RN

Courtney Lynn Kermani

Important Highlights:

•14+ years of experience as a Nurse.

•8 + years of experience in Mental Health and Detox.

•4+ years of experience as a Utilization Review.

•3+ years of experience in Obstetrics.

•2+ years of experience in Orthopedics.

•1 year of experience as a School Nurse.

•1year of experience as a Case Manager Supervisor.

•Experience in Reviewing Prior Authorizations, Retro Authorizations, Claims, and billing practices.

•Registered Nursing License number: 95095660.

•Candidate is eligible for Right to Hire.

•Candidate will work remotely.

•Good communication and interpersonal skills.

Education:

Grand Canyon University- Phoenix, AZ, March 2017 - November 2018

Master of Science in Nursing with an Emphasis in Nursing Education

Grand Canyon University- Phoenix, AZ, August 2016 - March 2017

Bachelors of Science in Nursing

Stanbridge College- Irvine, CA, October 2014- May 2016

Associates of Arts, Nursing

North Orange County ROP- Anaheim, CA, January 2010 - December 2011

Licensed Vocational Nurse, Certified Nursing Assistant, Health Unit Coordinator and Emergency Medical Technician

California State University, Fullerton- Fullerton, CA, January 2007- May 2009

Bachelors in Psychology and Bachelors in Sociology

Golden West College- Huntington Beach, CA, August 2004 - May 2006

Associates of Arts, Biology

Professional Experience:

Health Comp, Fresno, CA August 2023 - Present

Case Manager (RN- Remote)

•Coordinate care and services and develop member treatment plans for cases: New parents, expecting mothers, and NICU babies.

•Perform frequent case reviews.

•Check medical records and request medical records.

•Speak with member’s and care providers regarding treatment, and respond to the plan of care.

•Telephonically manage cases on a long or short-term basis per established company guidelines.

•Assist with creating policies and procedures, as well as other standardized case criteria for “Mothers to Be” or “Nurturing Together” Department.

•Contact members and complete a thorough assessment, including physical, psychosocial, emotional, spiritual, environmental and financial needs.

•Refer members who may need to be evaluated further by company therapist.

•Develop treatment plan in collaboration with the member, member’s providers, caregivers or family, community resources and multidisciplinary healthcare providers that include obtainable short- and long-term goals.

•Monitor interventions and evaluate the effectiveness of the treatment plan in a timely manner, report measurable outcomes that record effectiveness of interventions.

•Initiate and maintain contact with the member/family, provider, employer group and multidisciplinary team as needed through the continuum of care.

•Advocate for the member by facilitating the delivery of quality member care and by assisting in reducing overall costs, provide member/family with emotional support and guidance.

•Meet daily productivity requirements for department (6.4 a day or 128 per month), hourly billing metrics.

•Prior authorizations, retro authorizations, discharge planning, active participation in Care Team’s “High Risk Case Management” program, assess, identify problems, plan goals, monitor and evaluate member plans and develop strategies that meet the members immediate and long term needs, document management, management of durable medical equipment, prior authorizations of needed medications or other services, using practice guidelines and protocols.

•Use of flow sheets, problem lists, and medical data bases; Development and use of critical pathways; Tracking outcomes and reporting to primary care provider; Tracking and expediting referrals, assist with discharge planning / home care referrals, in collaboration with the Health Team, assessment, diagnostic, and intervention services for members who are overwhelmed by an acute episode, or for those others who have limited self-care abilities.

•Prior Authorizations “Pre-Certifications: Discuss medications, insurance and prior authorization documents with members.

•Assess accounts for completeness and accuracy.

•Follow up on missing or incorrect information so members receive the right reimbursement.

•Document account activity using correct medical and billing codes.

•Negotiate and implement cost management strategies to affect quality outcomes and reflect this data in monthly case management reviews and cost avoidance reports.

•Perform data entry and maintain complete and detailed documentation of case managed member in the computer system, maintain site specific logs and files, ensuring confidentiality according to company policy and HIPAA.

Job Search January 2023 – May 2023

Loma Linda University Medical Center, Loma Linda, CA October 2022 - January 2023

Registered Nurse Maternity Services (Worked Concurrently)

•Registered Nurse/Postpartum and Labor and Delivery Postpartum. Initial assessment and evaluation, administered medications to mother: IV triple antibiotics (Gentamycin, Ampicillin and Clindamycin), IV pushes (Morphine, Toradol and Zofran), vaccines (Influenza, Tetanus, Diphtheria and Pertussis, Measles, Mumps, Rubella and Rhogam) and standard postpartum medications, phenylketonuria test, Blood Sugar checks and Transcutaneous Bilirubinometry Test.

