Utilization Reviewer
Resume:
Dr. Donna Janisse-McCarty, D.C.
Ontario, CA 91762
Cell 909-***-****
Fax 206-***-****
Email ***********@*******.***
To Whom It May Concern:
I am an experienced Peer Review Physician looking for work auditing over-utilization, fraud, and cases that do not meet medical necessity. I am actively licensed in CA, TX, OK, MS, MN, KY, UT, CO, TN, and NJ. I have completed a 100 hr Continuing Education program for Insurance Consultant//Peer Review.
I have worked in orthopedic, urgent care, and chiropractic clinics, and have also practiced on my own for several years while also performing Physician Review/Peer Review for multi-state worker’s compensation and Personal Injury cases. I have acted as liaison between the patient, physician, employer, attorney, insurance carrier, the nurse case manager, and other provider facilities. As such, I have become proficient in communicating with patients, insurance carriers, office staff, and other physicians and have learned how to wear many different hats. I am very comfortable and confident in my abilities in building rapport, and in doing so, I am able to ensure service and quality goals are met through communication which both enhances and supports the activities of the company. I foster positive interpersonal relationships and a professional image by adhering to stringent customer service standards with internal and external contacts.
I have a lot of experience in performing peer reviews, working full time as a Peer Review Physician for the past 4 years while also practicing chiropractic part-time. I have experience in performing examinations, establishing treatment protocols, ordering appropriate diagnostic studies and therapy, documenting chart notes, and writing/dictating Initial reports, Permanent and Stationary reports, Interim reports, Review of Record reports, QME reports, PI reports, Progress reports, AOE/COE reports, Request for Surgical Authorization reports, etc. I also provided pier review and payor relation justification for equipment and/or treatment. This was a very challenging position, working with worker’s compensation patients with multiple and extremely complex cases, requiring extensive knowledge of the State of CA Worker’s Compensation rules and regulations for determining impairment and apportionment.
I have additional education and experience in office management and supervision, worker’s compensation, managed care, major medical, and Medicare and have a lot of experience with billing, CPT and ICD-9 coding, patient management, diagnostic testing, rehabilitation, physical therapy, etc. , report writing, performing physical exams, pre-employment physicals and drug screening and reporting...and much more. \
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I have great values and the foundation stones of honesty, integrity, faith, love, loyalty, ethics, confidence, and competence. I am organized, committed, disciplined, high energy, and possess good communication skills. I am very creative, open, flexible in thinking and adaptive to filling others needs and desires. I have the ability to affect and empower people because I am a positive thinker and positive believer. These qualities have always assisted me in establishing trust, which is the most important aspect of a relationship, be it with colleagues, patients, peers, and/or authority figures.
I am looking for a challenging yet rewarding experience. I like to keep busy working as a team member in all aspects. I bring to the win/win relationship my willingness to work hard, my enthusiasm, initiative, intelligence, experience, knowledge, dependability, superior professional and personal ethics and character, high energy, and tremendous focus and drive.
As you can see, I am a very versatile and capable individual with the experience and education required to work with your company. I am very confident in my abilities. I look forward to hearing from you soon and can be reached at 972-***-**** or at ***********@*******.***.
Sincerely,
Donna Janisse-McCarty, DC
DONNA JANISSE-McCarty, DC
***********@*******.***
EMPLOYMENT HISTORY:
Oct 2011-present Independent Contractor
Self-employed performing Complex Case/Chart Reviews and Peer-to-Peer
Reviews of Chiropractic Treatments for Medical Necessity
May 2007-Oct 2011 Physician Advisor/Peer Review
Concentra Salary $85,000 + bonuses
5080 Spectrum Dr, Suite 1200W
Addison, TX 75001
August 2005 - April 2007 Clinical Application Specialist
Axiom Worldwide Salary: $70,000/yr + commission
9423 Corporate Lake Dr
Tampa, FL 33634
August 2004 - April 2005 Medical Liaison/Sales Associate
VQ OrthoCARE Salary: $5,000/mo + bonuses
18011 Mitchell S.
Irvine, CA 92614
September 2002 - present Independent Contractor ($30.00/hr)
September 2002 - July 2004 Chiropractor/Examination Doctor (full time employee)
Sobol Medical Group Salary: $5,000/mo + bonuses
8618 Sepulveda #130
Westchester, CA 90045
January 2002-July 2002 Teacher, Limited X-ray Technician Program
American College of Medial Salary: $40,000/yr
Technology
Gardena, CA
October 1997 - June 2001 Chiropractor (self-employed full and part time)
1900 Tahquitz Cnyn, C-1
Palm Springs, CA 92262
June 1999 - June 2001 X-ray Technician, Worker’s Compensation Coordinator
Desert Urgent Care/JFK $24/hr + OT
Memorial Hospital
74990 Country Club Dr#310
Palm Desert, CA 92260
December 1996-October 1997 Associate Chiropractor to Dr. Jeffrey Hockings, D.C.
Indian Wells Health Center
74976 Hwy 111
Indian Wells, CA 92210
January 1981-June 1988 Chief Clerk/Administrative Assistant/Office Supervisor
Canadian Armed Forces Reserves
Windsor Militia District HQ
General Delivery, Station A
Windsor, Ontario Canada
EDUCATION HISTORY:
Jan 2009-Oct 2009 100 Hr Insurance Consultant/Peer Review Certification
Jan 2003-April 2003 Qualified Medical Examiner Certification
June 1999-2001 Tenet Corporation Seminars
July 1998 APEX Nutritional Supplement Certification
August 1998 24 Hour Fitness Personal Training Certification
October 1998 National Academy of Sports Medicine Personal Training
Certification
March 1996-January 1997 LACC Post-Graduate Certified Chiropractic Sports Physician program
January 1993-April 1996 Doctor of Chiropractic
LACC Magna Cum Laude graduate
16200 E. Amber Valley Dr. Cumulative Grade Point:3.69
Whittier, CA 90609
January 1990-December 1992 Pre-Med/Chiropractic prerequisites/AA
MiraCosta College Biology Major
Oceanside, CA Cumulative Grade Point: 4.0
September 1976-June 1980 High School Graduate
Belle River District High School General Academics
Belle River, Ontario Canada Cumulative Grade Point: 3.6
MEMBERSHIPS:
Past Chairperson, LACC Certified Chiropractic Sports Physician Program
Past President, LACC Sports Injury Council
Member, Delta Sigma Honorary Society
Member, LACC Delta Tau Alpha Fraternity
Member. LACC Alumni Association
World Vision Sponsor
REFERENCES:
Dr. Barry Korn Nadine Miller-Reedus
Medical Director, Concentra Junior Vice-President
Addison, TX Culver Careers
215-***-**** 951-***-**** or 714-***-****
Dr. Kimberly Rollheiser, D.C. Carolyn Williams, RN
555 S. Rancho Santa Fe Rd #201 Director of Medical Advisory Solutions
San Marcos, CA 92069 Auto Injury Solutions
Dr. Jeff Derkach, D.C.
8618 Sepulveda. #130
Westchester, CA 90045
Contact this candidate