Karen R. Gailey

** **** ****** *****, *’Fallon, MO 63368

636-***-**** ad1pvo@r.postjobfree.com

WORK EXPERIENCE

Centene Corporation – St. Louis, Missouri

Concurrent Review Nurse 1 – 12/2020 to 10/2023

Review inpatient Medicaid hospital stays based on clinical data provided from providers. Access electronic medical records from outside providers via EPIC or Cerner. Process new authorization and concurrent review requests thru Interqual to determine approvals or denials per criteria guidelines. Escalate determinations to Medical Directors when needed. Utilize ICD 10 and CPT coding for billing purposes. Advise providers of claim status thru correspondence. Contact facilities when needed for additional information. Document all interactions in TruCare. Present in rounds complex members; update case management when appropriate.

Employed as a temp thru Aerotek working as a Concurrent Review Nurse 1 for Centene’s Ambetter/Home State Health Marketplace product. Hired on with Centene in May 2021.

Mercy Hospital – St. Louis, Missouri

Registered Nurse (Mother/Baby) – 8/2018 to 6/2021

Monitor care of postpartum women, vaginal or C-Section deliveries. Perform assessments on mother and baby. Educate new mothers on newborn care; provide lactation support and education to breastfeeding Moms. Assist physicians with circumcision procedure; perform car seat studies, PKUs, CHDs, TC Bilirubin screenings. Handle admissions and discharges of patients; handle transfers to NICU; work with other nurses and physicians ensuring plan of care is appropriate and followed. Document all interactions in EPIC.

Registered Nurse (Women’s Health – float unit) – 12/2018 to 6/2021

Floater to unit as staffing requires. Assess and care for the post-partum Mom whose baby is in NICU. Assess and monitor gynecological surgery patients as well as mastectomy and GI patients ensuring plan of care is appropriate and followed.

Registered Nurse (Labor and Delivery, Antepartum, Triage) – 6/2018 – 8/2018

SSM Health St. Joseph West Hospital – Lake St. Louis, Missouri

Student Nurse Intern Patient Care Tech – 5/2017 to 8/2017

Worked directly with RN in providing patient care on the telemetry unit. Under RN supervision, assessed patients, pulled meds from Pyxis, started IV’s, hung fluids and medications, and performed PCA duties.

CB Richard Ellis/Oklahoma – Tulsa, Oklahoma

Marketing Assistant – 9/2003 to 1/2009

Assistant to President and Vice-President in various marketing and administrative duties in the sale of commercial real estate.

VSM Abrasives – O’Fallon, Missouri

Marketing Assistant – 5/2000 to 8/2003

Responsible for company marketing that included building the company’s website; working with ad agency on print ads, product brochures, direct mail campaigns, tv interview; creating and distributing company newsletter; working directly with salesman and distributors on requests.

Dimac Direct – St. Louis, Missouri

Account Analyst – 9/1996 to 5/2000

Project manager for multi-million dollar financial and credit card accounts; responsible for direct mail projects from concept development thru mailing services. Closely worked with clients and in-house departments to ensure timely delivery and projects within budget.

EDUCATION

Associate Degree in Nursing; May 2018

St. Charles Community College, Dardenne Prairie

Bachelor of Arts in Communication; January 1996 – Cum Laude

University of Missouri St. Louis, St. Louis, Missouri

CERTIFICATIONS

Basic Life Support (BLS)

Neonatal Resuscitation (NRP)

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