R.N Medical Review
Resume:
Summary Self motivated professional with ** years experience diverse nursing experience in Case Management and clinical education, adult care, telephone triage, medical review and quality management.
Professional Experience
Friendly Nursing Home April 2002-Feb 2009
300 Astoria Road
Germantown,Ohio
* Performed case management duties
* skilled nursing assessments and treatments, admissions, supervision, staff nursing
* bridged the gap between facility and home.
Optum Nurseline as an independent contractor through Ewing Associates and as employee for United Healthcare, Dayton, ohio
3100 Research Blvd.
Dayton,Ohio
Bonnie Watson D.O.N. Sept. 2006 - Dec. 2008
* Making outbound calls to assess current health status
* receiving inbound calls providing Telephonic Triage, health education, disease process
* identified the barriers or/gaps in treatment
* interacting with medical directors
* coordination services for Emergency Transportation and DME
Anthem Blue Cross and Blue Shield Feb 2002 -Aug 2006
William Howard Taft Blvd.
Cincinnati,Ohio
Medical Review Analyst R.N.
* Applied medical knowledge and expertise in reviewing claims/subscribers/provider inquires.
*Rendered medical decisions based on claims, information submitted with Anthem Corporate Policies and Procedures to allow for re-imbursement
* Managed medical review inventory, to include resolving workflow issues and identifying medical cost savings
* attended weekly meetings to identify cost saving workflow issues/ review medical policy updates and procedures/ identified fraudulant concerns
*routed medical claims to appropriate ques for further processing.
Extendicare Communicare Companies 2009- 2014
300 Arbors Court
Dayton,Ohio 45417
Rick Harmon 1-937-***-****
LTAC and specialty Sub acute care
* staff R.N.
LTAC and specialty sub acute care
Department of Corrections
2014-2016
Mary Mcclendon ARNP
Blue Ash Care Center/ADON
2017
Mike Meyers
DON
Heartland of Miamisburg
8/1/2017 to current
RN supervisor
Current employer
Rhonda Knotts
12 Burton Road
Middletown, Ohio 45044
Summary Self motivated professional with 23 years experience diverse nursing experience in Case Management and clinical education, adult care, telephone triage, medical review and quality management.
Professional Experience
Friendly Nursing Home April 2002-Feb 2009
300 Astoria Road
Germantown,Ohio
* Performed case management duties
* skilled nursing assessments and treatments, admissions, supervision, staff nursing
* bridged the gap between facility and home.
Optum Nurseline as an independent contractor through Ewing Associates and as employee for United Healthcare, Dayton, ohio
3100 Research Blvd.
Dayton,Ohio
Bonnie Watson D.O.N. Sept. 2006 - Dec. 2008
* Making outbound calls to assess current health status
* receiving inbound calls providing Telephonic Triage, health education, disease process
* identified the barriers or/gaps in treatment
* interacting with medical directors
* coordination services for Emergency Transportation and DME
Anthem Blue Cross and Blue Shield Feb 2002 -Aug 2006
William Howard Taft Blvd.
Cincinnati,Ohio
Medical Review Analyst R.N.
* Applied medical knowledge and expertise in reviewing claims/subscribers/provider inquires.
*Rendered medical decisions based on claims, information submitted with Anthem Corporate Policies and Procedures to allow for re-imbursement
* Managed medical review inventory, to include resolving workflow issues and identifying medical cost savings
* attended weekly meetings to identify cost saving workflow issues/ review medical policy updates and procedures/ identified fraudulant concerns
*routed medical claims to appropriate ques for further processing.
Extendicare Communicare Companies 2009- 2014
300 Arbors Court
Dayton,Ohio 45417
Rick Harmon 1-937-***-****
LTAC and specialty Sub acute care
* staff R.N.
LTAC and specialty sub acute care
Department of Corrections
2014-2016
Mary Mcclendon ARNP
Blue Ash Care Center/ADON
2017
Mike Meyers
DON
Heartland of Miamisburg
8/1/2017 to current
RN supervisor
Current employer
Rhonda Knotts
12 Burton Road
Middletown, Ohio 45044
Summary Self motivated professional with 28 years experience diverse nursing experience in Case Management and clinical education, adult care, telephone triage, medical review and quality management.
