Medical Nurse
Resume:
Lagrange, KY *****
************@*****.***
LORA THEISS, LPN
SKILLS
Interqual and Milliman criteria. Medical necessity reviews - pre and post pay. Coding guidelines. Applying medical policies. Inpatient, Outpatient, Long Term care.
EXPERIENCE
Evolent Health/Passport Health — WAH - Care Advisor July 2019 - PRESENT
● Medical necessity reviews for Pain management, Therapies, Cosmetic surgeries, High cost medications using Interqual.
● Train other staff members
● Retro medical necessity reviews
Centersone — LPN - Charge Nurse
November 2017 - July 2019
● Special projects
● Addict clinic - Vivitrol and Suboxone
● Treatment team
● Physician liaison
Humana, Louisville, KY — Nurse Consultant
October 2012 - August 2016
● Review claims - pre and post pay to ensure payment correct
● Special projects
● FDA regulations were used correctly
Baptist Hospital East, Louisville, KY — Patient Coordinator August 2011 - October 2012
● Obtain prior authorizations with MCOs for inpatient/continued stays
● Interqual criteria
● Various other duties
EDUCATION
Galen School of Nursing, Louisville, KY — LPN
Obtained LPN - March 2002
REFERENCES UPON REQUEST
Contact this candidate