•Placed hug tags/verification of Identification tags with parents and infant hug tag, inserted and Removed foley catheters and intravenous lines, assisted in Circumcision, assisted with a Code Hemorrhage (Administered Cytotec), administered newborn vaccines/medications: Vitamin K, Hepatitis B and Hepatitis B immunoglobulin, educated clients on proper care and feeding of newborn: Breastfeeding techniques, Formula feeding amount and routine, swaddling and adequate wet and soiled diaper counts, educated mothers on breast pumping for their newborn in the Neonatal Intensive Care Unit, educated mother on benefits of ambulation and proper diet, removed cesarean section dressings and staples, assisted with transition of newborn from mother to new adoptive parents and discharge education for mother and infant.

Incredible Health, San Francisco, CA July 2022 - November 2022

Registered Nurse Scheduler (RN- Remote)

•Creation and execution of growth strategies with a defined set of clients focus for talent they are requesting.

•Accountable for overall partnership with clients through the entire customer lifecycle - from onboarding throughout the hiring funnel.

•Served as a customer consultant, helping our clients achieve their hiring goals through process improvement, hiring funnel optimization.

•Analyzed internal and external market data to deliver strategic and focused results.

•Build "incredible" relationships with our clients and deliver an "incredible" customer experience for our talent.

•Operated with a high degree of autonomy.

Job Search May 2022 – July 2022

AM LLC., Phoenix, AZ December 2021 - May 2022

Registered Nurse Case Manager Supervisor (RN- Remote)

•Direct supervision of a unit of 6-8 people that collectively performs all functions of the COVID-19 Community Team response.

•Liaised with client and AM corporate staff, alongside client, manages initial outreach to case.

•Alleviate knowledge gaps of team members.

•Assisted local health department with collection of laboratory reporting and identifies PUIs.

•Allocated tasks to the team, provides oversight of team operations and performance, ensures compliance with client guidelines and protocols and shares feedback and best practices with the client. Assists in disease tracking. Protect and maintain individuals’ privacy and confidentiality.

•Provided guidance to Case Investigators and Contact Tracers to ensure that case interview activities are conducted according to applicable protocols, policies and procedures.

•As needed, conduct case reviews with Case Investigators and Contact Tracers to ensure comprehensive and high-quality interviews.

•Coordinated the unit’s schedules and provide daily, remote supervision and troubleshooting.

•Conducted phone calls, as needed, including to cases and/or contacts who have been exposed to COVID-19, to places of business a COVID-19 positive patient has frequented and to refer patients and their families to different social services.

•Tracked daily and weekly progress for the unit, including cases contacted successfully, contacts tracked and referred and patients and contacts referred to social support systems.

AM LLC., Anchorage, AK October 2021 - December 2021

Registered Nurse Case Navigator (RN- Remote)

•Act as primary point person to call people with a positive diagnostic test for COVID-19, provide support and gather information, including information about the disease and isolation procedures, Call contacts of newly- diagnosed patients, Triage and coordinate next steps for isolation for cases and quarantine for individuals the person has been in contact with, Communicate with cases and contacts in a professional and empathetic manner, Collect and record information on symptoms into the CRM, Provide contacts with approved information on state/local quarantine procedures, and, if appropriate, refer them to testing according to protocol, Coordinate tracking efforts with local health authority and refer cases and contacts to local resources, Oversee quality control of data collection and data reporting, Make informed, educated decisions on case management based on interview guidelines, Maintain daily contact with the Supervisor/Case Navigator.

Home Schooled children during Covid Period July 2019 – October 2021

Garden Grove Hospital, Garden Grove, CA November 2017 - July 2019

Registered Nurse Postpartum and Labor and Delivery (RN)

•Initial assessment and evaluation.

•Administered medications to mother: IV triple antibiotics (Gentamycin, Ampicillin and Clindamycin), IV pushes (Morphine, Toradol and Zofran), vaccines (Influenza, Tetanus, Diphtheria and Pertussis, Measles, Mumps, Rubella and Rhogam) and standard postpartum medications, phenylketonuria test, Blood Sugar checks and Transcutaneous Bilirubinometry Test.

•Placed hug tags/verification of Identification tags with parents and infant hug tag.

•Inserted and Removed foley catheters and intravenous lines.

•Assisted in Circumcision, assisted with a Code Hemorrhage (Administered Cytotec), administered newborn vaccines/medications: Vitamin K, Hepatitis B and Hepatitis B immunoglobulin.

