Gina Delancy

***** ******** *******, *****, ** **161

Phone: 954-***-****

Email: adx8z0@r.postjobfree.com

PROFESSIONAL SUMMARY:

Over 5 years of experience performing Utilization Reviews, ensuring compliance with federal guidelines with Providers in a Manage Care setting.

Experience with Provider's Medical charts auditing, servicing members on (PSN, MEDICAID/MEDICARE) and Commercial members

Knowledgeable in processing prior authorization and retrospective reviews, ensuring InterQual and Milliman guidelines.

Extensive knowledge and experience as a Quality Assurance Nurse, reviewing reports and following State and Federal mandates.

PROFESSIONAL EXPERIENCE:

Maxim Healthcare Staffing

July 2022 – Present

Debra K. Johnson Rehabilitation Center

Travel Nurse: Region-Nashville, TN

• Plan, implement, treat and evaluate the patient/inmate.

• Integrate and implement referrals of inmates to the staff physician, nurse practitioner, dentist, mental health professionals.

• Look for signs and symptoms indicating physiologic and psychosocial changes in the patient’s condition and report to RN.

• Document the patient’s plan of care using identified nursing diagnoses, expected patient outcomes, and selected nursing interventions.

• Monitor consistency between patient plan of care and actions of medical staff.

• Collaborates with RN regarding the plan of care according to evaluation, changes in medical plan of care, and effective/ineffective nursing interventions.

• Document the patient’s response to nursing and other interventions.

• Use clinical judgment in evaluation and responding to emergency medical situations involving inmates or staff.

• Monitor the safety and effectiveness of the environment and equipment.

• Participate in infection control activities in accordance with department and as directed by Infection Control Coordinator

• Participate in the orientation and continuing education of staff.

• Participate in the Health Quality Improvement Program

• Support professional practice by observing the following: Uses knowledge in accordance with 1) the Nurse Practice Act; 2) Standards of Nursing Practice; 3) Standards of Patient Care; 4) The Joint Commission, state and local laws; 5) Patient’s Bill of Rights; and 6) Maxim Healthcare, nursing and client policies. Jogen Healthcare Staffing

May 2022 – July 2022

Travel Nurse: Region-Oregon

• COVID-19 Testing/Swabbing.

• Lead draw and administering COVID-19 vaccine (Pfizer/Moderna).

• Conduct testing and vaccine registration.

• Administer COVID-19 testing in compliance with testing protocols.

• Administers COVID-19 vaccination in compliance with licensure.

• Packaging testing kits to be shipped.

• Providing instructions to patients during and after vaccine administration

• Assisting with traffic control when needed.

• May also act as a runner, taking the samples to the labs.

• Utilize continuous improvement mindset and assists in identifying opportunities to improve processes.

• Continue to follow good manufacturing practices and required work safe practices.

• Maintain a clean, sanitary, and safe work area.

• Restock inventory as needed.

• Keep products separated, organized and in good rotation.

• Monitor product quality frequently, reporting problems to mitigate safety issues.

• Operate various pieces of equipment.

• Report any mechanical problems.

• Comply with FEMA mandatory vaccination training as required.

• Perform other duties as assigned.

Favorite Healthcare Staffing

October 2021 – April 2022

Travel Nurse: Region-San Francisco, CA

• COVID-19 Testing/Swabbing.

• Lead draw and administering COVID-19 vaccine (Pfizer/Moderna).

• Conduct testing and vaccine registration.

• Administer COVID-19 testing in compliance with testing protocols.

• Administers COVID-19 vaccination in compliance with licensure.

• Packaging testing kits to be shipped.

• Providing instructions to patients during and after vaccine administration

• Assisting with traffic control when needed.

• May also act as a runner, taking the samples to the labs.

• Utilize continuous improvement mindset and assists in identifying opportunities to improve processes.

• Continue to follow good manufacturing practices and required work safe practices.

• Maintain a clean, sanitary, and safe work area.

• Restock inventory as needed.

• Keep products separated, organized and in good rotation.

• Monitor product quality frequently, reporting problems to mitigate safety issues.

• Operate various pieces of equipment.

• Report any mechanical problems.

• Comply with FEMA mandatory vaccination training as required.

• Perform other duties as assigned.

MedX

September 2020 - September 2021

LPN

• Responsible for COVID-19 Testing/Swabbing.

• Lead draw and administering COVID-19 vaccine (Pfizer/Moderna).

• Conduct testing and vaccine registration.

• Administer COVID-19 testing in compliance with testing protocols.

• Administers COVID-19 vaccination in compliance with licensure.

