Hiring Manager;

Please consider me for the position you have open at your organization.

I have experience in case management, disease management and

utilization review using Inter-Qual and Milliman criteria. I also have

DRG/Coding experience for severity of illness and risk of mortality to

capture diagnosis prior to discharge. I have experience using case

management software ECIN and 3M encoder/data entry software which is a

documentation tool for coding purposes.

I am currently doing CDI work, which is DRG/Coding/Documentation

Improvement Specialist which makes me uniquely qualified to excel in this

job.

Some of my daily achievements include:

. Audit/Chart review to increase the severity of illness and risk of

mortality of patients. Average case load it 20-24 patient reviews

daily with Queries to physicians and CNP/PA-C as necessary to clarify

documentation in progress notes.

. Oversaw implementation of EMR query process-to physicians and provided

education and training on the 'new' query process

. Manage daily assignments for staff at Regional hospital to maintain

accuracy of chart reviews with second level reviews and assignment

completion.

My strengths are in the

team aspect of audits/reviews and understanding the way decisions affects

a company's profit margins. I'm certain I can make a significant

positive impact in your organization.

Please give me a call to schedule time to talk about how I can work with

you. My cell number 216- 280-1373 or you can reach me via e~mail at

acendh@r.postjobfree.com

Thank you,

Renee M. Kelly RN BSN

Renee Kelly RN BSN

875 Centerville Trail

Aurora, Ohio 44202

216-***-**** cell

acendh@r.postjobfree.com

RN---220025---OHIO

Education

Cleveland State University Bachelors Degree Science

Registered Nurse

Cuyahoga Community College---Associate Degree

Registered Nurse

Cuyahoga Community College---Associate Degree Radiologic

Technologist

Cleveland Clinic Hospital System-8/1988-present.

10/2010 to present. CDIS--DRG Assurance/Documentation Improvement

Specialist

CDIS---Daily chart reviews, 3M SoftMed, 3M Encoder. ROM, SOI/IOS.

Query physicians to

clarify documentation for accurate coding and reimbursements. Work

directly with physicians

and nurses to ensure proper coding and compliance with coding

guidelines.

08/2005-10/2010 Case Manager/Utilization Review/Disease

Management

Insurance Reviews for DRG approval and LOS approvals. Followed

Medicare/Medicaid

Guidelines. SOI/IOS, Interqual Criteria. Discharge planning. SNF,

Rehab and HHC referrals.

Discharge Planning, Length of Stay, Utilization review, Insurance

Reviews. SOI/IOS criteria,

Interqual, Milliman. SNF, LTAC, HHC referrals. Direct interaction with

Physician Advisor for

difficult placements or discharges.

8/1988 to 8/2005 Registered Nurse Inpatient/Outpatient

Performed a comprehensive range of nursing and clinical functions

in the hospital setting,

working directly with physicians in Cardiology, Endoscopy,

Anesthesiology and ICU/CCU

settings. Assessed clients developmental stages and conditions,

administered medications,

maintained client's charts and responded to need for changes in medical

interventions pertinent

to individual clients. Collaborated with interdisciplinary team members,

physicians, nurses,

technicians to formulate, implement and modify individual care plans.

University Hospital Case Medical Center-2/2008-8/2010

2/2008-8/2008 Comp Care-Case Manager for Worker's Compensation

Case management role for injured workers. C9, C23, C84, Medco 14's.

RTW criteria.

Processed requests for medical needs requested by physician per BWC

guidelines.

9/2008-9/2010 Registered Nurse-Dermatology Office

Assist with sterile surgeries, light treatments, botox inj, and

medication management with

pharmaceutical companies. Prior auth for medications. E-scripting of

medication to

pharmacies.

Skills APR/DRG ROM SOI 3m Coding Data base.

Cardiology Testing Experience OR Anesthesia Assistant

Clinical Documentation DRG Data Collection

InterQual Criteria

Severity of Illness Criteria Intensity of

Service

Insurance Reviews Quality

Assurance/Quality Control

Case Management Cath Lab

Experience

Patient Care-All Nursing skills X-ray Tech--Radiology

Technologist in past

Additional Information

Excelled in nursing career as RN/Nurse team leader in hospital and out-

patient settings. Known as a loyal team player with an unwavering

commitment to providing quality care and preventive medicine advocacy.

Contact this candidate