LPN, UTILIZATION REVIEW

Trina L. Cham

**** ****** *****, ***** ** *****; ****************@*****.***; 718-***-****

EXPERIENCE

Memorial Sloan Kettering

*/ **** -******* *********** ***** Specialist

Monitors and continuously evaluates established treatment plan on assigned patient population. Reviews medical records using standard review criteria to evaluate medical acuity of patients to determine records substantiates for continued acute stay. Assesses patient responses to treatment confer with clinical staff to understand variances from plan, relay changes to insurances through review process and telephonically if needed. Identify quality of care issues, report issues to Quality Assurance. Coordinates retrospective reviews with insurance. Uses the case management application and medical record to track and document activity. Identify potential denials and escalates these cases to RN case manager. Records all information in the medical record and case management application including avoidable days, delays and QA issues Provides clinical information as per departmental protocol while maintaining HIPPAA compliance.

10/2009 – 3/2011 Montefiore Medical Center, Bronx, NY

Medical Utilization Review Analyst

Telephonic case management to achieve goals through patient teaching, care

coordination, problem identification, and intervention. Manages post-

discharge process including outreach activities, problem identification, and

Intervention. Responsible for ensuring case management activities to improve

health outcomes and decrease health care resource use.

2/2003 - 9/2009 Harlem Hospital, New York, NY

Licensed Practical Nurse

Direct care of patients, administer medications IVPB, PO, feedings via NG and peg tube, care for tracheotomy, dressing changes, discharging patients from unit. Patient teaching on medication, procedure and diagnosis. Maintain universal precaution and aseptic technique.

11/16/2007-1/2009 Independent Home Care Provider

Medicaid Provider #: 02915277

Perform intake assessments of patients being discharged from the hospital. Approve

discharge plans, including medication and equipment regime. Ensure medical

equipment is functional and that patients and their families have been educated on

such equipment and on comprehensive discharge plans. Collaborate with Social

Workers and clinical staff at both discharging facility and outpatient services

providers.

2000-2004 Morningside House, Bronx, NY

Licensed Practical Nurse

Provide Direct care of residents and maintained safety, supervised and delegate responsibility CNA’s participate in all phases of client care management, peritoneal dialysis experience in manual exchange and cycler

2000-2003 Mount Sinai Hospital, New York, NY

Licensed Practical Nurse

Direct care of dialysis patients, pre/post dialysis assessment of patients, monitoring patients during dialysis, recognition of complications and emergency conditions with appropriate interventions, give medication PO, IVP and IVSS, initiate treatment via fistulae, grafts and catheters using sterile technique, maintaining infection control and unit guidelines

2000-2000 Community Healthcare Network, New York, NY

Licensed Practical Nurse

Triaging clients, patient teaching on birth control, medications, STD prevention and family planning, assisting MD with office visits, obtaining specimens and cultures, alerting MD of abnormal results and arranging referrals for additional test ordered by MD

SKILLS

Computer: Soap and Web Services (Proficient) and MS Office (Proficient)

EDUCATION

1998 Iona College, New Rochelle, NY

Certificate in Practical Nursing

REFERENCES

Available Upon Request

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