CV, Curriculum Vitae and Online Resumes Search

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Online Resumes with "Inter Qual"

Registered Nurse - 30 Years of Experience, 20 years experience in Utilization Review - Near 43068

I am seeking a position in Utilization Review. I have been a Registered Nurse for 30 years with the last 20 doing Utilization Review. I have experience with InterQual and Milliman Criteria.

Tags for this Online Resume: RN, Case manager, Utilization Review, insurance

Registered Nurse - 10 Years of Experience - Near 85132

I have been a nurse since 1999. I worked as an LPN from 1999 until 2009 when I graduated from the University of Phoenix with my BSN. I was a part of the first graduating class of the LPN to BSN bridge at the University of Phoenix. In the clinical setting I have worked in the long-term care, sub-acute and medical-surgical settings. I began my career in managed care at TriWest Healthcare Alliance as a prior authorization nur...

Tags for this Online Resume: Phoenix, Prior Authorization, Utilization Review, Managed Care, Case Mgmt, MS Office, Medicare, Medicaid

Registered Nurse with 20+ years experience in the Creedmoor area

A professionally trained Registered Nurse with 20 plus years of experience ensuring high standards of culturally competent care for a wide variety of patients with diverse needs. Recently received my BSN with plans of going on to get my Master’s Degree.

Tags for this Online Resume: Creedmoor, Case management, Geriatric Psychiatry, BSN, Raleigh-Durham, InterQual, Group Therapy

Experienced Registered Nurse -EHR/ICD-9, HEDIS documentation expert

My career uniquely combines a solid understanding of medical health care practice and business management and my goal is to continue as a hospital provider advocate within the medical auditing and clinical documentation career path.

Tags for this Online Resume: Registered Nurse, Medical/Surgical, Home Health, Infusion Therapy, Director of Nurses, CCU/ICU/Telemetry, Documentation Review EHR, Quality Assurance, Telecommute, Medicare Recovery Auditor, IternQual, ICD--9 ICDCCU/ICU/Telemetry, Integrated Case Manager, Quality Assurance/HIM; Healthcare Information & Documentation Manager, Medicare Denials appeal and Managed Care Risk/ medical necessity auditor, InterQual/ICD-9/MCG;Millliman/DRGs/Lean/CMS Guidelines MS Office, telephonic/remote, CCU/ICU/Telemetry/evidence based best practice provider and physican advocate, HEDIS abstractor, internal risk auditor, EHR quality assurance, ICD-9, Interqual/Milliman, clinical coordinator

Case Management Manager - 20 Years of Experience - Near 60409

I am a Nurse Case Management professional with upwards of 16 experience. My experience includes but is not limited to Telephonic Complex Case Management, Occupational Health/Worker’s compensation, and Psychiatric Nursing. Additionally, my proficiency with Utilization Review software, namely InterQual criteria and guidelines as well as Epic allows me the opportunity to make determinations on admissions, prior authorization, ...

Tags for this Online Resume: Utilization Review, ICD-9, Health Care Industry, Interqual, MCG, Communication Skills, Computer Aided Software Engineering, Patient Care, Coding, ICD-9, Health Care Industry, Management, Benefits, Communication Skills, Computer Aided Software Engineering, Patient Care, Utilization Review Nurse, Allscripts, Powerchart, Epic, EMR, CPT Codes

Case Management Manager - 11 Years of Experience - Near 32162

Professional Summary: I have over 17 years experience in Case Management in the provider setting as Director of Case Management, Lead Case Manager and Key account Manager for Managed Care Companies, Physicians, Hospitals and Home Health Care Agencies. Specializing in admissions and concurrent reviews using Inter-Qual Criteria and MCG on a daily basis to determine decisions of appropriateness of admissions and continued stay...

Tags for this Online Resume: Insurance, Benefits, Home Health, Health Care Industry, Referrals, Compensation, Computer Aided Software Engineering, Assessments, Management, Medication Adherence

Medical or Health Services Manager - 20 Years of Experience - Near 33534

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 Nu...

Tags for this Online Resume: 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

Licensed Nurse - 20 Years of Experience - Near 33610

Healthintegrated - April 18 2016 to May 19 2017 Utilization Review Coordinator Telephonic pre-authorization of procedures over the phone for inpatient and outpatient utilizes clinical skills to support the coordination documentation and communication of medical services and/or benefit administration determinations. Critical competencies include flexibility professionalism as well as clinical knowledge with claims. InterQual...

Tags for this Online Resume: Back Office, LPN, Drug Screen, Home Health, Injections, Management, Nursing, Patient Care, Patient Education, Policies and Procedures

Registered Nurse - 20 Years of Experience - Near 21076

an opportunity to utilize my knowledge & skills as a Utilization Review Specialist remotely. EMPOLYMENT HISTORY Utilization Review Manager VA Hospital Baltimore, MD 2013 to present My current position as a Utilization Review Management is a fulltime position and I work as an autonomist nurse from home. I am a member of an interdisciplinary team for the Critical Care Service Line. The team consists of a Case Manager, Social ...

Tags for this Online Resume: Cardiovascular, Medical, Medical/Surgical, Neurological, Nursing, Surgical, Telemetry, physical therapist, outpatient physical therapy, outpatient rehabilitation, physical therapy, pt, medical

Case Manager - 19 Years of Experience - Near 07110

SUMMARY OF QUALIFICATIONS: Nursing professional with diversified clinical and leadership background in case management, utilization review and discharge planning independent consultant as a Health and Wellness Advisor. * Experience with acute / critical care settings, insurance companies, skilled nursing and assisted living facilities. * Proven record in obtaining high quality outcomes, reduction in length of stay and cost-...

Tags for this Online Resume: Management, Referrals, CCU, registered nurse, healthcare

Case Management Manager - 10 Years of Experience - Near 48331

Tags for this Online Resume: Human Resources, Insurance, Nursing, Medication Administration, Assessments, Policies and Procedures, Services, Computer Aided Software Engineering, Consulting, Documentation, registered nurse, healthcare, Case Manager, Care Coordinator, Health Service Director, NQCA, InterQual, Milman, Neonatal nurse