Receptionist Medical
Resume:
Paula Scanlon
RN
North Chesterfield, VA *****
admgon@r.postjobfree.com
Work Experience
Behavioral Health Concurrent Reviewer
CVS Aetna - Richmond, VA
July 2019 to January 2021
Reviewed Behavioral Health faxes for medical necessity based on MCG criteria, customer service with providers, deferred cases to MD for reviews that needed denials.
Revenue Integrity Analyst
UHS of Delaware, Inc. - Richmond, VA
April 2015 to January 2019
Reviewed medical records of inpatient psychiatric and medical hospitalizations as well as outpatient claims, drafting appeal letters to payors outlining medical necessity of the stays in order to procure payment for the services rendered.
Clinical RN Utilization Management Care Manager
Magellan Behavioral Health - Richmond, VA
April 2000 to April 2015 Performed precertification for Psychiatric Admission and Concurrent reviews. Worked DMAS contract
Medicare Specialist
DYNCORP - Richmond, VA
June 1997 to April 2000
Reviewed Medicare policies and LMRPs and reviewed Medicare outpatient claims for medical necessity. Special project to study Partial Hospital Programs.
Behavioral Health Reviewer/Assistant Supervisor
West Virginia Medical Institute - Richmond, VA
1994 to April 2000
Telephonic review of Behavioral Health cases for precertification of Admission and Concurrent regarding medical necessity. Was promoted in less than a year.
Psychiatric Nurse
Westbrook, St Johns substance abuse, Chippenham- Tucker Pavilion - Richmond, VA January 1977 to April 1994
Worked as psychiatric RN, charge nurse, medication nurse. Half time Day Supervisor. Head Nurse supervisor at Tucker Pavilion.
Hospice RN
Hospice of Central Virginia - Richmond, VA
April 1990 to April 1992
UNSURE OF THE DATES. Was a hospice nurse. Had very limited PICC machines experience. Other than that my skills were good.
Education
RN in Nursing
Johnston Willis School of Nursing - Richmond, VA
September 1973 to June 1976
Other
Nursing License
RN
Skills
Microsoft Word, Microsoft Outlook, Microsoft Excel spreadsheets, Cerner, SMS (10+ years) Certifications
RN diploma
Nursing license
Additional Information
Excellent leadership capabilities, ability to complete assignments with minimal supervision. Broad knowledge base translates well into various positions. Many, many years nursing experience.
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