ALICIA GRECO
Land O' Lakes,FL
Summary
Dedicated Registered Nurse with over 28 years of extensive experience in hospital, hospice, and community nursing environments, delivering exceptional care to patients across all age groups. Proven expertise in advanced software systems such as TruCare, Cerner, and Epic, complemented by strong proficiency in documentation and record maintenance to uphold accuracy and patient confidentiality. Comprehensive understanding of clinical criteria across various care levels, from inpatient stays to home health care, supported by exceptional organizational skills that enhance both independent and collaborative productivity. Well-versed in ICD-9 and ICD-10 coding, with a solid foundation in commercial and Medicare DRGs, utilization review, and Medicaid practices.
Overview
30
30
years of professional experience
1
1
Certification
Work History
Utilization Review Nurse
AdventHealth Connerton
01.2022 - Current
- Conducted comprehensive utilization reviews to ensure compliance with healthcare regulations.
- Analyzed medical records and treatment plans for accuracy and appropriateness of services.
- Contributed to organizational success by providing expert advice on medical necessity criteria and evidence-based practices in utilization review nursing.
- Assisted discharge planning efforts through prompt identification of medically stable patients who were ready for transition to alternate levels of care.
- Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
RN- Pediatric Case Manager
Centene / Sunshine Health / Children's Medical Services
01.2021 - Current
- Evaluate and assess the needs of the member via phone and develop the care plan/service plan for the best outcome, which includes both physical health, behavioral health and social determinant needs
- Perform telephonic outreach to assess member needs and collaborate with resources
- Develop ongoing care plans for members with high level acuity and works to identify providers, specialists, and community resources needed for care including mental health and substance use disorders
- Coordinate as appropriate between the member and/or family/caregivers, community resources, and the care provider team to ensure identified services are accessible to members
- Facilitate care coordination and collaborates with appropriate providers or specialists to ensure member has timely access to needed care or services
- Collect, document, and maintain member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators
- Provide education to members and their families on procedures, healthcare provider instructions, treatment options, referrals, and healthcare benefits, which may include behavioral health and social determinant needs
RN- Manager of Case Management
Centene / Sunshine Health / Children's Medical Services
01.2016 - 01.2021
- Develop and maintain strong relationships with referral sources and payers to ensure repeat business. Interact with patients and families to enhance guest relations.
- Contribute to the development of and assures compliance with hospital policies and procedures. Maintains departmental manuals.
- Direct supervision of case management department staff including recruitment and training of all new employees and annual performance reviews.
- Ensure all patients have an active payer and that continued stay is justified through oversight of clinical reviews and InterQual.
- Collaborated with interdisciplinary teams to develop comprehensive treatment plans for complex patients with multiple comorbidities.
- Skillfully managed challenging patient situations using de-escalation techniques, crisis intervention strategies, and therapeutic communication skills.
- Utilize a thorough working knowledge of PPS and monitors DRGs for accuracy in order to accurately manage patients length of stay.
- Oversee all discharge planning, including interdisciplinary meetings and family meetings. Assure that all documentation is timely according to policies.
- Direct supervision of Utilization Review Nurse to ensure resolution of all payer related work items for timely billing of accounts.
RN – Case Manager
AdventHealth Connerton
01.2012 - 01.2016
- Follow a team of patients throughout hospital admission ensuring compliance with external review agencies.
- Perform continuous assessments and evaluations, identifying barriers to discharge, and ensuring patient is progressing towards desired outcomes.
- Collaborate and consult with physicians on patient's progress and discharge planning needs.
- Coordinate and lead interdisciplinary team meetings to ensure all members of the health care team are involved in planning of discharge goals.
- Accountable for the organization, sequence of services and resources necessary for the achievement of patient care outcomes within effective time frames on a specific group of patients, with emphasis on decreasing length of stay and monitoring cost effectiveness of diagnostic tests.
- Use InterQual criteria to determine observation/ inpatient status and assess level of inpatient care.
- Collaborate with personnel at other facilities to coordinate smooth patient transfers.
RN – Utilization Review Nurse
AdventHealth Connerton LTAC
01.2015 - 01.2015
- Perform utilization review using InterQual to ensure Medicare patients meet criteria for appropriate level of care throughout hospital admission.
- Obtain initial authorizations from payers for patients referred to hospital for admission.
- Evaluated medical necessity for services, ensuring appropriate resource utilization and cost-effectiveness.
- Collaborated with interdisciplinary teams to optimize patient outcomes through effective treatment planning.
- Facilitated communication between healthcare providers and insurance representatives to resolve authorization issues.
- Working knowledge of payer contracts, providing clinical information to payers in a fiscally responsible manner.
RN- Admissions Nurse
HPH Hospice
01.2010 - 01.2012
- Visited patients in their homes to determine eligibility for hospice services.
- Documented assessments into electronic health record system
- Administered patient care with emphasis on comfort and pain management in hospice settings.
- Educated families on end-of-life processes and provided emotional support during transitions.
- Conducted thorough patient assessments to identify changes in condition, promptly notifying physicians and initiating appropriate interventions when necessary.
- Administered medications safely according to established guidelines while closely monitoring for side effects or adverse reactions requiring intervention.
RN Case Manager
Children's Medical Services
01.2006 - 01.2010
- Determined clinical eligibility for programs
- Provided case management to chronically ill children
- Worked with parents to assist with resources
- Performed and entered intake assessments into the medical management system
LPN
St. Joseph's Hospital
01.1996 - 01.2008
- Outpatient Infusion Room staff nurse, 1999
- Cancer Center- Oncology floor staff nurse, 1997-1999
- Administer medications and treatments as per physician orders and hospital protocols.
- Monitor patient vital signs and report significant changes to healthcare team.
- Improved patient outcomes by administering medications, monitoring vital signs, and documenting relevant information.
- Cared for wounds, provided treatments, and assisted with procedures.
- Demonstrated excellent technical skills in wound dressing changes, IV therapy administration, catheter insertion, and other routine nursing procedures.
LPN
Dunedin Mease Hospital
01.1996 - 01.2008
- Ortho/Neuro floor staff nurse, 1997
Education
RN - Nursing
Galen Health Institute
St. Petersburg, Florida01.2008
LPN - Nursing
Galen Health Institute
St. Petersburg, Florida01.1996
Skills
- InterQual criteria
- Utilization review
- Medical coding
- Case management
- Teamwork
- Strong clinical judgment
- Microsoft office
- Documentation
- Creative problem solving
Certification
- Registered Nurse, State of Florida
- CCM, Board Certified in Case Management
COMMUNITY SERVICE
LPN, Tampa, Florida, Educated people with diabetes about proper exercise and diet and answered any questions they had at the time., Diabetes Expo
Timeline
Utilization Review Nurse
AdventHealth Connerton
01.2022 - Current
RN- Pediatric Case Manager
Centene / Sunshine Health / Children's Medical Services
01.2021 - Current
RN- Manager of Case Management
Centene / Sunshine Health / Children's Medical Services
01.2016 - 01.2021
RN – Utilization Review Nurse
AdventHealth Connerton LTAC
01.2015 - 01.2015
RN – Case Manager
AdventHealth Connerton
01.2012 - 01.2016
RN- Admissions Nurse
HPH Hospice
01.2010 - 01.2012
RN Case Manager
Children's Medical Services
01.2006 - 01.2010
LPN
St. Joseph's Hospital
01.1996 - 01.2008
LPN
Dunedin Mease Hospital
01.1996 - 01.2008
LPN - Nursing
Galen Health Institute
RN - Nursing
Galen Health Institute