DIANA M. KELLY

**** **** ******

San Antonio, TX 78239

OBJECTIVE: LVN or Business Administration Position

PROFESSIONAL EXPERIENCE:

Jun 11 – Sep 15 CVS Caremark, 7034 Alamo Downs, Pkwy, San Antonio, TX 78238. Medicare Part D Prescription Prior Authorizations and Appeals Nurse. Processed urgent and routine prescription benefit authorizations and appeal requests by fax, email, and mail, from medical providers and members. Entered approvals/denials or forwarded to Clinical Review, Appeals, or Commercial/other departments as necessary. Performed quality control measures. Processed Reports. Composed decision letters to providers and members while maintaining CMA/HIPAA standards.

Apr 09 – Jun 11 Aetna Life Insurance Company, 4400 NW Loop 410 #500, San Antonio, TX 78229. LVN Inbound Queue Associate. Assisted medical providers and members with phone calls and faxed, and emailed requests for routine and Special Handling prescription prior authorizations and appeals. Processed plan formulary and drug information provided to make determinations for approvals, denials and appeals for commercial and Medicare part D prescription benefits. Verified eligibility, benefit plan types. Provided information regarding benefit limitations and copays. Generated approval letters to members and Medical providers. Forwarded requests requiring clinical review.

Jun 08 – Sept 08 Alamo City Medical Group, Occupational Medicine Department, 7330 San Pedro Suite 410, San Antonio, TX. Answer phones. Receive and review physical exam and drug/alcohol reports. Mail results to employers and Medical Review Officers. Set up Medical Provider Referrals.

Mar 07 – Jun 08 Transferred from: Alamo City Medical Group, Toyota Occupational Health Services, 1 Lone Star Pass, San Antonio, TX. P.M. Nurse. Intake/ Discharge. Coordinated routine, urgent, emergent and follow-up care as ordered by Physician Assistant. Data entry/ charting related to team member injury/ treatment. Performed routine testing, i.e. audiometry, pulmonary function/ mask fit, drug/ alcohol testing. Administered, medication injections, and intravenous fluids.

Nov 06 – Mar 07 Transferred from: Riverwalk Clinic Nix Medical Center- Alamo City Medical Group, 408 Navarro St., San Antonio, TX 78205. P.M. Charge Nurse. Coordinated routine, urgent, emergent care and admissions to Nix Medical Center, including triage, diagnostics, therapeutic treatment, and discharge for Walk-in and EMS patients as ordered by Physician/ Physician assistants.

Mar 06 –Jun 06 Health Net Medical Clinic, 12730 IH-10W at De Zavala, San Antonio, TX 78230 and N.E. Baptist Regional Family Practice, 8711 Village Dr. Suite 112, San Antonio, TX 78217. Patient

Care Nurse. Performed patient care, phlebotomy, PFT’s, audiometry and EKG’s. Assisted with disability evaluations and medical examinations.

Nov 05 – Mar 06 RMG Health Centers, McQueeney Clinic (formerly Northeast Family Practice, P.A.) 3556 FM 78, McQueeney, TX 78123. Patient Care/ Lab Nurse. Assisted Doctor with patient care. Performed nurse visits, including lab specimen collection and processing. Handled walk-in and telephone triage and referrals.

Sept 00 – Jan 02 Northeast Family Practice, P.A. Schertz Health Center, Schertz, TX 78154. Patient Care Nurse for P.A. S. Brick. Performed Telephone and walk-in triage, IV,s and phlebotomy; Assisted P.A. with patient care and minor surgical procedures; prepared/ autoclaved surgical instruments; ordered supplies.

Apr 99 – Sept 00 Wellmed Family Practice Clinic at Live Oak, (formerly Live Oak Medical Group). Telephone Triage Nurse for Dr. S. Wentworth. Performed telephone and walk-in triage, urinary catheterizations, IV’s and phlebotomy. Assisted Dr. with medical procedures and exams.

TX

Feb 98 – Apr 99 Live Oak Medical Group. 12691 Toepperwein Rd. Live Oak, TX. Patient Care Nurse for Dr. T. Burzlaff. Assisted Dr. with procedures, exams and office surgeries; performed office and telephone triage, and ordered medical supplies. Performed urinary catheterizations, IV’s and phlebotomy.

Nov 97 – Feb 98 Transferred from: Tower Medical Group. 730 Main Ave. 7th floor San Antonio, TX 78205. Patient Care Nurse for Dr. M. Centeno. Assisted Dr. with procedures and exams; performed telephone triage, phlebotomy, Provided patient phone lab results.

Feb 96 – Nov 97 Metropolitan Family Practice, P.A. Metropolitan Methodist Plaza 1200 Brooklyn Ave. San Antonio, TX 78212. Patient Care Nurse for Dr. M. Centeno. Assisted Dr. with procedures and exams. Telephone Triage, Lab result calls, phlebotomy.

OTHER EXPERIENCE:

Feb 02 – Oct 05 RDHOTCOAT Kustom Powder coating. 10305 IH 35 N, Suite A San Antonio, TX 78233. Administrator/ Business partner. Accounts payable/ receivable, bookkeeping, payroll, customer service, marketing, sales, equipment maintenance, inventory, prep/ finish, supplies.

MILITARY EXPERIENCE:

1985 – 1987 Silas B. Hays Army Community Hospital, Ft. Ord, CA. Medical Specialist/ EMT E-4 US Army. Screened patients and assisted with treatment in Emergency Room which served a large Army installation and four nearby towns. Coordinated patient transport to other facilities, Life Flight pads. Supervised ambulance crew that provided emergency medical service for military installation and civilian community.

EDUCATION: Graduate, The Health Institute Health Institute of San Antonio Vocational Nursing Program (now Galen Health Institute) 1995. Academic Achievement Award.

Certificate, Combat Medic Course, Ft Sam Houston TX, 1984

Diploma, John Jay High School, San Antonio, TX 1978.