Case Manager Registered Nurse
Resume:
Kerri Malea Anderson, RN BSN
Jacksonville FL 32218
A dedicated and well qualified registered nurse with extensive experience in: patient centered in-home health, critical care, telemetry, emergency services, as well as case management. These skills help aid in providing a comprehensive background within the health-care field.
Education
Bachelor of Science in Nursing, 2000
University of Phoenix, Phoenix, AZ
Associate Degree of Nursing, 1999
Central Piedmont Community College, Charlotte, NC
High School Diploma
Portsmouth High School, Portsmouth, OH
Certifications
Certified Medical Assistant (CMA)
Committees
Bed Huddle Rounds
Length of Stay (LOS)
Palliative Care
NICHE (Nurses Improve Care for Hospital Elderly)
Experience
Carecentrix, October 2019 - Present
Role: Utilization review nurse/ Case Manager
Duties:
●Calling case managers at skilled nursing facilities, inpatient rehabs, and/or long term care facilities to obtain updates regarding physical/occupational therapy
●Following medicare/medicaid guidelines according to Interqual/Milliman requirements
●Attending meetings with Medical Directors when dealing with elevating cases for denials, approvals, or peer to peer reviews
●Collaborating with facility case managers in formulating safe discharge plans
●Aid colleagues with learning new review procedures per Ambetter, Wellcare, Florida Blue and Excellus
●Assist with developing the RDT for EOS reviews
●Trained new nurses for the Florida PAC team
WorkCare, June 2016 - July 2019
Anaheim, California
Role: Case Manager
Duties:
●Triaging calls of injured workers
●Verified worker’s comp state laws and contracts of companies working with WorkCare.
●Obtained and reviewed assessments related to work injury incidents and made sure all necessary documents were presented.
●Build rapport with physicians, adjusters, and employer health & safety managers.
●Aid in case direction
Humana Medicare Health Insurance, November 2014 - June 2016
Charlotte, NC
Role: Case Manager
Duties:
●Reviewed medical clinical notes to determine if member incidents qualify for inpatient or observation status.
●Documented detailed summaries for medical directors to make final decisions in complex cases.
●Verified HMO, PPO, or fee for service along with plan benefits.
●Establish relationships with other case managers and communicate decisions via phone call and fax.
●Work with team to review and evaluate cases within the NCQA time frame.
Carolinas Medical Center, September 2012 - July 2014
Charlotte, NC
Role: Utilization Review Nurse
Duties:
●Verified insurance to determine a patient's length of stay.
●Reviewed hospital notes and compared to patient’s care as well as admission status.
●Communicate with physician, insurance companies, veteran affairs, and other collaborative caregivers.
●In cases of denial, aided in the preparation of peer-to-peer conferences.
●Abided by Interqual criteria when reviewing Medicaid, Medicare, Self-Pay, and commercially insured patients.
Travelers Insurance, August 2011- August 2012
Charlotte, NC
Role: Telephonic Medical Case Manager
Duties:
●Utilization review
●Collaborated with attorneys, medical providers, and the insured to manage healthcare plans.
●Determined if injured workers could return to work full-duty or until maximum medical improvement status was reached.
Presbyterian Hospital March 2009 - March 2010
Charlotte, NC
Role: Floor Nurse
Duties:
●Administered head-to-toe assessments.
●Extensive experience with telemetry and blood administration to monitor patients.
●Assisted in minor surgeries.
●Reported any significant patient changes to physicians and home healthcare providers as needed.
Carolinas Specialty Hospital - Long Term Acute Care June 2005 - March 2009
Charlotte, NC
Role: Floor Nurse and Liaison
Duties:
●Administered head-to-toe assessments.
●Extensive experience with telemetry, ventilation monitoring, and blood administration to monitor patients.
●Started IV’s and administered oral, rectal, and IV medications.
●Served as hospital liaison which included verifying insurance benefits.
Contact this candidate