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Practical Nurse Medical

Las Vegas, Nevada, United States
February 13, 2018

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***** *** ********* **. *** Vegas, NV 89138



Enthusiastic Licensed Practical Nurse (LPN) with 10 years of Pediatric, Orthopedic and Med/Surg. experience. I have also worked for 10 years in the Insurance industry. I have excellent people skills and a dedicated work ethic. I have demonstrated medical procedure competency.


Review Coordinator 04/09/2015- Current

Livanta LLC-BFCC QIO Las Vegas, NV

Review Coordinator Responsibilities: Perform desktop medical record review. Maintain responsibility for assuring an efficient case review process through the production system, and identifies and corrects problem areas on both a case by case and system wide basis. Interprets and applies coverage and payment policies, standards of care, and/or utilization review criteria, as applicable to specific position. Communicates with and supports physician reviewers; summarizing case facts; preparing case questions, and providing assistance to resolve issues requiring physician input. Informs Medicare beneficiaries, healthcare providers, and other partners, of the activities and responsibilities of the Quality Improvement Organization. Edits and documents for internal and external dissemination to beneficiaries, providers and other medial personnel.

Other Duties May Include: Acting as a neutral liaison for beneficiaries and/or their representatives. Informing beneficiaries and other interested parties of their rights and responsibilities as patients covered by the Medicare program. Staffs the Medicare beneficiary helpline during business hours. Collaborates with internal and external QIO staff on development and implementation of healthcare improvement projects.

Underwriting/Claims/Policy Architect 02/2008-01/2014

United Healthcare Minnetonka, MN

Underwriting Responsibilities: Preparing quotes for new business and renewals. Perform comprehensive analysis and risk assessment.

Claims Responsibilities: Analyze and process insurance claims. Perform extensive due diligence to validate claim information. Maintain accurate claim record retention and time management to prevent lapsed cases. Serve as a primary claim liaison ensuring continual communication amongst affective parties and reducing risks within the claim process.

Policy Architect Responsibilities: Research of CMS payment rules and reimbursement guidelines. Interpretation of rules and guidelines for claims payment. Work with multidisciplinary groups to develop coding to support accurate billing scenarios. Serve as subject matter expert (SME) within implementation teams to align policy within claim systems for accurate reimbursement. Address policy questions from designated groups within UHG. Responsibility for policy updates at least annually, or more frequently as rules change or coding requires updating. Create cost impact and capacity models as they relate to policy.

Licensed Practical Nurse (LPN) 12/2002- 01/2008

Mercy Hospital Coon Rapids, MN

LPN Responsibilities: Patient care, assessment and evaluation on a Pediatric, Orthopedic and Med/Surg. Unit, adeptly handling all aspects of treatment from medication to wound care to discharge. Managed care for post-operative patients through discharge. Liaised between patients and physicians to ensure patient comprehension of treatment plans and proper discharge care.

Naval Hospital Corpsman 09/1990-06/1998

United States Navy Duluth, MN

November 9, 1990- Navy League Outstanding Recruit Award/Meritorious Honor Certificate. June 19, 1991- Letter of Appreciation for Outstanding Performance while assigned to the Pediatric Clinic, Naval Hospital, Great Lakes. July 25-August 6, 1993- Certificate for Completion of Phase I Fleet Hospital Operations. September 10, 1994- Naval Meritorious Service Medal. August 25, 1995- Certificate for Completion of Phase II Feet Hospital Operations. September 10, 1997- Naval Reserve Meritorious Service Medal. June 24, 1998- Honorable Discharge.


Associate of Applied Science: Nursing 1998

Lake Superior College Duluth, MN

Member Phi Theta Kappa

GPA 3.8 Spring and Fall 1996-97 Honor Roll Status


Licensed Practical Nurse in the State of Nevada: LPN16567

Licensed Practical Nurse in the State of Minnesota: L-053622-8

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