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Data Entry Utilization Review

Location:
Baton Rouge, LA
Posted:
March 22, 2023

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Resume:

Rosanne Masse

Professional Seeking Career Change

Baton Rouge, LA 70816

adv251@r.postjobfree.com

+1-334-***-****

Accomplished health care professional with more than 35 years of leadership expertise in diverse settings. Adept at cultivating and directing high performance teams to meet regulatory compliance and ensure delivery of high quality patient care. Detail oriented exhibiting excellent communications, proactive strategist, and comprehensive planning skills. Successful at ensuring compliance with all levels of management and direct care staff in health care organizations. Seeking a career change in a position where I can flourish. Master's degree with a minor in Human Resources.

Willing to relocate to: Alabama

Authorized to work in the US for any employer

Work Experience

Director of Quality Assurance

In Loving Arms HealthCare for Kids - Baton Rouge, LA November 2022 to Present

Quality Measures

Regulatory compliance

Policy and Procedures

Infection Control

Licensure/ Certification

Education

Director of Nursing Services

Apollo Behavioral Health Hospital - Baton Rouge, LA April 2020 to November 2022

24 bed behavioral health hospital for adults with acute psychiatric symptoms who are a danger to self or others

Case Manager

Utilization Review/Social Services - Demopolis, AL August 2018 to April 2020

• Comprehensive utilization review and management with success in preventing denials, appropriate use of resources, promotion in improved quality of care

• Perform three types of assessments; prospective, concurrent, and retrospective.

• Minimize LOS by appropriate needs assessment and care transitioning planning

• Initiated staff education (behavioral health units) to enhance documentation to minimize denials Manager of Inpatient Behavioral Health

Tombigbee Healthcare Authority/BWWMH - Demopolis, AL 2016 to 2018

• 10 bed adult unit, 10 bed geriatric unit, 15 bed medical detox unit

• Oversight and responsibility for managing all aspects of inpatient census volumes - admissions, treatment planning, interdisciplinary communication, physician relationships and discharge planning

• Managed ~ 40 FTE to include licensed and unlicensed nursing staff, MSW's, MSCE, Activities Director

• Coordinated medical and psychiatric service integration

• Collaborated with colleagues in the ER to effectively solve clinical and operational challenges

• Well versed in governing regulations (CMS) and standards for the program; well versed in Baker Act

• Instrumental with operational, clinical and EOC preparation for opening of 10 bed adult unit; CMS survey deficient free at 1 year follow up

• Quality measures improved by 70% in 1 year

Psychiatric RN Case Manager

Amedisys - Demopolis, AL

2015 to 2016

Director of Nursing

Prattville Health & Rehab - Prattville, AL

2014 to 2015

Interim Director of Nursing

Central Desert Behavioral Health - Albuquerque, NM February 2014 to May 2014

Diamond Healthcare

Director of Nursing/QA/Ed

The Orchard - Warsaw, VA

2012 to 2014

145 bed nursing facility, to include assisted living and rehab beds Completed AIT process and was licensed in state of Va Education

Master's in Management/HCA

Troy University - Troy, AL

2008

Bachelors in Nursing

Russell Sage College Troy - Troy, NY

1988

Associate in Nursing

Junior College of Albany - Albany, NY

1986

Certification LPN in Practical Nursing

Albany Occupational School of Nursing - Albany, NY 1981

Nursing Licenses

RN

Skills

• Program management; "big picture" perspective

• Natural leader/Inspirational motivator

• Staff training/development

• Versed in the regulatory/CMS survey process; Core measures; patient safety goals; quality indicators

• Therapeutic expertise

• Proficient at root-cause problem solving and designing enduring systems which: 1) Integrate work/systems to create interdepartmental checks and balances to decrease wasted effort and minimize error, 2) Improve information flow, 3) Improve timeliness of task completion, 4) Maximize reimbursement, 5) Minimize exposure to litigation.

• Nurse Management

• Behavioral Health

• Dementia Care

• Case Management

• Nursing

• Medication Administration

• Hospital Experience

• Leadership Experience

• Home Care

• Conflict Management

• Data Entry

• Utilization Review

• Quality Assurance

• Discharge planning

• Documentation review

• Medical records

• Leadership

• Infection Control Training

Certifications and Licenses

BLS Certification

Assessments

Attention to Detail Skills — Expert

July 2018

Measures a candidate’s ability to use diligence when drafting and editing documents. Full results: Expert

Clinical Judgment — Proficient

September 2020

Assessing a patient's condition and implementing the appropriate medical intervention Full results: Proficient

Supervisory Skills: Motivating & Assessing Employees — Expert July 2020

Motivating others to achieve objectives and identifying improvements or corrective actions. Full results: Expert

Management & Leadership Skills: Planning & Execution — Proficient October 2020

Planning and managing resources to accomplish organizational goals Full results: Proficient

Case Management & Social Work — Highly Proficient

March 2020

Prioritizing case tasks, gathering information, and providing services without judgment. Full results: Highly Proficient

Electronic Health Records: Best Practices — Expert March 2020

Knowledge of EHR data, associated privacy regulations, and best practices for EHR use Full results: Expert

Indeed Assessments provides skills tests that are not indicative of a license or certification, or continued development in any professional field.



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