•Educated clients on proper care and feeding of newborn: Breastfeeding techniques, Formula feeding amount and routine, swaddling and adequate wet and soiled diaper counts, educated mothers on breast pumping for their newborn in the Neonatal Intensive Care Unit, educated mother on benefits of ambulation and proper diet, removed cesarean section dressings and staples, assisted with transition of newborn from mother to new adoptive parents and discharge education for mother and infant.

Job Search November 2016 – November 2017

Mission Hospital, Laguna Beach, CA August 2016 - November 2016

Registered Nurse Emergency Room and Utilization Management for Detox and Mental Health Unit (RN)

•Admitting Nurse for Chemical Dependency and Behavioral Health Unit.

•Screened potential clients: 1-hour initial assessments, obtain authorization and coordinate admission process.

•Called to ER for crisis calls and 5150 evaluations.

•Oversaw client admissions and transfers, provided information/referrals, and completed follow up calls to discharged clients.

•Prior authorizations, retro authorizations, discharge planning, active participation in Care Team’s “High Risk Case Management” program, assess, identify problems, plan goals, monitor and evaluate client plans and develop strategies that meet the clients immediate and long term needs, document management, management of durable medical equipment, prior authorizations of needed medications or other services, using practice guidelines and protocols; Use of flow sheets, problem lists, and medical data bases; Development and use of critical pathways; Tracking outcomes and reporting to primary care provider; Tracking and expediting referrals, assist with discharge planning / home care referrals, in collaboration with the Health Team, assessment, diagnostic, and intervention services for clients who are overwhelmed by an acute episode, or for those others who have limited self-care abilities.

•Prior Authorizations “Pre-Certifications: Discuss medications, insurance and prior authorization documents with patients.

•Get prior authorization approval from insurance firms and nurse managers.

•Appeal insurance companies after prior authorization refusals.

•Assess accounts for completeness and accuracy.

•Follow up on missing or incorrect information so patients receive the right reimbursement.

•Document account activity using correct medical and billing codes.

•Retro Authorizations: After calls with insurance companies, submitting forms for the necessary approval of retro authorizations. b) Once the form and paperwork are submitted, followed up for the review and decision on whether retro authorization was granted.

•Negotiate and implement cost management strategies to affect quality outcomes and reflect this data in monthly case management reviews and cost avoidance reports.

•Perform data entry and maintain complete and detailed documentation of case managed patient in the computer system, maintain site specific logs and files, ensuring confidentiality according to company policy and HIPAA.

Job Search October 2014 – August 2016

Santa Ana Unified School District, Santa Ana, CA November 2013 – October 2014

Licensed Vocational Nurse/School Nurse

•Admitting Registered Nurse Case Manager for Chemical Dependency and Behavioral Health Unit (RN)

•Educated students on administration of insulin and oral insulin medications

•Facilitated Carb Control Diet meetings (How to Carb Count)

•Administered students oral and G-tube medications and feedings, performed trachea and suctioning care, straight catheterizations

•Completed data collection and routine vital signs, Member of the campus Emergency Response Team.

Spencer Recovery Detox Center, Laguna Beach, CA February 2013– February 2014

Licensed Vocational Nurse (Case Management)

•Conducted initial admission evaluation to determine proper placement in facility (referred data, collected during evaluation to physician, if further medical needs were unable to be met at facility referrals were made: 5150 placement or critical health conditions).

•Received medication orders from physicians, called in prescriptions to pharmacy and administered medications to patients on-site.

•Performed testing including VS, UA’s, Breathalyzer, mouth swab tests and wound cultures

•Followed patient care plan, documented patient’s progress in electronic chart and provided patient education upon discharge.

CompPartners, Irvine, CA July 2012 – February 2013

Licensed Vocational Nurse/Case Assigner (Utilization Review/Case Management)

•Performed workers’ compensation utilization review, assigned workers’ compensation cases to physicians, edited and processed claims.

•Update physician schedules and RN’s status of claims in network system.

•Oversaw client admissions and transfers, provided information/referrals, and completed follow up calls to discharged clients.

•Prior authorizations, retro authorizations, discharge planning, active participation in Care Team’s “High Risk Case Management” program, assess, identify problems, plan goals, monitor and evaluate client plans and develop strategies that meet the clients immediate and long term needs, document management, management of durable medical equipment, prior authorizations of needed medications or other services, using practice guidelines and protocols; Use of flow sheets, problem lists, and medical data bases; Development and use of critical pathways; Tracking outcomes and reporting to primary care provider; Tracking and expediting referrals, assist with discharge planning / home care referrals, in collaboration with the Health Team, assessment, diagnostic, and intervention services for clients who are overwhelmed by an acute episode, or for those others who have limited self-care abilities.

