*** ****** ***

Lagrange, KY *****

502-***-****

add89i@r.postjobfree.com

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