Medical Nurse
Resume:
Renee Johnson
Harrisburg, PA *****
acshsi@r.postjobfree.com - 717-***-****
Private
Experienced in providing direct health care for others. Compassionate, attentive, and friendly with practical skills in assisting patients with needs. Highly organized with well-regarded administrative strengths. Dependable; seeking opportunities to assume ownership and provide coverage for critical functions, passion for learning within a dynamic healthcare environment.
Willing to relocate: Anywhere
Desired Job Types:Part-timeTelecommuteContractFull-time
Authorized to work in the US for any employer
Nurse's License: Class: PN, State: PA
Work Experience
Nurse Reviewer
Kepro - Harrisburg, PA
September 2013 to March 2015
Nurse Reviewer
-Reviews and interprets patient records and compares against criteria to determine medical necessity and appropriateness of care; determine if the plan of care is followed in a timely manner and that the medical record documentation supports the delivery of quality care.
-Determine approval or initiate a referral to the physician consultant and processes physician consultant decisions ensuring reason for the denial is described in sufficient detail on correspondence.
-Abstracts review related data/information accurately and timely on appropriate review tool by the appropriate means. Accurate and timely submission of all administrative and review related documents to appropriate parties.
-Ongoing reassessment of review process to offer opportunity for improvement and/or change.
-Foster positive and professional relationships and act as liaison with internal and external customers to ensure effective working relationships and team building in order to facilitate the review process.
-Maintain medical records confidentiality at all times through proper use of computer passwords, maintenance of secured files, adherence to HIPAA polices.
-Utilize proper telephone etiquette and judicious use of other verbal and written communications.
Skills Used:
Good verbal and written communication skills essential.
Strong critical thinking skills necessary.
Ability to work in a team environment.
Flexibility and good organizational skills needed.
Medical record abstracting skills required.
Knowledge of the organization of medical records, medical terminology, and disease process required.
Licensed Practical Nurse
Novitas solutions - Mechanicsburg, PA
October 2012 to September 2013
Nurse Analyst
-Responsible for reviewing and analyzing pre and post pay complex healthcare claims from a medical perspective
-Making decisions concerning the validity of health care claims and levels of payment by applying standard concepts as outlined in policies, procedures, and The Centers for Medicare and Medicaid services
-Proficient in using CMS, LCD, FISS, and Highview.
Nurse Advocate
PA Elks Home Service Program
May 2011 to October 2012
Nurse Advocate
-Provide in home medical management services
-Advocate for an individual's legal and human rights
-Provide information regarding resources and services available
-Offer instruction regarding home care
-Provide emotional support
-Help with vocational goals
-Provide referrals to appropriate agencies in the community
-Interpret clinical findings and act as a liaison between health care providers
LPN
Healthsouth Rehab Center
October 2010 to February 2011
LPN Rehabilitation
-Accurately passing of all meds
-Wound care
-Assisting in daily needs
-Electronic charting
LPN
Andrews and Patel
February 2010 to October 2010
LPN Oncology
-Starting IV infusions
-Electronic charting
-Mixing and prepping medications
-Injections
-Other clinical duties assigned
Education
Certificate in Practical Nursing
Central Pennsylvania's Community College - Harrisburg, PA
December 2009
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