Certified Professional in Utilization Review 2002
State of NY
PRI Certification 2000
Molloy College Rockville Centre, NY
Case Management Certificate Program 1998
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