Utilization Review Staff Nurse
Resume:
Jody Webb RN
Lincoln, CA 95648
Objective: To obtain a position as a staff nurse.
Qualifications: CA Nursing License No. 577932
Work Experience:
1.Sutter Shared Services Nurse Auditor- May 2015- Current
Duties: Performs third party audits, billing, coding review, utilization review, risk management, quality assurance, compliance per hospital policy, patient generated disputes regarding charge/billing issues, donor/cosmetic accounts transferring charges per chart/MD orders/nursing documentation and complying with policy/procedure guidelines along with utilization review experience.
*Performs audits on paid managed care accounts where an external auditor identifies discrepancies (defense audits) adding charges as appropriate per documentation and removing charges if they are not supported in the MD/nursing documentation. An RN with vast clinical background is required to perform these determinations and find missing charges as well as maintaining communication with the third-party auditors. When completed, posting additional/removing charges according to supporting/lacking documentation.
*Performs charge audits requested by patient’s (salesforce tickets, e-mails, IM’s from various departments), also requires phone contact with the patient, which requires clinical experience and most of all diplomacy when the conversation becomes escalated.
*Works with various staff/departments such as HIM, Revenue Integrity, Central billing office, clinical staff, MD’s, to obtain the necessary information in order to make a determination which is the best interest of the patient and perform an accurate audit.
*Supports positive customer relations, nurse auditors are required to research and investigate issues (chart documentation) and prepares a written or oral response as needed, as in a clinical scenario, the best outcome for the patient.
*Assists with complying with administrative policies and external auditing requirements, as well as other regulations such as CMS guidelines, along with policies/procedures of the organization and to ensure an appropriate audit trail is maintained consistently.
*Performs special studies/projects such as the modifier 59 assist charge edit team, Maternal/child audit, assist subject matter experts preparing reports as needed.
*Performs other duties as assigned by management.
2.Sutter Auburn Faith Hospital 01/2012- 5/2015 (Full time)
Position: Staff Nurse – Telemetry
Supervisor: Denise Finch RN 530-***-****
Duties: All aspects of patient care and monitoring
3.Washington Hospital 09/2010-01/2012 (Full time)
Position: Staff Nurse- Telemetry
Supervisor: Harold Smith RN 510-***-****
Duties: All aspects of patient care and monitoring
4.San Ramon Regional Hospital 09/2008-09/2010 (Full time)
Position: Staff Nurse- Telemetry
Supervisor: Mary Carr MSN 510-***-****
Duties: All aspects of patient care and monitoring
5.Mather VA 06/2004-09/2008 (full time)
Position: Staff Nurse- Urgent Care/ Interventional Radiology
Supervisor: Charles Barbiere 916-***-****
Duties: All aspects of emergency medical care. All aspects of interventional radiology nursing Including pre-op, intra-op sedation, recovering the patient in PACU
6.South Placer Surgery Center 04/2003-06/2004 (Full Time)
Position: Pre-op/ PACU Staff nurse
Supervisor: Lorraine Pucher- Petersen 916-***-****
Duties: All aspects of pre-operative and post-surgical care
7.Pulse Health Care Staffing- RN Registry 01/2003-06/2004
8.Greater Sacramento Surgery Center- 02/2002-04/2003 (full time)
Position: Pre-op/ PACU Staff Nurse
Supervisor: Jane Glaser- Stull 916-***-****
Duties- All aspects of adult/ pediatric pre-operative and post -surgical care
9.Kaiser Permanente- 01/2001-02/2002 (full time)
Position: Staff Nurse II Intensive Care Unit
Supervisor: Theresa Doucette 916-***-****
Duties: All aspects of patient care in a large Intensive Care Unit
Education:
1.Sacramento City College 01/1998-12/2000
Associate Degree in Nursing
Recipient of Geraldine Olson Scholarship
2.CSU Fresno- Pre-nursing courses 08/1996- 05/1997
3.Fresno City College- Gen Ed Courses 08/1994-05/1996
4.UTA undergraduate BSN 07/2018
References
Personal
Terri Marcum RN 530-***-****
Denise Thayer RN 530-***-****
Diane Jackson RN 530-***-****
Business
Terri Marcum RN 530-***-****
Jodi Buriani RN 209-***-****
Paul Shelley RN 916-***-****
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