Description
I am an LPN with over 10 years' experience dealing with the geriatric population specifically in the home-health setting. For the past five years I have been employed in roles that required me to perform chart auditing. I have a strong knowledge of Medicare Guidelines from past work as an MDS coordinator, and I am comfortable working in the non-clinical setting of nursing. I seek a challenging position where my extensive Medical, Professional and Practical experience will be fully utilized. 03/2015 - 05/2015 Megellan LPN Concurrent Review Nurse Miami, Fl * Responsible for concurrent and retrospective review to assure State-wide compliance with core measure guidelines * Reviewed case records and reports, collected and analyzed data, evaluated client's medical status and defined needs and problems in order to provide proactive case management services. * Responsible for ensuring reports meet state and federal medical necessity criteria, client specifications and company protocols. * Prepared and responded to client inquiries, identifying areas for confirmation and clarity. * Process Prior Authorizations through the use of Interqual processing system * Monitored file activity to ensure timeline requirements are met accordingly * Responsible for Maintaining records, by reviewing notes, logging events and noting progress of work. 04/2014 - 02/2015 Broadspire Sunrise, Fl. Quality Assurance Nurse Reviewer * Reviewed case records and reports, collected and analyzed data, evaluated client's medical status and defined needs and problems in order to provide proactive case management services. * Responsible for editing workman's compensation claims dictated by the physician in order to review claims for various assigned states i.e. (California, New York, Massachusetts, Florida, Texas, Tennessee and Louisiana) * Responsible for ensuring reports meet state and federal medical necessity criteria, client specifications and company protocols. * Prepared and responded to client inquiries, identifying areas for confirmation and clarity. * Monitored file activity to ensure timeline requirements are met accordingly * Responsible for Maintaining records, by reviewing notes, logging events and noting progress of work. 9/2010 - 03/2014 Miami, Fl. Jackson Memorial Health Plan Quality Assurance Nurse * Responsible for Concurrent reviews and Utilization Case Management * Perform auditing of Provider's Medical charts that served members of (PSN, CMS, MEDICAID/MEDICARE) as well as Commercial members. * Participate in both pre-release and post-release audit reviews * Utilize audit reviews and reports to identify performance issues with a focus on continuous quality improvement * Responsible for identifying, documenting and recommending training of processes or techniques to meet accuracy Requirements 06/2009 - 06/2010 Miami Lakes, Fl. Patient Resources Company Quality Assurance Nurse * Responsible for chart audits for quality assurance * Document and report quality related concerns to management * Participate in both pre-release and post-release audit reviews * Utilize audit reviews and reports to identify performance issues with a focus on continuous quality improvement * Responsible for identifying, documenting and recommending training of processes or techniques to meet accuracy requirements * Collects and report data to the required agencies 11/2007- 03/2009 Boca Raton, Fl. Whitehall Boca Geriatric Unit LPN * Basic health monitoring of Senior adults with mental illnesses living in residential treatment programs * Medication admission * Scheduled patient admissions and discharges * Assess patient status and notify physicians of clinical changes * Interact with departments regarding patient care * Educate patients/families on health care needs, conditions, options etc. * Provide assistance to Nursing Manager in the supervision of staff nurses * Maintain patient charts and confidential files 06/2004- 09/2011 Express Home Health Agency Miramar, Fl LPN Worked with the following companies through Express Home Health Agency: Miami Jewish Home, St. John Catholic Services, Vitas. Duties include but were not limited to: * Assigned to provide patient care * Assisted with the admittance and discharge of patients * Performed clinical tasks according to Company policies * Assess members' current medical condition (s) and functional status within established time frames * Coordinate medically necessary services 02/2004 - 07/2005 Kelly Services Agency Ft. Lauderdale, Fl. LPN * Responsible for Private Case work * Conducted home safety assessment of participant home living environment * Identified appropriate follow-up services for participants that screens positively. * Arrange for any additional in-home clinical and social services that may be required * Conduct follow-up as well as initial face-to-face evaluations of participants and their living situations * Provide Supported Self-Care interventions to participant and makes substantial nursing judgments through regular home visits, follow-up calls, and alert calls. 12/2001 - 05/2004 Fair Haven Center Miami Springs, Fl. LPN Staff Nurse, Night Supervisor * Schedule patient admissions and discharges * MDS Coordinator * Provide comprehensive, advanced treatment to patients with chronic, non-healing wounds, such as diabetic ulcers, pressure ulcers, venous ulcers and wounds resulting from trauma. * Provided quality patient care 12/2000 - 06/2003 Favorite Nurses Agency Miami, Fl. LPN Staff Nurse, Worked with the following companies through Favorite Nurses Agency Relief Nurse Pan American, Jackson Memorial, Doctors Hospital and Coral Gables * Coordinate care of Inpatient Hospital stay * Performing telephonic case reviews * Ensuring patients receive the proper levels of care * Coordinating care for Patients * Planning patient discharges with providers * Referring patients to disease or case management programs 10/2000 - 12/2001 Mercy Hospital South Miami, Fl. Med Surge Unit, * Implement nursing interventions to maximize health status and minimize symptoms associated with acute or chronic disease. * Deliver care within the scope of nursing practice and in accordance with accepted standards of practice. * Practice universal precautions in all contacts with patients, and special isolation techniques as warranted by patient diagnosis. * Provide emotional support to patients and families in a manner that fosters independence, affirms existing and new strengths, and promotes and develops strengths.
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