I am a certified case manager who has worked with fully insured/medicare and Medicaid. I have also done disease education/management.
I have experience with several computer programs,windows,outlook,lotus notes.interqual,Milliman and Roberts. I have also done authorizations, medical records review, education,training, presentations, HEDIS collection and referrals. I have worked at home and in office/ clinical settings.
•Case Manager Certified
•Facilitated results-oriented, empathetic and professional adult nursing care for over 23 years.
•Respect for compliance in all regulated environments while maintaining a clear vision to accomplish the company goals.
•Advocated for members to resolve health concerns.
•Communicated with all levels of personnel.
Skills Include:
•Demonstrated computer and internet literacy. ...
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Case Manager, computer and Internet literate, Utilization review experience, Organized, CPR certified, Motivation interviewing techniques, Chronic condition management, Leader
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
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...
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Phoenix, Prior Authorization, Utilization Review, Managed Care, Case Mgmt, MS Office, Medicare, Medicaid
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
I am a Registered Nurse of 32 years with 12 years of DRG Integrity reviewing, 8 years of utilization Reviewing, and 5 years of Case Management. I am proficient in the use of Interqual and Milliman quidelines. My objective is to concentrate all efforts on further developing my skills in the area of information management, specifically as a Clinical Documentation Integrity Specialist, and enter the field of CDS consulting in ...
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Clinical Documentation Integrity Specialist, Utilization Reviewer, Case Manager
