Registered Nurse Medical
Resume:
Rose Matuozzi, RN **********@*****.***
Objective
Registered nurse seeking a position which will make use of comprehensive healthcare training and education with a demonstrated record of accomplishment of excellent communication skills and self-directed prioritization.
Experience
April 2008 –
Present
Medical Policy Analyst / Utilization Analyst II Horizon Blue Cross Blue Shield of NJ
Review clinical documentation of post service procedures for appropriateness of service based on medical necessity, correct billing, company policies, CMS guidelines, member plans
Route un-approvable determination to medical directors in a case format with all required clinical information for the determination
Department representative at NCQA audit, consisting of prepping case files, and ensuring all standards are met
Cover business analyst of my team when on PTO. Duties include running reports, distribute work to staff, and keep track of levels of inventory.
Cover my manager when on PTO if business analyst is on PTO concurrently. Duties include corresponding to urgent e mails and follow ups.
Direct peer collaboration with medical directors regarding various subjects for the department and cases.
Participate in clinical policy and cross division work group meetings with reporting back to team of changes, updates and new medical policy information.
Participate in work groups which focus on appeals, medical policy, and business requirement documents, to promote best practices.
Assist in the on boarding and training of the new hires to the department.
Helping reduce inventory and meet goal standards for the team.
Attend lunch and learn sessions, complete required web-based training timely, complete the required CEU credits as outlined by the State of NJ Board of Nursing
August 2007-
February 2009
RN Staff Nurse, Medical/Surgical, Ortho Unit JFK Medical Center
Delivered patient care for pre/post surgical patients within a 31 bed unit, which included orthopedic, general as well as isolation patients.
Implemented patient care and clinical skills which included; dressing changes, medication administration, Foley/straight cath insertion, IV infusions, injections, phlebotomy, respiratory treatments, insertion and care of NG tubes, G-tube care, heparin drip calculations, as well as patient teaching regarding many aspects of medication to safety issues.
Critical thinking, prioritization, and evaluation of care to patients.
Interacted with doctors in person and via phone.
Computer charting and administration of medications via Med RX.
August 1996-
December 2006
Medical Assistant - Sept 2002- Dec 2006 Westerliegh Medical, Internal Medicine
Patient intake; height, weight, vital signs, chief complaint, symptoms, durations relieving factors, patient history, family history, venipuncture, injections, urine analysis, throat cultures, wound dressings, ear irrigations.
Performed complete physicals, EKG, Pulmonary function tests, bone density.
Called patients with test results after doctor’s review.
Referral Coordinator - October 1996- August 2002
Office liaison to several insurance companies.
Responsible for informing entire office of all credentialed insurance companies of procedures for referrals, pre-certification requirements, facility locations, covered medications.
Obtained pre-certification for procedures.
Devised a folder system process for each insurance company.
Implemented own voice mail for patients to leave request for referrals, consisting of over one hundred calls a day to retrieve and return as well as complete referrals
Education
Brookdale Community College, Lincroft,NJ 2003-2007
A.A.S. – Associates in Applied Science, Nursing
License/ Certifications
RN, BLS, CPR, HHA, MA
Computer skills
Proficient in the use of MS word, Lotus notes, Excel, Siemens Medical Solution application, Medication Rx. Clinstar, Horizon Clinical.
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