Review Nurse Medical

Cathy Power, LVN

**** ********* ****

Prosper, Texas 75078

214-***-**** ************@*****.***

Dedicated and experienced LPN seeking employment in medical review, clinical appeal and medical insurance opportunities.

EXPERIENCE

United Health Group, Richardson, Texas June 1998 – December 2019 Pre-certification review nurse September 2004 – December 2019

• Reviewed documentation for authorization for inpatient/outpatient procedures, home healthcare, durable medical equipment and medication

• Selected to be one of 15 people nationwide to serve as a liaison for key account

• Considered a subject matter expert on spinal review

• Exceeded daily production quota and consistently maintained 100% rating on quality review metrics

• Trained approximately 20 new hires (including registered nurses) on company policies/ procedures and daily assignments

• Coordinated first-hand with senior level medical directors to resolve complicated cases

• Communicated with medical office personnel to obtain information and informed of medical rights to appeal

• Assisted case managers with discharge planning

• Utilized nursing knowledge to determine medical necessity review

• Volunteered to work additional hours or weekends to meet turnaround times Additional Roles/Responsibilities within United Health Group June 1998 – August 2004

• Discharge planning

• Hysterectomy review nurse

• Telephonic review nurse

TECHNICAL SKILLS

• Milliman Care Guidelines

• ICD 10 coding

• CPT coding

• HCPCS coding

• Microsoft Word, Outlook, Excel

EDUCATION

Oscar B. Jones School of Nursing Marshall, Texas

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