Appeals Nurse Consultant
Resume:
Tracy S. Acri
Cranberry Township, PA 16066
724-***-****) advpz7@r.postjobfree.com
OBJECTIVE
A registered nurse position which will provide the opportunity for professional development and delivery of quality nursing care that will take advantage of my more than 30 years of experience as a professional.
EXPERIENCE
2007-present Registered Nurse/Appeals Nurse Consultant
Aetna
Work at home-PA
* Reviews complaint/appeal requests of all clinical and benefit documentation. Considers all previous information as well as any additional records/data presented to render a recommendation/review. Data gathering requires navigation through multiple system applications. Contacts the provider of record, vendors or internal Aetna departments to obtain additional information.
Coordinates appeal process, in collaboration with members and their authorized representatives, providers, regulators, internal/external consultants and participants (e.g. fair hearing, state mandated reviews, chairs appeal panel hearings) in compliance with state regulation and benefit plan designs.
Reports findings to team leader/supervisors, responds to rebuttal issues and makes recommendations for improvement as indicated.
Reviews proton beam therapy, expedited appeals, Medicare, panel cases, OMFS (oral and maxillofacial) cases as well as standard pre-service member appeals and post service member and provider appeals.
In addition, am part of the expedited intake team to determine if criterion are met for expedited review.
2010-2017 Registered Nurse
Children’s Express Care
2599 Wexford Bayne Road
Sewickley, PA 15143
Pediatric patient triage including basic vital signs and assessment, medication administration, assist with suturing, maintain patient flow, parent education, phlebotomy, data entry.
2001-2010 Registered Nurse
The Heart and Vascular Center
605 Sharon Road
Beaver, PA 15009
Supervise nursing department, create and post staff schedules, cover all nursing areas in office including ECP treatments, stress echo’s, message management, coordinate and schedule medical service for patients, phlebotomy, assist physician with hospital rounds in heart catheterization lab.
1996-2001 Registered Nurse
Aliquippa Hospital
Hospital Drive
Aliquippa, PA 15001
(closed)
Nursing of critical and progressive care patients pertaining to arrythmia analysis and treatment, artificial ventilation management, documentation maintenance and knowledge of invasive procedures, charge nurse duties, code team and computer input management.
1991-1996 Licensed Practical Nurse
Aliquippa Hospital
Hospital Drive
Aliquippa, PA 15001
(closed)
Nursing of critical and progressive care patients pertaining to arrythmia analysis and treatment, artificial ventilation management, documentation maintenance and knowledge of invasive procedures, code team and computer input management.
EDUCATION
1995-1996 CCBC Monaca, PA
Associate Degree-Nursing
1990-1991 CCBC Monaca, PA
Licensed Practical Nurse-Diploma
LICENSURE
1996- present Registered Nurse Licensure RN513985L
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