Professional Experience
Friendly Nursing Home April 2002-Feb 2009
300 Astoria Road
Germantown,Ohio
* Performed case management duties
* skilled nursing assessments and treatments, admissions, supervision, staff nursing
* bridged the gap between facility and home.
Optum Nurseline as an independent contractor through Ewing Associates and as employee for United Healthcare, Dayton, ohio
3100 Research Blvd.
Dayton,Ohio
Bonnie Watson D.O.N. Sept. 2006 - Dec. 2008
* Making outbound calls to assess current health status
* receiving inbound calls providing Telephonic Triage, health education, disease process
* identified the barriers or/gaps in treatment
* interacting with medical directors
* coordination services for Emergency Transportation and DME
Anthem Blue Cross and Blue Shield Feb 2002 -Aug 2006
William Howard Taft Blvd.
Cincinnati,Ohio
Medical Review Analyst R.N.
* Applied medical knowledge and expertise in reviewing claims/subscribers/provider inquires.
*Rendered medical decisions based on claims, information submitted with Anthem Corporate Policies and Procedures to allow for re-imbursement
* Managed medical review inventory, to include resolving workflow issues and identifying medical cost savings
* attended weekly meetings to identify cost saving workflow issues/ review medical policy updates and procedures/ identified fraudulant concerns
*routed medical claims to appropriate ques for further processing.
Extendicare Communicare Companies 2009- 2014
300 Arbors Court
Dayton,Ohio 45417
Rick Harmon 1-937-***-****
LTAC and specialty Sub acute care
* staff R.N.
LTAC and specialty sub acute care
Department of Corrections
2014-2016
Mary Mcclendon ARNP
Blue Ash Care Center/ADON
2017
Mike Meyers
DON
Heartland of Miamisburg
8/1/2017 to current
RN supervisor
Current employer
Rhonda Knotts
12 Burton Road
Middletown, Ohio 45044
Summary Self motivated professional with 28 years experience diverse nursing experience in Case Management and clinical education, adult care, telephone triage, medical review and quality management.
Professional Experience
Friendly Nursing Home April 2002-Feb 2009
300 Astoria Road
Germantown,Ohio
* Performed case management duties
* skilled nursing assessments and treatments, admissions, supervision, staff nursing
* bridged the gap between facility and home.
Optum Nurseline as an independent contractor through Ewing Associates and as employee for United Healthcare, Dayton, ohio
3100 Research Blvd.
Dayton,Ohio
Bonnie Watson D.O.N. Sept. 2006 - Dec. 2008
* Making outbound calls to assess current health status
* receiving inbound calls providing Telephonic Triage, health education, disease process
* identified the barriers or/gaps in treatment
* interacting with medical directors
* coordination services for Emergency Transportation and DME
Anthem Blue Cross and Blue Shield Feb 2002 -Aug 2006
William Howard Taft Blvd.
Cincinnati,Ohio
Medical Review Analyst R.N.
* Applied medical knowledge and expertise in reviewing claims/subscribers/provider inquires.
*Rendered medical decisions based on claims, information submitted with Anthem Corporate Policies and Procedures to allow for re-imbursement
* Managed medical review inventory, to include resolving workflow issues and identifying medical cost savings
* attended weekly meetings to identify cost saving workflow issues/ review medical policy updates and procedures/ identified fraudulant concerns
*routed medical claims to appropriate ques for further processing.
Extendicare Communicare Companies 2009- 2014
300 Arbors Court
Dayton,Ohio 45417
Rick Harmon 1-937-***-****
LTAC and specialty Sub acute care
* staff R.N.
LTAC and specialty sub acute care
Department of Corrections
2014-2016
Mary Mcclendon ARNP
Blue Ash Care Center/ADON
2017
Mike Meyers
DON
Heartland of Miamisburg
8/1/2017 to current
RN supervisor
Current employer
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