R.N. Case Management, Care Management, Utilization Review Nurse

Angela S. Thomas

Seeking Part-Time position (continuing education) for areas of Winston-Salem, Lexington, Statesville, or Salisbury, N.C.

OBJECTIVE: CASE MANAGEMENT/UTILIZATION REVIEW

BLUE CROSS BLUE SHIELD (CASE MANAGER, RN) May ’07 – Jan '08

• Primary focus on Coordination of Care and Service of Medicare insured members

• Daily communication and interaction with other allied health professionals in the review, assessment, and explanation of Medicare ordered services.

• Individually responsible for the entire Home Care entity of business. Additional accountabilities include the initiation and coordination of health care services for Medicare patients in acute and skilled care settings relative to patient assessment.

• Proficient understanding of “Medicare Guidelines” and their efficient application in assessing the approval of patient benefits.

OUTCOMES INCORPORATED (FIELD REVIEW NURSE) Nov ’06 – Mar ’07

• Field visits to area hospitals, clinics and physician offices for medical review of records and their download via company scanning process using QI, HEDIS, and other Clinical Audits.

KAISER PERMANENTE (HMO) MEDICAL CENTER Nov ‘93- June ‘06

Pediatric Registered Nurse, Family Practice Registered Nurse, Allergy Registered Nurse

• Provided clinical nursing care to pediatric and adult members in an ambulatory setting.

• Evaluation, assessment of patients needs within the clinic and via telephone triage.

• Determine urgency of appointments, Clinical advice provision, and teaching efficient utilization of Nursing Protocol Standards.

• Administer allergy injections to patients in the Allergy Department.

CHARTERED HEALTH PLAN, HMO - UTILIZATION REVIEW NURSE (Nov ’92-Nov ’93)

• Performed medical record review in hospitals and physician’s offices by Q/A standards

Using the Internet and ICD Manuel.

• Provided documented reports at weekly supportive team meetings. Follow-up communication directed with client to ensure quality care.

EDUCATION

Lynchburg General-Marshal Lodge, School of Nursing, Lynchburg, Virginia.

Registered Nurse Diploma - 1979, North Carolina Registration License - Active.

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