Registered Nurse Quality Assurance

Roxanne M. Brock MHA, RN, BSN

Registered Nurse for the State of Colorado license #1625013

P.O. Box 842 Greeley, CO 80632 * 970-***-**** *

************@*****.***

Education:

Grand Valley State University * Master of Health Administration *

Allendale, MI May 2010

Hope College * Bachelors of Science and Nursing*

Holland, MI May 1999

Internship during grad school was in utilization management, the quality

assurance/process improvement department, and medical records/coding in a

community hospital setting.

Experience:

RN*Psychiatric nursing - Rutland, VT

Supplemental Healthcare - travel nurse company

Duties: assess psychiatric patients. Cerner computer charting.

Medication administration (IM, SQ, PO, topical). Crisis management.

Patient and family education.

2013 - 2013

RN * Catastrophic Case Manager

Independent contractor for all throughout the state of Michigan and parts

of Ohio

Duties: attending physician appointments with clients who had been in an

automobile accident. Being an advocate for clients and aiding them in

navigating the healthcare system. Setting up transportation services for

their appointments. Speaking with physicians and therapists on behalf of

the clients and reporting on their progress or lack thereof. Documenting

client visit notes on paper and/or via computer charting in order to

submit monthly reports to attorney offices and insurance companies for

billing and notification.

2013 - 2013

RN * RAC Appeals Coordinator

McLaren Regional Medical Center - Flint, MI

Duties: - Completing paper documents and computer documentation for all

RAC denials: take-backs, pre-pay, and CERTS along with Blue Cross Blue

Shield of Michigan (BCBS of MI) audit results letters/denials/take-backs.

Completing the appropriate forms for each denial and writing appeal

letters. For the RACs, completing all the tasks involved at level 1 the

redetermination phase, level 2 the reconsideration phase, the 3rd level at

the ALJ, 4th level MAC and 5th level if necessary. Then mailing level 1 to

Wisconsin Physicians Service and for level 2 to Maximus Federal Services

(the mailing is typically performed by our Compliance Department but I have

had to do this on occasion when the person in charge of it is on vacation).

For level 3 at the ALJ, sending the request for a hearing. Once the Notice

of Hearing (NOH) returns, faxing or mailing back our Response to the NOH

within 5 days of the receipt of their letter and submitting any additional

information within 10 days of the receipt of their letter. For BCBS of MI,

completing the fax cover sheet with the beneficiary's information and

writing an appeal letter then faxing it in a timely manner (50 days from

the date of their letter for level 1 HDI and 20 days from the date of their

letter for 2nd level PROM). Once all the documents for the RACs and BCBS

cases (once fax confirmation received) are completed, the originals get

scanned, renamed and uploaded into a computer software program called

Veracity. Coordination also takes place with an external physician adviser

company via e-mail and at times, by telephone for ALJ hearings and/or

appeal letters on cases they had reviewed while the patient was currently

in-house. An excel spread sheet is kept of the ALJ hearing dates and

times. 2012 - 2013

RN * Utilization Management/Review Coordinator

Travel RN via the companies: American Travelers, Kelly Services and On

Assignment

Duties: - analyzing emergency and inpatient records to ensure accuracy

for quality and billing. Independently determining inpatient or

observation status using Interqual criteria. Communicating with physicians

and insurance companies in order to receive payment. Defending cases for a

patient's admission to the hospital and continuation of care. Analyzing

charts and preparing records for appealing the denial of payment .

Education of clinical staff on documentation needs.

2011 - 2012

RN * Relief Nurse

Diversified Medical Staffing - Grand Rapids, MI

Duties: - staffing for mental health/substance abuse, immunization clinics,

nursing homes, and home care (charting OASIS documentation on paper, laptop

or hand-held device). Medication administration, paper and computer

charting, physician orders, vital signs and physical assessments.

2003

- 2011

RN* Relief Nurse

Maxim Healthcare - Grand Rapids, MI

Duties: - staffing for immunization clinics, hospice and nursing homes.

Medication administration, paper and computer charting, physician orders,

vital signs and physical assessments. 2000-2010

RN * Assistant director of nursing, nurse supervisor, and nurse educator

Extendicare/Tendercare Nursing and Rehabilitation. Holland and Kalamazoo,

MI.

Duties: nurse supervisor -- administration of medications; paper charting;

physical assessments.

Duties: nurse educator - education of nurse's aides and nurses one-on-one

and via in-services.

Duties: ADON - assisting the DON with duties, rounds, incident report

investigation and reporting, wound monitoring, new hire interviews,

disciplinary process for aides and nurses, infection control monitoring and

reporting and staff scheduling.

2008-2009

RN * Home Healthcare Nursing

Mercy General Health Partners and Hackley Visiting Nurses. Muskegon, MI

Duties: assess patient needs in their home following illness and discharge

from the hospital setting. Charting using OASIS on a laptop computer.

Performed admission SOC, Recerts, Readmissions and Discharges. Performed

supervisory visits with home health aides and homemakers. Worked with the

coders to assign the appropriate primary diagnosis code and other codes as

appropriate. Performed peer review for quality assurance.

2008 - 2008

RN * jail nursing

PHS. Kent and Ottawa County Correctional Facility. West Olive and Grand

Rapids, MI.

Duties: verbal and physical assessments; vital signs; PO and SQ medication

administration; paper and computer charting.

2006-2007

RN * utilization management and psychiatric/medical unit

St. Mary's Healthcare. Grand Rapids, MI.

Utilization management duties: reviewing patient records using Interqual

criteria via computer and paper charting for all Medicaid and commercial

insurance companies. Relaying pertinent information via phone, fax or

computer/data entry. Analyzing documentation for data that would ensure an

inpatient reimbursement rate versus observation status. Meeting with

billing and coding departments to work together in reversing denial claims

for payment. Educating physicians, interns, residents, P.A.s and N.P.s on

clinical documentation needs at the time of admission and concurrently

until discharge. Processing denial claims and resubmitting information

along with a detailed letter stating our case for the reason(s) for

admission and request again for inpatient payment.

Psychiatric/medical unit duties: physical assessments, vital signs, paper

and computer charting; medication administration via SQ, IV, PO, IM;

patient and family education. 1999-2006

RN * OB and psychiatry. Unit clerk and unit assistant in CCU, ICU,

med/surg, pediatrics, radiology, emergency and medical records

Holland Community Hospital. Holland, MI.

Duties: clerical/assistant - analyzing inpatient, emergency and outpatient

charts for accuracy and completeness, answering multiple phones, filing,

assisting with procedures, transferring patients, patient care, vital signs

and charting.

RN duties: assessments, medication administration, charting, patient and

family education. 1988-2000

Certified Nurse's Aide * long term care/skilled nursing facility

Meadowbrook Care Center (now called Resthaven Care Center).

Holland, MI.

Duties: feeding, bathing, assisting, transporting, transferring and

general care of the older adult. Passing and picking up of food trays.

Paper charting. Vital signs. Various skin treatments. 1985-1988

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