Registered Nurse
Resume:
Nicole Tusa
Biloxi, MS *****
adjc7l@r.postjobfree.com
Skilled Master's prepared Registered Nurse with 16 years of experience in health care. Areas of primary experience include but not limited to are: Case Management, Utilization Management, Nursing Education, Care Coordination, Public Health, Home Health, Mental Health, Medical Surgical Nursing, Long Term Care, OB/GYN, Postpartum, L & D, Well-baby Nursery, Pediatrics, Level III NICU. Authorized to work in the US for any employer
Work Experience
RN Utilization Management
MSN
May 2019 to Present
Duties include but not limited to case management, utilization management, STARS/Hedis. Provides utilization management services and support to health insurance members and health care providers, including but not limited inpatient admissions, continued stay reviews, service referrals and out- of-network referrals. Applies medical criteria, medical policy and benefit information in response to inpatient and home health precertification request. Perform utilization review activities, including precertification, and retrospective reviews according to CMS guidelines. Determine the medical necessity of requests by performing first level reviews using approved evidence based guidelines/ criteria. Answer Utilization Management directed telephone calls managing them in a professional and competent way. Refer cases to reviewing physician when the treatment request did not meet necessity per guidelines, or when guidelines were not available. Identify and refer potential cases to Disease Management and Case Management appropriately for proper follow up. Provides utilization management services and support to health insurance members and health care providers, including but not limited inpatient admissions, continued stay reviews, service referrals and out-of-network referrals. Applies medical criteria, medical policy and benefit information in response to inpatient and home health precertification request.
RN Nursing Faculty
MSN
2008 to 2019
Duties included but not limited to educating, supervising, observing, guiding, and empowering nursing students. Developing effective and efficient clinical skills, to act as a mentor, and create a safe environment for the students and patients. I develop and present lectures, grad student assignments, evaluate student's clinical performance, and work in conjunction with other nursing faculty to maintain a high-quality RN program. Provide students with instruction of the highest standards, evaluate student progress, preparation of syllabi, assist in activities furthering the work of the institution, communicate necessary information to students, and provide academic advice to students as needed. MSN, RN Case Manager/Home Health
Duties included but not limited to complete the Plan of Care, assist the Support Coordinators with problems, questions, any issues that may arise with the clients/providers. Educate staff on common health problems within the community. Assist with quarterly reports/ support waivers. Review client charts to ensure accuracy, organization, completely/correctly documented. Complete Initial assessments. Go on home visits to assist and address any issues with client and provider compliance/ noncompliance of the Plan of Care. Providing client/provider education regarding the client's care, and how to maintain compliance. Staff education. Ensure completion of incident reports and ensure proper documentation. Assume responsibility of any Quality Assurance issues. Maintaining an open relationship/access with the Support Coordinators at all times and addressing any issues immediately. Helping create a person/client centered model. Be a positive influence for all of the staff. RN Program Coordinator, Nursing Instructor
MSN - Houma, LA
May 2012 to June 2015
Duties included but not limited to educating, supervising, observing, guiding, and empowering nursing students. Developing effective and efficient clinical skills, to act as a mentor, and create a safe environment for the students and patients. I develop and present lectures, grad student assignments, evaluate student's clinical performance, and work in conjunction with other nursing faculty to maintain a high quality RN/LPN program. Provide students with instruction of the highest standards, evaluate student progress, preparation of syllabi, assist in activities furthering the work of the institution, communicate necessary information to students, and provide academic advice to students as needed. Assistant Director of Nursing/RN Charge Nurse Med/Surg, LTC MSN - Patterson, LA
January 2012 to June 2012
Duties include but not limited to assisting the Director of Nursing in directing the day-to-day activities. Develop, maintain, and update policies and procedures. Assist in developing methods for coordinating nursing services with resident services to ensure the continuity of the residents' total regimen of care. Participate in the development, maintenance, and implementation of the facility's quality assurance program. Admit, transfer, and discharge residents as required. Complete incident/accident reports as necessary. Ensure all staffing and work assignments are adequate to ensure that high quality care is maintained. Interview and hire nursing staff as positions become available. Educate staff and complete training sessions to maintain excellence.
RN Nurse Consultant/Case Manager Peds
The Columbus Organization - Kenner, LA
February 2011 to January 2012
Duties included but not limited to complete the Pediatric Client's Plan of Care, assist the Support Coordinators with 90-L problems, questions, any issues that may arise with the clients/providers. Educate staff on common health problems within the community. Assist with quarterly reports/ support waivers. Review client charts to ensure accuracy, organization, completely/correctly documented. Complete Initial assessments. Go on home visits to assist and address any issues with client and provider compliance/noncompliance of the Plan of Care. Providing client/provider education regarding the clients care, and how to maintain compliance. Staff education. Ensure completion of incident reports and ensure proper documentation. Assume responsibility of any Quality Assurance issues. Maintaining an open relationship/access with the Support Coordinators at all times and addressing any issues immediately. Helping create a person/client centered model. Be a positive influence for all of the staff and any. RN Nursing Faculty OB/Peds
Delgado Community College - Metairie, LA
July 2010 to November 2010
Duties included but not limited to educating, supervising, observing, guiding, and empowering nursing students. Provide students with instruction of the highest standards, evaluate student progress, assist in preparation of syllabi, assist in activities furthering the community involvement of the institution, communicate necessary information to students, and provide academic advice to students as needed. My purpose there was to encourage students to develop rapport, develop effective and efficient clinical skills, act as a mentor, and create a safe environment for the students and patients. I created student assignments, graded assignments, and worked in conjunction with other nursing faculty to maintain a high quality RN program.
Education
MSN in RN Nursing Faculty
Taylor College - Belleview, FL
November 2016 to August 2017
MSN in Internship
University Hospital OB Clinic - New Orleans, LA
November 2009 to July 2010
Master's in Nursing
University of South Alabama - Mobile, AL
May 2006 to July 2010
Skills
• Case Management
• EMR Systems
• HEDIS
• Managed Care
• Nursing
• Utilization Management
• Microsoft Office
• Epic
• Hospital Experience
• Medical Records
• Triage
• Critical Care Experience
• Experience Administering Injections
• Nurse Management
Certifications and Licenses
Registered Nurse (RN)
Contact this candidate