School Nurse Case Manager

Jacqueline Basso

Millis, MA

Work Experience

Reason for gap in employment (May 2019 to Current):

Assisted in my family/dad’s business, a paper and chemical supply business assisting family members with orders, inventory and customer service.

Also, during this time I worked for Fallon as a nurse vaccinator at Gillette Stadium per diem.

HEDIS Review RN

HARVARD PILGRIM HEALTHCARE - Wellesley, MA

January 2017 to May 2019

(Contractor)

*Reviewed and interpreted medical records and compares against clinical criteria to determine medical necessity, appropriateness of setting, potential billing/coding issues, and quality concerns

*Followed contract specifications when performing medical record reviews

*Used clinical expertise to determine approval or referral to the physician reviewer

*Abstracted review related data/information accurately on appropriate review tool by the appropriate means

*Ensured accurate and timely submission of all administrative and reviewed related documents to appropriate parties

*Maintained production goals and quality standards, while meeting deadlines in a fast-paced environment

*Prepared well-written clinical review letters that summarize review activity and decision

School Nurse

BLESSED SACRAMENT SCHOOL - Walpole, MA 2011 to 2016

Directly support school Nurse with student needs, including medical situations and examinations for standard health / growth requirements based on state regulations

*Ensure compliance with mandated standards for recording statistical documentation

*Volunteer Activities: Coordinate graduation ceremonies working collaboratively with PTO, plan student field trips, and facilitate fund raising / social events. Participate in reading programs at both grammar and middle schools

Nurse Liaison

FLATLEY REHABILITATION AND NURSING CENTERS - Braintree, MA 1997 to 1999

Charged with performing medical screenings and evaluations of potential residents working collaboratively with cross-functional hospital personnel and physicians

*Acquired Medicare and Medicaid authorizations working directly with providers

*Participated in department head meetings, Quality Assurance issues, and contributed to (CQI) initiatives

*Cultivated relationships with hospital discharge planners, coordinated in-services promoting educations, and orchestrated programs for community elders

Case Manager

BLUE CROSS - Quincy, MA

1993 to 1997

Clinical Review Unit / Home Health Care & Home Infusion Therapy, Case Review Unit

*Involved in many aspects of Utilization Review /Utilization Management. Assisted with precertifications for outpatient procedures utilizing BCBS Medical Necessity guidelines.

*Involved with physician office reviews, and authorizations for DME.

*Responsible for inpatient/outpatient services entailing health care cost effectiveness and accreditation surveys

*Conducted onsite admission activities and reviewed outlier data optimizing MCAP criteria

*Administered rehab, SNF, and Chronic pain pre-certifications and contributed to quality improvement initiatives

*Cultivated strong relationships and interacted with physicians, Medical Director, and Administrator to achieve and sustain regulatory requirements

*Ensured adherence to company Credentialing Department standards through detailed physician reviews

Education

certification

BOSTON COLLEGE - Boston, MA

Present

Bachelor of Science in Nursing

SAINT ANSELM COLLEGE - Manchester, NH

Nursing Licenses

RN

Skills

•RN

•HEDIS

•Nursing

•Nursing

Contact this candidate