Post Job Free
Sign in

Spartanburg Data Entry

Location:
United States
Posted:
June 07, 2022

Contact this candidate

Resume:

TANNISHA BRIGGS

MSN, RN, CCM

**********@*****.***

404-***-****

PROFESSIONAL SUMMARY

Expert Registered Nurse with more than 14 years healthcare experience in various environments. Performs professional nursing work of considerable difficulty including care of clients & exercising supervision over licensed & non-licensed personnel. Skilled quality assurance professional with expertise in various testing methodologies for both client-facing & non-client-facing applications & processes in a clinical environment. Excellent time management & critical thinking skills. Meticulous attention to detail. Committed to compliance reporting & results oriented.

LICENSES & CERTIFICATIONS

CERTIFIED CASE MANAGER (CCM #4240158)

•SC RN (#224046)- 2014 to Present; GA RN (Compact License)(#RN247238)- 2015 to present; WA RN(RN60695478) 2016 to Present

•NV RN(#RN90426) 2016 to Present; CA RN(#95117316)- 2016 to Present; MN RN(#2396848) 2016 to Present; WY RN(#38838) 2016 to Present

•OK RN (#RO124450)-2016 to Present NY RN-In Progress; CT-Pending; SC LPN (#P42358)- 2009 to 2014; MI RN Exp 2017; OH RN Exp 2017

•Basic Life Support (BLS) Certification; Advanced Life Support (ACLS) Certification; Cardiac Rhythms Interpretation Course

SKILL HIGHLIGHTS

Preceptor

Acute & Rehab care

CLABSI Team Specialist

Wound Care & Vac

Utilization Review

IV therapy

Blood transfusions

Pain management

NG & PEG Tubes

Utilization Review

Medical Mgmt

Central line blood drawing

Computerized charting specialist

PCA Administration

Behavioral Health

Triage

Strong medical ethic

Chart analysis

Diabetes, Hospice, & Stroke Education

Data Abstraction

Resource advocacy

Case Mgmt

Message mgmt

Telemetry Rhythm interpretation

Patient/Family Education

Ambulatory

Medicine

Cardiac Monitoring & Assessment

PROFESSIONAL EXPERIENCE

PATRICK B HARRIS ACUTE PSYCHIATRIC HOSPITAL

Anderson, SC

Registered Nurse Temporary Contract Assignment 2/2020 to Current

Provide care to psychiatric patients

Provide psychological support to patients and their families

Transcribe doctor's orders, review charts

Administer medications or treatments as directed

Monitor patient progress and document changes to behavior or health

Facilitate group activities

Acts as charge nurse/unit manager

NAVIHEALTH INC

Remote

Registered Nurse Preservice Coordinator/utilization review 2/2019 to 11/2021

Coordinates the transition of patients from the community or acute setting to the next appropriate level of care while following established facility policies and procedures. (Medicare/Medicaid patients)

Responsible for reviewing pre-authorization requests for skilled nursing and rehabilitative services and determining if requests meet medical necessity for the requested level of care.

Perform in a hybrid role as either clinical “gatherer and authorization document creator” or solely as a clinical and authorization “reviewer” for all prospective, concurrent, and retrospective requests within established parameters.

Perform review for all direct admits to SNF via physician office, ED or HH.

Perform all expedited prospective reviews, including patient oral and/or written notifications.

Perform all standard prospective reviews, including patient oral and/or written notifications.

May have EMR access to mirror Inpatient Care Coordinator partner access.

Coordinator peer to peer reviews with naviHealth Medical Directors.

Notify hospital and SNF of review outcome for non-engaged patients.

Partner with Medical Directors for Pre-Service Coordinator training as needed.

Complete processes as it relates to pre-service authorizations.

Educate facilities on pre-service denial process.

Participate in the clinical phone queue to ensure customer SLA’s are met.

Support new delegated contract start-up to ensure experienced staff work with new contracts.

Partner with the full care coordinator team as needed, this may include but is not limited to Operations Leadership, Medical Directors, Skilled Inpatient Care Coordinators, IRF/LTAC Coordinators, Engagement Specialists, and Clinical Leadership.

Perform other duties and responsibilities as required, assigned, or requested.

ANTHEM BLUE CROSS BLUE SHIELD

Atlanta, GA

Nurse Medical Management,Utilization Review/Case Management 08/2017 to 2/2019

•Collaborates with providers & members to promote quality member outcomes, to optimize mbr benefits, & to promote effective use of resources.

•Performs Initial, Concurrent and Retro review to ensure medically appropriate, high quality, cost effective care through assessing medical necessity of

inpatient admissions, outpatient services,

Skilled/LTACH/REHAB, focused surgical & diagnostic procedures, out of network services, & appropriateness of treatment setting by utilizing the

applicable medical policy & industry standards, accurately interpreting benefits & managed care products, & steering members to appropriate providers,

programs or community resources.