• Packaging testing kits to be shipped.

• Providing instructions to patients during and after vaccine administration

• Assisting with traffic control when needed.

• May also act as a runner, taking the samples to the labs.

• Utilize continuous improvement mindset and assists in identifying opportunities to improve processes.

• Continue to follow good manufacturing practices and required work safe practices.

• Maintain a clean, sanitary, and safe work area.

• Restock inventory as needed.

• Keep products separated, organized and in good rotation.

• Monitor product quality frequently, reporting problems to mitigate safety issues.

• Operate various pieces of equipment.

• Report any mechanical problems.

• Comply with FEMA mandatory vaccination training as required.

• Perform other duties as assigned.

Pinecrest Nursing & Rehabilitation Center

August 2015 – September 2020

Staff Nurse

• Conduct ongoing assessments as determined by patient’s condition and/or the client facility’s policies, procedures or protocols and reprioritize care accordingly.

• Perform appropriate treatments as ordered by physician in an accurate and timely manner.

• Document patient assessment findings, physical/psychosocial responses to nursing intervention and progress towards problem resolution.

• Perform therapeutic nursing interventions as established by individualized plan of care for the patient and his/her family.

• Initiate emergency resuscitative measures according to adult resuscitation and advanced life support protocols.

• Deliver care with appropriate age and cultural competence to specific patient populations according to individualized needs.

• Maintain current competency in nursing specialty by attending educational workshops. Meridian Healthcare

October 2018 to April 2019

Utilization Management Pre-Service Review Nurse

• Perform reviews of service request/procedures including, but not limited to, elective surgery (inpatient and outpatient), Durable Medical Equipment, Home care therapy services, and IV infusions that requires medical necessity review and/or benefit interpretation.

• Employ established medical criteria to approve services based on information obtained from attending physician and/or other providers.

• Ensure timely disposition of requests according to established timeframes.

• Consult with Medical director as appropriate for all requests that do not meet criteria and inform Providers of the Medical Director’s decisions.

• Ensure full collection of clinical information prior to rendering a decision. Centene Corporation

January 2018 to October 2018

Prior Authorization Nurse Reviewer

• Perform telephonic review of prior authorization requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with recommendations for other determinations.

• Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings.

• Collaborate with various staff within provider networks and case management team electronically or telephonically to coordinate member care.

• Educate providers on utilization and medical management processes.

• Provide clinical knowledge and act as a clinical resource to non-clinical team staff.

• Enter and maintain pertinent clinical information in various medical management systems. Molina Healthcare

December 2016 to September 2017

Clinical Care Reviewer

• Provided concurrent review and prior authorizations as part of the Utilization Management team.

• Identified appropriate benefits, eligibility and expected length of stay for members requesting treatments and/or procedures.

• Participated in interdepartmental integration & collaboration to enhance the continuity of care for members including Behavioral Health and Long-Term Care.

• Maintained department productivity and quality measures.

• Maintained professional relationships with provider community and internal and external. Evolution Health - Pompano Beach, FL

June 2015 to November 2016

Nurse Navigator

• Responsible for triaging calls and requests from patients, families, and care givers according to established procedures.

• Coordinated care with Providers and other internal departments and outside agencies.

• Scheduled physician/provider interventions and visits as needed.

• Provided medical advice and clinical support for tele monitoring, telehealth, telepresence and telemedicine devices, and platform in accordance with protocols.

• Effectively communicated with patients and significant others in diverse cultures and age groups to interview patient, family members, and bystanders to discern deviation/changes patient's condition and give direction as appropriate, according to approved Health Maintenance Rules and SOPs.

• Documented the course of care and all communications in the EMR as appropriate. Megellan - Miami, FL

March 2015 to May 2015

LPN Concurrent Review Nurse

• Responsible for concurrent and retrospective review to assure State-wide compliance with core measure guidelines.

• Reviewed case records and reports, collected and analyzed data, evaluated client's medical status and defined needs and problems to provide proactive case management services.

• Responsible for ensuring reports meet state and federal medical necessity criteria, client specifications and company protocols.

• Prepared and responded to client inquiries, identifying areas for confirmation and clarity.

• Processed Prior Authorizations ensuring InterQual guidelines were met.

• Monitored file activity to ensure timeline requirements are met accordingly. Broadspire - City of Sunrise, FL

April 2014 to February 2015

Quality Assurance Nurse Reviewer

• Reviewed case records and reports, collected and analyzed data, evaluated client's medical status and defined needs and problems to provide proactive case management services.

• Responsible for editing workman's compensation claims dictated by the physician to review claims for various assigned states i.e. (California, New York, Massachusetts, Florida, Texas, Tennessee, and Louisiana).

