Administrative Assistant Review Nurse
Resume:
Resume of:
Michelle Brown
Perryville, MO 63775
Cell: 573-***-****
********@***********.***
Summary of Qualifications:
I have been a registered nurse for 29 years. I have experince in long term care, geriatrics,geriatric mental health, home health, Quality Stars Ratings and HEDIS measures. I also have 5 years experience performing medical record reviews for quality purposes along with 2 years experience perfoming medical claim reviews. I have 7 years experience working in a telecommute position.
Professional Experience:
RN Clinical Claim Review Nurse Optum/United Health Care, Telecommute position.
July 2021 to present.
Performing medical claim review using medical records and UHG policy and procedures to determine if claim is to be approved or declined. Communicating with Claim Medical Directors for further clarification on specific claims for approval or denial. Working with EWD to obtain work assignments, time and attendance reporting and a variety of other programs to complete daily assignments.
RN Practice Performance Consultant-Optum/United Health Care, Telecommute postion in The Villages, Florida.
August 2015 to July 2021
Assisting with GAP closure for quality star ratings for multiple practices within Florida.
Reviewing PCOR reports and providing notification to providers of open care opportunities for individual members utlitizing the UHC Care Connect Tool
and Athena, ECW, Quanum, CureMD electronic medical records systems.
Particpation in HEDIS chart chases. Implementing and managing provider initiated campaigns within the CORRAL outreach tool.
Performing member outreach to members to assist with GAP closure and medication adherence.
Collaborating with designated practice performance managers to target GAP specific approachs for providers as needed. Providing descrepanices from chart reviews to PPM to pass on to provider offices.
RN Home Health-Brookdale Home Health, The Villages, Florida
April 2013 to July 2015
Providing in home care based on patient needs. OASIS assessment with diagnosis coding. Patient and family education on disease management.
LPN supervision.
RN Home Health-Greystone Home Health, The Villages, Florida
August 2010 to July 2012
Provided in home patient care based on patient needs. OASIS assessment with diagnosis coding. Wound vac and IV medication administration.
Supervision of LPN and home health aides.
RN Psych Nurse/Social Worker-Missouri Veterans Home, Cape Girardeau, Missouri
September 2007 to February 2009
Provided social work duties on 50 bed special care unit. Staff inservice training. MDS and care planning. Psychotropic medication monitoring.
Facilitation of Alzheimer's support group meetings.
RN-Home Health-Southeast Missouri Hospital, Cape Girardeau, Missouri
March 2005 to December 2006
Provided in home care based on patient needs OASIS assessment with diagnosis coding. Wound care per patient needs. TPN and IV medication administration.
Patient and family education on disease process. Venipuncture.
RN-Clinical Assessment Coordinator- Horizon Health Corporation, Sikeston, Missouri
November 1999 to September 2004
Performed assessments on patients 55 and older to determine need for psychiatric services. Assisted attending psychiatrists with consults
and managing outpatient practice. Assisted program director with quality assurance and employee training.
RN-Director of Nursing-Fountainbleau Lodge, Cape Girardeau, Missouri
March 1995 to November 1999.
Supervised 30 bed skilled nursing unit and 60 bed assisted living facility. Staff scheduling. Charge nurse duties.
MDS/PPS data collection and entry. Inservice training. CNA training. Quality assurance measures.
Education:
CRC Coding Certification: Completed July 2021.
CPC Coding Certification: Completed December 2020.
M&R Level I & II Certification. United Healthcare, completed 2020.
Multi-Disciplinary Certificate Program in Geriatrics. 44 clock hours completed November 2003.
Qualified Mental Health Professional training. Completed in 2002.
Certified Nurse Assistant Instructor/Clinical Supervisor training. Completed in March 1995.
Associate of Arts Degree in Nursing. Graduated in December 1993.
Medical Administrative Assistant. Graduated in June 1983.
Diploma of General Studies, Perryville Senior High. Graduated in June 1979.
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