•Works with medical directors in interpreting appropriateness of care & accurate claims payment. May also manage appeals for services denied. Primary

duties may include, but are not limited to:

•Conducts pre-certification, care coordination for appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy,

& member eligibility, benefits, & contracts.

•Ensures member access to medical necessary, quality healthcare in a cost effective setting according to contract.

•Facilitates accreditation by knowing, understanding, correctly interpreting, & accurately applying accrediting & regulatory requirements & standards.

•Consult with clinical reviewers &/or medical directors to ensure medically appropriate, high quality, cost effective care throughout the medical

management process.

•Collaborates with providers to assess member’s needs for early identification of & proactive planning for discharge planning.

•Facilitates member care transition through the healthcare continuum & refers treatment plans/plan of care to clinical reviewers as required & does not

issue non-certifications.

NORTHSIDE HOSPITAL

Atlanta, GA

Registered Nurse

04/2017 to 02/2019 (PRN-float pool)

•Floats to various units throughout the hospital

•Supervises assigned team members, directing and mentoring team in proper care, policies, and procedures

•Collaborates with multidisciplinary team to provide appropriate care in accordance with unit standards

•Reports abnormal findings and change in patient status to MD, applying appropriate nursing measures

•Serves as Express Admit nurse for the hospital in order to expedite and streamline the admission

•Served as preceptor for new Float Pool hires

•Case Management

CENTENE PEACHSTATE HEALTH PLAN

Atlanta, GA

Clinical Nurse Liaison, Quality Improvement/Case Manager

04/2017 to 4/2018

•Establishes Assesses Establishes & fosters a healthy working relationship between large physician practices, IPAs & Peach State.

•Educates providers & supports provider practice sites in regards to the NCQA HEDIS measures.

•Request & abstract appropriate medical records for HEDIS & Clinical Practice Guidelines (CPG) for Medicaid, healthcare marketplace & Medicare.

•Provides education for HEDIS measures, appropriate medical record documentation & appropriate coding.

•Assists in resolving deficiencies impacting plan compliance to meet State &Federal standards for HEDIS.

•Acts as a resource for the market on HEDIS measures, appropriate medical record documentation &appropriate coding.

•Supports the development &implementation of quality improvement interventions & audits in relation to plan providers.

•Advises & educates large Provider practices & IPAs in appropriate HEDIS measures, medical record documentation guidelines & HEDIS ICD-9/10 CPT

coding in accordance with NCQA requirements.

•Collects, summarizes & trends provider performance data to identify & strategize opportunities for provider improvement.

•Collaborates with Provider Relations to improve provider performance in areas of Quality, Risk Adjustment & Operations (claims & encounters).

•Delivers provider specific metrics & coach providers on gap closing opportunities.

•Identifies specific practice needs where Peach State can provide support.

•Defines gaps in Peach State's service relationship with providers & facilitate resolution.

•Leads & or supports collaborative business partnerships, elicit client understanding & insight to advise & make recommendations.

•Partners with physicians/physician staff to find ways to explore new ways to encourage member clinical participation in wellness & education.

•Provides resources & educational opportunities to provider & staff. Captures concerns & issues in action plans as agreed upon by provider.

•Supports quality improvement HEDIS & program studies as needed, requesting records from providers, maintaining databases, & researching to identify

members' provider encounter history.

•Ensures that documentation produced & /or processed complies with state regulations &/or accrediting body requirements.

•Participates in & represents plan at community, health department, collaborative & other organizational meetings focusing on quality improvement,

member education, & disparity programs, as assigned.

•Ensures accuracy in medical records for data collection, data entry & reporting. Enters documentation of findings in identified databases.

KAISER PERMANENTE

Atlanta, GA

Supplemental Staffing Registered Nurse, Ambulatory Medicine & Pediatrics 01/2017 to 9/2017 (Contract assignment)

•Assesses & triages patients presenting to the health care setting, including unscheduled patients, emergencies & others using critical thinking skills

•Monitors patient & work flows, directs other clinical support staff in the delivery of safe & effective patient care.

•Serves as a role model for quality & service & as a resource, coach & mentor for other members of the Health Care Team.

•Initiates & monitors IV therapy, administration of medications & other nursing procedures as ordered by the physician or associate practitioner.

• Assists w/ procedures & nursing care w/in scope of practice & skill. Monitors patients' response during & after the procedure.

• Ensures readiness of the Health Care Team members to respond to emergencies, including equipment & staff knowledge & skill.

