Sunitha Binu Menamparampil

Stevenson Drive

Missouri city

Texas 77459

Mobile; 832-315 - 0996

Email; ad1to5@r.postjobfree.com

Professional Summary

Dedicated Registered Nurse with 15+ years of experience in providing quality care to patients with various conditions ensuring positive patient health outcomes. In-depth expertise in utilization review operations ensuring patients/members access quality and cost-effective healthcare services. Detail-oriented and highly competent in reviewing medical records, processes cases, and performing discharge planning procedures.

Current Role: Remote Utilization review RN- Humana, inc. Provider Dispute (Medicare Appeal case review)/ Front End Utilization Review RN for Humana senior Products (Medicare) - since October 2016.

Manage concurrent / appealed Medicare cases by reviewing medical records ensuring adherence to review standards and best practices.

Evaluate admission statuses through close collaboration with providers on multiple cases to drive decision-making in appropriate admission changes.

Perform medical records review for appealed/ retro / or concurrent cases.

Analyze medical records and choose appropriate level of care.

Implementation of a comprehensive outpatient/inpatient review process utilizing criteria-based review standards and standards of best practice.

Discuss cases/ clinical records with MD/ CM/UM/ responsible party.

Discuss cases with providers and make appropriate change in admission status.

Utilize appropriate MCG criteria/ ICD 10 codes/ CPT codes in claims / cases.

Process/ prepare cases to review, including detail claim review.

Provide explanations and information to others on difficult issues.

Coach, provide feedback, and guide others.

Review clinical records review that received from multiple facilities / multiple states.

Discharge Planning/ appropriate placement SNF, L tac, IRF .

Bedside nurse--March 2002 to October 2016

I have extensive knowledge regarding care of patients in Medicine, Surgery, Neuroscience / Spine/ Orthopedic /Trauma/ Telemetry settings/MIMU/MICU /SIMU/ observation/ charge nurse for multiple units. Experience in various clinical information system applications like EMR, Order Entry, patient classification, results reporting, clinical documentation, staffing systems, charge of the unit and admission and discharge process.

Ortho, Trauma, Medical surgical, observation, MIMU Charge RN- August 2009 to September 2016

Memorial Hermann Texas Medical Center - Houston, TX

6400 Fannin Street, Houston TX- 77459

Telephone:713-***-****

Registered Nurse - Med/Surgical / Neuroscience- February 2008 to August 2009

Regional medical Center - Hudson, FL

Bayonet Point, 14000 Fivay road Hudson FL 34667

Telephone: 727-***-****

Registered Nurse - Med/Surgical, Orthopedic -September 2006 to February 2008

Kendall Regional Medical Center - Miami, FL

11750 SW 40 Street, Miami, FL 33175

Telephone: 305- 223-3000

Assistant lecturer / Clinical Instructor- October 2004 to July 2006

Josco College of Nursing

Bangalore, Karnataka, India -562123

Telephone: 91-984-***-****

Registered Nurse -ER -March 2002 to August 2004

Trichur Heart Hospital LTD - Thrissur, Kerala, India 680 001

Telephone: 91 - 487 -243-3101.

Skills:

Nursing, Patient Care, Utilization Review, Case Management, Discharge Planning, Medical Records Management, …

Proficient in NCQA/ CMS rules and regulations .

Proficient in Medicare rules and regulations

Expert in multitasking and work in fast paced environment.

Expert in multiple policy rules / Delegates

Able to work with minimal guidance; seeks guidance on only the most complex tasks.

Technical Skills:

Microsoft Office, Epic/, Cortex/ Xsolis / multiple EMR programs.

Excellent computer knowledge/ experience.

Expert in WebEx, Zoom meetings, PowerPoint presentations etc

Education

Cherraan's College of Nursing, Coimbatore, Tamilnadu, India 641039

Telephone: 91 - 422 - 341066

Bachelor of Science in Nursing: November 1997 to November 2001.

Active Licenses

Texas Board of nursing –RN

NV Board of Nursing – RN

CA board of Nursing: RN

Current Certification

MCG

Future Certification Plan – Obtain Coding Certification -CPC

Awards

Multiple Excellence / Star awards

References

Humana, Inc.

Danielle Barnaby (Current Manager)

Phone ; 800-322- 2758 x1096015

Angela Golden Former Provider Dispute team Manager

Cell; 940-***-****

Carmen Shaw –Former Provider Dispute team Manager

Phone ; 800-***-**** Ext 1091576

Dasha Crain - Former team Manger

Phone : 800-***-**** Ext 1090309

Memorial Hermann Healthcare System

Denise Perez

Former COU Manager, MHHS

Mobile ; 832-***-****

Bonny Galindo

Charge RN COU

Mobile ; 713-***-****.

Thank you for your kind review.

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