Katherine E. Gittrich, LPN, CMCN

309-***-**** • ad2laq@r.postjobfree.com

Professional Summary

Experienced Quality Management Nurse with 23 years experience in managed care review and compliance, including commercial and Medicare/Medicaid. Core Qualifications

● Outstanding communication skills with extensive experience working with medical directors and all members of the medical team

● Extensive familiarity with nursing procedures, managed care principles, medical terminology, and knowledge of CMS requirements

● Consistently exceeds company performance metrics, including timelines according to Medicare and NCQA

● Extensive computer experience with MS Office Suite applications and proven record of navigating and efficiently learning new applications and systems Experience

Humana, Compliance Nurse, 2010-2023

• Reviewed cases for skilled nursing facilities, inpatient rehab and long-term acute care hospitals in accordance with Medicare/Medicaid guidelines

• Compliance review of approval letters, denial letters

• Consistently a top producer, with extensive experience writing Detailed Explanation of Non-Coverage (DENC) and Detailed Notice of Discharge

(DND) letters

Kindred Long Term Acute Care, Case Manager, 2009-2010

• Case management specializing in complex discharges

• Commercial and Medicare choice reviews with managed care companies Humana, Utilization Review Nurse, 2008- 2009

• Authorized outpatient procedures, referrals, durable medical equipment, network authorizations for commercial clients.

OSF HealthPlans, 1999-2008

● Consistent top performer responsible for pre-service, retro claim reviews, outpatient and inpatient surgery, CT and MRI prior authorization and Durable Medical Equipment.

● Responsible for in-network and out-of-network referrals and procedures.

● Completed internal audits for NCQA certification Education and Certifications

Certified Managed Care Nurse CMCN

Licensed Practical Nurse active 043.078712

Associates Degree – Nursing, 1995, Illinois Central College, East Peoria, IL