• Manages electronic messaging & e-mail related to patient & provider requests & inquiries (In-basket support) as appropriate through triage & direct

response to the member w/in scope of practice &/or triage/staging message for provider response.

• Evaluates emergency situations & initiate appropriate nursing interventions. Lead the nursing response to medical emergencies.

• Accurately documents patient data, actions, interventions & patient response according to established guidelines & policies.

• Provides follow-up care to patients by providing outgoing telephone calls, follow-up interaction, coordinating referrals, scheduling follow-up appointments,

call in/fax in prescriptions, obtain & integrate lab, x-ray & other results, & manage physician orders for lab/x-ray per guidelines.

• Partners w/ team to provide excellent customer service, respond to patient issues & complaints & initiate service recovery procedure.

• Assesses patient & family health education needs, provides health teaching & counseling & evaluates effectiveness of the education process.

• Serves as an advocate for the patient. Facilitates transitions & coordination of care across the continuum.

• Maintains established quality standards by leading or participating in quality monitoring, HEDIS & improvement activities.

Administered vaccinations

OPTUM UNITED HEALTHCARE

Atlanta, GA

RN Case Manager 06/2016 to 09/2017

•Maintains complete & accurate computerized management notes on each case, Disease management.

•Clarifies & coordinates return to work to ensure employee returned to work in a safe &timely manner.

•Interacts with members leaving the hospital - possibly with new medications or diagnoses, or assisting members with safe, effective transitions from care

environments to where they live

•Assists with quarterly QA.

•Determines appropriate level of care while consulting with Medical Director as needed.

•Outreaches to members & performs pre-admission counseling &post discharge assessment to promote optimal health & prevent hospitalization.

•Provides a complete continuum of quality care through close communication with members via on-phone interaction.

•Acts as an intermediary between providers and members - serving in numerous roles, such as educator, evaluator, service

coordinator, community resource researcher and more

• Supports members with condition education, medication reviews and connections to resources such as Home Health Aides or Meals on Wheels

• Assists members with the transition from a care facility back to their home.

EMORY UNIVERSITY HOSPITAL

Atlanta, GA

Nurse Clinician II, Medical-Surgical 05/2015 to 01/2018

•Monitors & mentors patient charting to facilitate accurate & complete patient records, Utilizes the nursing process in caring for patients.

•Facilitates strong multi-disciplinary communication with all member of the health team to enhance safety & excellent care.

•Oversees quality care at all times to ensure patient family satisfaction.

•Starts & maintains peripheral IV's, Implanted Ports, PICC lines

•Provides formal education to all new patients receiving chemotherapy, both IV &Oral

•Assists physicians with procedures & bone marrow biopsies

•Manages pre & post care of patients undergoing diagnostic tests, procedures, &treatments.

•Assesses needs & coordinates care of the medical & terminally ill patient.

•Prepares patients for transfer to SNF, Rehab Unit, & extended care centers.

•Manages pain control needs of patients with sickle cell crisis & acute &chronic pain.

•Provides education congruent with age related needs for the adult & older adult.

•Monitors & assesses patients requiring continuous cardiac monitoring (telemetry).

•Manages patients requiring heparin drips, insulin drips & some cardiac drips.

•Manages patients with chronic disease states (e.g. diabetes, sickle cell, asthma, TB etc.).

MARY BLACK HOSPITAL SYSTEM

Spartanburg, SC

Registered Nurse, Medical Surgical/Oncology 05/2014 to 05/2015

•Starts & maintains peripheral IV's, Implanted Ports, PICC lines

•Provides formal education to all new patients receiving chemotherapy, both IV &Oral

•Assists physicians with procedures & bone marrow biopsies

•Monitors & mentor patient charting to facilitate accurate & complete patient records.

•Facilitates strong multi-disciplinary communication with all member of the health team to enhance safety &excellent care.

•Oversees quality care at all times to ensure patient & family satisfaction, Utilizes the nursing process in caring for patients.

•Manages pre & post care of patients undergoing diagnostic tests, procedures, &treatments.

•Assesses needs & coordinates care of the medical & terminally ill patient, Prepares patients for transfer to SNF, Rehab Unit, & extended care centers.

•Manages pain control needs of patients with sickle cell crisis & acute & chronic pain.

SPARTANBURG REHABILITATION INSTITUTE

Spartanburg, SC

Registered Nurse 01/2014 to 09/2014

•Assesses persons requiring rehabilitative services including patients recovering from MVA, stroke, orthopedic knee &hip replacements amputation, &

Persons suffering debilitation from medical & surgical conditions.

•Performs continued post-operative care for patients with orthopedic & cardiovascular procedures to include wound &drain management. Monitors pain

through assessment, appropriate & timely medication, followed by clear & concise documentation.