•Prior Authorizations “Pre-Certifications: Discuss medications, insurance and prior authorization documents clients.

•Get prior authorization approval from insurance firms and nurse managers.

•Appeal insurance companies after prior authorization refusals.

•Assess accounts for completeness and accuracy.

•Follow up on missing or incorrect information so clients receive the right reimbursement.

•Document account activity using correct medical and billing codes.

•Retro Authorizations: After calls with insurance companies, submitting forms for the necessary approval of retro authorizations. b) Once the form and paperwork are submitted, followed up for the review and decision on whether retro authorization was granted.

•Negotiate and implement cost management strategies to affect quality outcomes and reflect this data in monthly case management reviews and cost avoidance reports.

•Perform data entry and maintain complete and detailed documentation of case managed client in the computer system, maintain site specific logs and files, ensuring confidentiality according to company policy and HIPAA.

Hoag Orthopedic Institute, Irvine, CA November 2010 – July 2012

Orthopedics Patient Care Technician

•Provided direct patient care activities of daily living: nutrition, hygiene and basic needs of adult/geriatric orthopedic patients

•Completed and documented clinical measurements including input/output, specimen collection, VS and Accouches (once additional certification was obtained)

•Performed ambulation and transferring/repositioning of post-op orthopedic patients.

Right at Home, Tustin, CA June 2010 – December 2010

On-Call Certified Nursing Assistant (Worked Concurrently)

•Obtained vital signs, intake/output measurements for home-health clients, instructed post-op clients on proper body mechanics and basic skin/wound prevention for clients

•Prepared meals for clients based on diet orders, preformed basic household chores that the client was unable to complete on their own.

SouthCoast Marriage and Family Therapist, Fountain Valley, CA January 2007 – November 2010

Office Manager and & Utilization Review

•Obtained intake information from new patients, acquired new client authorization, retro-authorizations and prior authorizations for prescriptions, collaborated with the billing department to process patients’ payments and calculate deposits.

•Prior authorizations retro authorizations and assist in the coordination of warm hand-offs or “Transfer of Trust” between Care Team, Behavioral Health Staff, or other support services during the office visit.

•Prior authorizations, retro authorizations, discharge planning, active participation in Care Team’s “High Risk Case Management” program, assess, identify problems, plan goals, monitor and evaluate patient plans and develop strategies that meet the clients immediate and long term needs, document management, management of durable medical equipment, prior authorizations of needed medications or other services, using practice guidelines and protocols; Use of flow sheets, problem lists, and medical data bases; Development and use of critical pathways; Tracking outcomes and reporting to primary care provider; Tracking and expediting referrals, assist with discharge planning / home care referrals, in collaboration with the Health Team, assessment, diagnostic, and intervention services for patients who are overwhelmed by an acute episode, or for those others who have limited self-care abilities.

•Prior Authorizations “Pre-Certifications: Discuss medications, insurance and prior authorization documents with patients.

•Get prior authorization approval from insurance firms and nurse managers.

•Appeal insurance companies after prior authorization refusals.

•Assess accounts for completeness and accuracy.

•Follow up on missing or incorrect information so patients receive the right reimbursement.

•Document account activity using correct medical and billing codes.

•Retro Authorizations: After calls with insurance companies, submitting forms for the necessary approval of retro authorizations. b) Once the form and paperwork are submitted, followed up for the review and decision on whether retro authorization was granted.

•Negotiate and implement cost management strategies to affect quality outcomes and reflect this data in monthly case management reviews and cost avoidance reports.

•Perform data entry and maintain complete and detailed documentation of case managed patient in the computer system, maintain site specific logs and files, ensuring confidentiality according to company policy and HIPAA.

•Prepared prescription refill documents and called in prescriptions as psychiatrist’s representative

•Opened and closed facility.

Volunteer Experience:

La Palma InterCommunity Hospital June - August 2016

Registered Nurse Intern Postpartum and Labor and Delivery

Saddleback College Clinic January 2015 - January 2016

Student Nurse Volunteer Mental Health Association

Orange Coast Memorial Hospital October 2014 - October 2015

Student Nurse Volunteer

CSUF Wellness Center June 2009 - August 2009

Student Nurse Volunteer

La Palma InterCommunity Hospital Medical Records Page Summer 2000

Fitness Trainer/Coach

Contact this candidate