• Responsible for ensuring reports met state and federal medical necessity criteria, client specifications and company protocols.

• Prepared and responded to client inquiries, identifying areas for confirmation and clarity.

• Monitored file activity to ensure timeline requirements were met accordingly.

• Responsible for maintaining records by reviewing notes, logging events and noting progress of work. Jackson Memorial Health Plan - Miami, FL

September 2010 to March 2014

Quality Assurance Nurse

• Responsible for Concurrent reviews and Utilization Case Management.

• Performed auditing of Provider's Medical charts that served members of (PSN, CMS, MEDICAID/MEDICARE) as well as Commercial members.

• Participate in both pre-release and post-release audit reviews.

• Utilize audit reviews and reports to identify performance issues with a focus on continuous quality improvement.

• Responsible for identifying, documenting, and recommending training of processes or techniques to meet accuracy Requirements.

Express Home Health Agency - Miramar, FL

June 2004 to September 2011

LPN

Worked with the following companies through Express Home Health Agency: Miami Jewish Home, St. John Catholic Services, Vitas. Duties include but were not limited to:

• Assigned to provide patient care.

• Assisted with the admittance and discharge of patients.

• Performed clinical tasks according to Company policies.

• Assess members' current medical condition(s) and functional status within established time frames.

• Coordinated medically necessary services.

Patient Resources Company - Miami Lakes, FL

June 2009 to June 2010

Quality Assurance Nurse

• Responsible for chart audits for quality assurance.

• Documented and report quality related concerns to management.

• Participated in both pre-release and post-release audit reviews.

• Utilized audit reviews and reports to identify performance issues with a focus on continuous quality improvement.

• Responsible for identifying, documenting, and recommending training of processes or techniques to meet accuracy requirements.

• Collected and reported data to the required agencies. Whitehall Boca Geriatric Unit - Boca Raton, FL

November 2007 to March 2009

LPN

• Basic health monitoring of Senior adults with mental illnesses living in residential treatment programs.

• Medication admission.

• Scheduled patient admissions and discharges.

• Assess patient status and notify physicians of clinical changes.

• Interacted with departments regarding patient care.

• Educated patients/families on health care needs, conditions, options etc.

• Aided Nursing Manager in the supervision of staff nurses.

• Maintained patient charts and confidential files. Private Duty Nursing via Staffing Agency - Fort Lauderdale, FL February 2004 to July 2005

LPN

• Responsible for Private Case work.

• Conducted home safety assessment of participant home living environment.

• Identified appropriate follow-up services for participants that screens positively.

• Arranged for any additional in-home clinical and social services that may be required.

• Conducted follow-up as well as initial face-to-face evaluations of participants and their living situations.

• Provided Supported Self-Care interventions to participant and makes substantial nursing judgments through regular home visits, follow-up calls, and alert calls. Fair Haven Center - Miami Springs, FL

December 2001 to May 2004

LPN Staff Nurse, Night Supervisor

• Scheduled patient admissions and discharges.

• MDS Coordinator.

• Provided comprehensive, advanced treatment to patients with chronic, non-healing wounds, such as diabetic ulcers, pressure ulcers, venous ulcers and wounds resulting from trauma.

• Provided quality patient care.

Multiple Locations via Staffing Agency - Miami, FL December 2000 to June 2003

LPN Staff Nurse

• Completed contracts with: Relief Nurse Pan American, Jackson Memorial, Doctors Hospital, and Coral Gables.

• Coordinated care of Inpatient Hospital stay.

• Performed telephonic case reviews.

• Ensured patients received the proper levels of care.

• Coordinated care for Patients.

• Planned patient discharges with providers.

• Referred patients to disease or case management programs. Mercy Hospital - South Miami, FL

October 2000 to December 2001

LPN Staff Nurse Med Surge Unit

• Implemented nursing interventions to maximize health status and minimize symptoms associated with acute or chronic disease.

• Delivered care within the scope of nursing practice and in accordance with accepted standards of practice.

• Practiced universal precautions in all contacts with patients, and special isolation techniques as warranted by patient diagnosis.

• Provided emotional support to patients and families in a manner that fosters independence, affirmed existing and new strengths, and promoted and develops strengths. EDUCATION:

License Practical Nurse, Miami Dade Community College, Miami, FL License Practical Nurse, Mercy Hospital School of Practical Nursing, Miami, FL LICENSURE / CERTIFICATION:

License Practical Nurse, PN5148677, State of Florida, Exp. Date 7/31/2019

Contact this candidate