Adriana Fowler
Luckey,Ohio
Summary
Highly motivated and detail-oriented nursing professional with over 10 years experience in patient education, new employee training, and analyzing improvements needed to produce quality results. Goal oriented and result driven on reaching goals set by management. Productive mentor and natural leader focused on fostering positive and collaborative organizational culture.
Overview
11
11
years of professional experience
Work History
Nurse Appeal Associate
Elevance Health
Remote
05.2021 - Current
- Compilation and submission of appeals case files to CMS' Independent Review Entities (IRE) per CMS regulations
- Liaison with those IREs for both Medicare Part C and D, 2nd level appeals across all time zones
- Researching and preparing case files that are reviewed during an Administrative Law Judge Hearing and activities related to preparing for those hearings
- Coordinating the request and effectuation activities for all 2nd and 3rd level and above IRE decisions
- Ensures that all related appeal activities are resolved timely to meet regulatory timeframe
- Contributes to external reviews site visit preparations by the State, accreditation review and Quality Management Committee; conducts internal monitoring and audits timeline compliance standards
- Generate appropriate written correspondence to providers, members, and regulatory entities
- Meets expectation for personal and professional goals set by management quarterly
- Assist in new employee training
Physicians Order Coordinator, LPN
Ohioans Home Healthcare
Perrysburg, Ohio
09.2020 - 05.2021
- Project manager/creator for wound care to ensure compliance with Medicaid, Medicare, and insurance guidelines
- Perform project tracking through clear and concise status reports; proactively identified issues
- Liaised between interdisciplinary teams and management to discuss findings of identified issues
- Networking with local wound care clinics regarding wound care protocol and creating rapport
- Responsible for Data Entry of patient information
- Communicating physician orders with interdisciplinary teams
- Audit all physician orders to ensure they met compliance with policies and procedures.
Licensed Practical Nurse
Promedica Physician Group
Oregon, Ohio
11.2018 - 08.2020
- Assisting office manager in reviewing applications and resumes
- Participating in panel interviews with office manager
- Responsible for rooming patients and obtaining vitals
- Inoculated and vaccinated patients to immunize against communicable diseases
- Assisting with patient education; diagnosis, medications, and results
- Triage patient phone calls to facilitate appropriate level of care and coordinate office visits
- Conduct patient education visits
- Coordinated computerized functions for automated prescriptions, patient medical records and laboratory information and trained other office staff members in electronic operations
- Assist management of patient care with follow-up phone calls to patients including interpretation of laboratory data and medication adjustment.
- Completed electronic documentation, prior insurance authorizations and scheduling of appointments for patients prescribed for diagnostic and therapeutic services from specialists
LPN
Ohioans Home Healthcare
Perrysburg, OH
03.2016 - 08.2018
- Trained new employees with field policies and procedures
- Educated patients and families about disease management, lifestyle changes, nutrition, and preventive healthcare measures
- Instructed family members in basic nursing skills including wound care, injections, catheterization, and other treatments as ordered by the physician
- Charted changes in patient conditions and discussed concerns with supervising healthcare provider
- Advocated for patient needs with interdisciplinary team and implemented outlined treatment plans
- Organization of patient lab draw
- Provided home health care services such as wound care and medication administration
LPN
Fulton County Health Center Medical Care, LLC
Wauseon, Ohio
06.2013 - 04.2018
- Triage patient phone calls to facilitate appropriate level of care and coordinate office visits
- Responsible for rooming patients, obtaining vitals, and facilitating injections
- Coordination of Physician orders/referral scheduling
- Assisting with patient education: diagnosis, medications, and results
- Mentored new employees on office procedures
- Assist management of patient care with follow-up phone calls to patients including interpretation of laboratory data and medication adjustment.
- Assisted physicians during office procedures by preparing exam rooms and sterilizing instruments.
- Recorded patient information in electronic medical records system accurately and efficiently
- Answered telephones promptly and courteously while scheduling appointments for patients
- Organized medical supplies and equipment to maintain a safe and efficient work environment
- Completed electronic documentation, prior insurance authorizations and scheduling of appointments for patients prescribed for diagnostic and therapeutic services from specialists
- Prepared and administered vaccines, medications, controlled substances and narcotics as prescribed and sterilized and stored instruments, equipment and supplies
LPN - Unit Supervisor
Fulton Manor
Wauseon, Ohio
03.2013 - 02.2016
- Led informative and engaging clinical training for new employees
- Establish and build rapport with patient and those involved in care
- Responsible for delegating tasks to STNA's to ensure efficient workflow
- Identified changes in patient's condition or behavior that may require medical intervention or additional assessment
- Management of patient admissions and discharge.
- Monitored vital signs such as blood pressure, pulse rate, temperature and respiration rates regularly throughout shift
- Assisted with admissions, transfers, discharges, and end-of-life decisions for patients in the facility
- Provided emotional support to family members during difficult times associated with a loved one's terminal illness or death process
- Responded quickly to emergency situations using critical thinking skills to assess the situation appropriately while providing timely interventions as needed
Education
Bachelor of Business Administration -
American Public University System
01.2020
Licensed Practical Nursing Program -
Northwest State Community College
01.2012
Skills
- Project Coordinator
- Problem Solving
- Leadership
- Organization Management Skills
- Decision Making
- Customer Service
- Attention to Detail
- Adaptability
- Strong Communication Skills
- Creative Thinking
- Active Listening
Languages
English
Professional
Spanish
Professional
References
References available upon request.
Timeline
Nurse Appeal Associate
Elevance Health
05.2021 - Current
Physicians Order Coordinator, LPN
Ohioans Home Healthcare
09.2020 - 05.2021
Licensed Practical Nurse
Promedica Physician Group
11.2018 - 08.2020
LPN
Ohioans Home Healthcare
03.2016 - 08.2018
LPN
Fulton County Health Center Medical Care, LLC
06.2013 - 04.2018
LPN - Unit Supervisor
Fulton Manor
03.2013 - 02.2016
Bachelor of Business Administration -
American Public University System
Licensed Practical Nursing Program -
Northwest State Community College