SUMMARY * 15+ years' experience as a clinical professional with a broad range of healthcare experience, talent and expertise also in Medicaid claims reviews programs * Extensive nursing experience in multiple areas (Utilization Review/Managed Care including Inpatient/Outpatient service for Pre-Cert, Concurrent Review, Case Management, Medical Claim/Bill Review, ICD-9/ICD-10 Coding, Hedis Reviews, Home Health Care, School Nursing, Women's Care and Post-Operative Services * Computer Literate and Proficient in Electronic Medical Records, InterQual, Paradigm/Diamond, Emma, Interaction Client, Casetrakker and Cisco Systems * Knowledgeable in Health Insurance for Managed Care HMO's, Medicare, Medicaid, Tri-Care and DOD contracts with multiple insurance carriers in different states and regions * Performed review of pre-certification requests for multiple clients in eleven states for Medicaid, Medicare and HMO's

Highlights:

• Medicare
• Computer Aided Software Engineering
• Management
• Injections
• Insurance
• VITAL SIGNS
• Medication Administration
• Nursing
• Wound Care
• D.O.D.
• Case Manager, Billing, Coding, Auditing, Utilization Review, Manager, Supervisor, Health Services, Nurse, LPN, Trainer