•Coordinates the multidisciplinary rehabilitative care of patients, & participates as a member of the rehabilitation interdisciplinary team. Contributes

information specific to the patient s response to education, medication therapy, pain control, skin condition, bowel/bladder training, &discharge planning.

•Encourages & instructs patients to do as much for themselves as possible, within safe guidelines. Such as: Assisting patients with Activities of Daily Living

(ADL s), socializing with others, & getting out of bed for meals.

•Provides rehabilitation education for the orthopedic, spine, neuro, stroke, cardiac, & oncology patient on safe & effective use of medical equipment, proper

body mechanics, mobility, transfer, ADLs, & home safety.

•Provides care & education congruent with age-related needs for patients ages18 through older adult populations with specific rehabilitation needs.

•Serves as patient advocate collaborating with the Social Worker & Physicians for the rehabilitation patient’s needs related to re-entry into the community.

•Proficient with the FIM (Functional Independent Measures) scoring system for Acute Rehab.

MASSIVE MEDICAL STAFFING

Spartanburg, SC

Per Diem Registered Nurse 01/2012 to 12/2016

SNF, Acute & Subacute facilities, vaccine clinics, Home Health, Case Management, Utilization Review, Ambulatory Medicine & Doctor offices

ADULT CARE OF SPARTANBURG

Spartanburg, SC

Administrator & Licensed Practical Nurse, Assisted Living Facility 02/2011 to 12/2013

•Hires, schedules & trains all personnel & assures adherence to all state regulatory standards.

•Maintains accurate resident charts & state required documentation, Prepares for state survey & health inspections at all times.

•Ensures Plan of Correction is properly completed, corrected, & returned in a timely manner & within identified timeframe.

•Completes all incident report investigations & reported findings according to state regulations & company policies.

•Monitors & communicates landscaping, property maintenance, capital improvement, & kitchen needs on an on-going basis.

•Manages petty cash funds & worked within established budgets.

•Coordinates complete move-in process for all new residents, Facilitated appointment scheduling & transportation.

•Addresses all issues & /or concerns of resident’s family members & ensures prompt resolutions for overall family satisfaction.

•Maintains overall safety of residents & the facility, Manages medication review, administration, & ordering from pharmacy.

•Directly manages caregivers, medication aids & dietary staff while maintaining high staff morale & fostered a supportive work environment.

SPARTANBURG REGIONAL HEALTHCARE SYSTEM

Spartanburg, SC

Licensed Practical Nurse, Restorative Care Subacute 03/2010 to 6/2011

•Provides clinical care for a wide range of patients, including sub-acute, hospice &long term care geriatric patients.

•Clinical duties include pain management, assessments, medication pass, treatments, admissions, discharges, IV therapy tracheostomy care, colostomy care,

wound care, wound vacs, dressing changes, oxygen therapy, nebulizers, BIPAP, CPAP, & accurate documentation.

•Educates patients & family members in regards to disease processes.

MAGNOLIA MANOR

Spartanburg, SC

Licensed Practical Nurse, Skilled Nursing Facility 02/2008 to 02/2011

•Provides clinical care for a wide range of patients, including sub-acute, hospice &long term care geriatric patients.

•Clinical duties include pain management, assessments, medication pass, treatments, admissions, discharges, IV therapy tracheostomy care, colostomy care,

wound care, wound vacs, dressing changes, oxygen therapy, nebulizers, BIPAP, CPAP, & accurate documentation.

•Educates patients & family members in regards to disease processes.

EDUCATION

DOCTORATE OF NURSING PRACTICE PRESENT

Capella University, Minneapolis, MN, USA

MASTER OF SCIENCE: NURSING LEADERSHIP & ADMINISTRATION 03/2019

Capella University, Minneapolis, MN, USA

BACHELOR OF SCIENCE: NURSING 05/2018

Capella University, Minneapolis, MN, USA

ASSOCIATE OF SCIENCE: NURSING

Piedmont Technical College, Greenwood, SC, USA 12/2013

DIPLOMA: LICENSED PRACTICAL NURSE

ECPI Medical Careers Institute, Greenville, SC, USA 2/2008

PROFESSIONAL AFFILIATIONS, AWARDS, HONORS

SIGMA THETA TAU INTERNATIONAL HONOR SOCIETY OF NURSING

COMPUTER SKILLS

•Microsoft Office Suite

•Clinview

•Cerner

•E-Chart

•Interqual

•Genesys

•Avatar

•Meditech

•Microsoft Outlook

•Siemens Healthcare

•Health Connect

•ClinDocs

•WGS

•Web Based Applications

•EPIC

•HMS

•McKesson

•Milliman Care Guidelines

•MCG

•MaxMC/WMDS

•Citrix



Contact this candidate