Experienced Registered Nurse
Resume:
SHEILA U. BERRY
West Point MS 39773
************@***.***
CAREER SUMMARY
Over 20+ years of excellence in nursing focused on team building, community service and patient advocacy. In the past 20 years developed a comprehensive medical background, became an articulate communicator, gained proficiency in the use of multiple computer software/systems as well as leadership/management modalities, skills and duties.
• 20+ years of experience performing skilled patient assessments focused on Neonates, Pediatric and Adult/Geriatric patients, documentation of patient assessments, patient education, wound care, diabetic care/education and discharge planning.
• 15+ years of Case Management
• 13+ years of Utilization Management
• 15+ years of Chart Auditing, Medical Documentation Review
• 4+ years of Home Care Experience including supervision and mentoring
• 3+ years of experience as a Telephonic Disease Management Clinician n including mentorship
• 2+ years of Long Term Care experience including Unit Manager, Staff Development, Infection Control , RN Supervisor and Assistant Director of Nursing
• 1 year of experience as a Short Term Disability Nurse Consultant
• 1 year of Legal /Litigation Chart Review for a Private Legal Practice
• 6 months experience as an Appeals Nurse
• Working knowledge of McKesson Star, Meditech, Eclipsys, EMR and Microsoft Access, Excel, Go To Meeting, Outlook, Power Point and Word
• Experience as a Staff RN working in Corrections
CAREER ACCOMPLISHMENTS
Auditing/Medical Review:
• Reviewed short-term disability cases for appropriate medical documentation to assist with the proper management of claims, use of appropriate criteria, and adherence to specified work-flow time guidelines.
• Communicated with claims examiners/case managers, other nurse consultants, physician consultants, claimants, and attending physicians and their office personnel using computer documentation to capture information accurately.
• Reviewed extensively chart/lab/bill, negotiation of contracted reimbursement rates, employee evaluation/counseling, and communicated with other medical disciplines.
• Performed utilization reviews (pre-certification, concurrent, retrospective) via telephone/fax for appropriate utilization management, utilization of Milliman and Interqual criteria for determination of the appropriate length of stay, utilization of computer documentation, adherence to specified work-flow time guidelines, utilization of appropriate ICD-9 and CPT codes and communication with other medical disciplines.
• Worked as part of a team of health care professionals responsible for HEDIS data abstraction for a managed care organization and a Federally Qualified Health Center.
• Worked in collaboration with the hospitals’ Care Coordination nurses as well as the Insurance Company to resolve claim issues. Reviewed medical bills and medical documentation for appropriate financial compensation. Responsible for negotiating rates or insuring that claims were reimbursed at the contracted rate.
Education and Training:
• Developed and presented educational seminars for the educational development of employees (non-clinical/clinical).
• Telephonic patient assessment offering health education to program participants with the conditions of asthma, chronic obstructive pulmonary disease, congestive heart failure, coronary artery disease, depression, diabetes and20oncology. Assisted members with benefit explanation and utilization, collaboration with physicians and other healthcare professionals to ensure that members received optimal healthcare. Patient admission/discharge and re-certification, documentation, supervision of home health aides and LPN’s, venipuncture, wound care, patient/family education, medication set up and/or administration.
• Mentorship/Preceptorship of new employees for Home Care and Disease Management
• Clinical experience on an Oncology Unit. Experience administering Chemotherapy and Radiation therapy to Oncology patients. Patient/Family education regarding Chemotherapy/Radiation therapy and possible side effects. Assisted Oncology patients to utilize available community resources.
Documentation:
• Extensive computer documentation skills.
• Created medical reviews and recommendations for use by case managers and other disability managers.
• Created/Implemented medical leaves, clinical appeal letters and restrictions for worker’s compensation claims.
• Created/Implemented appropriate documentation to facilitate appropriate plan of care, expedite timely return to work or to facilitate discharge planning needs.
• Gained useful knowledge of Private Insurance, Medicare, Medicaid, Worker’s Compensation, URAC standards and documentation and Disability Guidelines. Certificate of Completion for training in Interqual.
SouthSide Medical Center 2009 - 2010
Perinatal Case Manager
CCA Shelby Training Center 2008
Staff RN
ComForce (Contract/Temporary) 2007
Disability Specialist/Worker’s Compensation Nurse Case Manager
United Health Care 2006 - 2007 Custom Care Coordination Disease Management Nurse
APS Healthcare 2005
Health Coach
Kelly Health Services/ Medical Gatekeepers (Temporary/Contract Position) 2005 Occupational Health Nurse/ Utilization Review/Case Manager
METLIFE (Workload relocated to another state) 2004 - 2005
Nurse Consultant
MATRIA HEALTHCARE 2003
Clinician II
COMPHEALTH (Temporary/Contract position) 2001-2003
Contract RN (Med/Surg/NICU/OB/GYN)
PREFERRED HEALTHCARE/NMS (Temporary/Travel Assignment) 2000-2001
Travel/Contract RN (Med/Surg/Neurology/Orthopedics)
CARE CENTER OF CLINTON 1999-2000
Resident Care Manager
HEALTH SYSTEMS OF MISSISSIPPI 1997-1998
Utilization Review Coordinator
SERVE U HOME HEALTH 1996-1997
Home Care RN/Assistant Supervisor
ALEXANDER HOME HEALTH 1994-1995
Home Care RN
CLAY COUNTY MEDICAL CENTER /GTR Medical Center 1992-1993
Staff RN (Labor&Delivery/NICU/Well Baby Nursery)
EDUCATION
Associate of Applied Science Degree
Itawamba Community College, Fulton MS
ACCREDITATION AND LICENSES
Licensed Registered Nurse in the states of, Georgia and Mississippi (Multi-State License)
Willing to relocate.
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