Angela Eilf
Kissimmee,FL
Summary
Organized and knowledgeable Registered Nurse experienced in treating and caring for patients. Successful in providing fast and accurate assessments and working calmly under pressure. Recognized for collaborating well with doctors to maintain top-notch healthcare practices.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Nurse Care Manager PCU/Oncology Nurse
Adventhealthcare
Celebration, FL
03.2023 - Current
- Advocated for patient needs with interdisciplinary team and implemented outlined treatment plans.
- Utilized computerized Electronic Health Record (EHR) system.
- Linked clients with social services, health care providers and governmental agencies to help claim or reclaim individual autonomy.
- Assisted individuals with eligibility for available benefits.
- Maintained logs and electronic client records following department and agency policies for effective monitoring.
- Developed and implemented care management plan to address needs and goals.
- Created plan of care to assist patients in reducing problems or barriers to achieve optimal level of health.
- Monitored risk assessment by using available tools and implementing discharge interventions.
- Liaised with multidisciplinary team to discuss barriers to discharge or concerns impacting readmission risk.
- Provided case management services including intake, assessment, crisis intervention, advocacy, referral and monitoring of families.
RN Utilization Case Manager
Tampa General Hospital Emergency Room
Tampa, FL
09.2022 - Current
- Utilized computerized Electronic Health Record (EHR) system.
- Collaborated with providers to obtain required clinical information, supporting prior authorization determinations and individual inquiries.
- Referred cases to secondary review for failure to meet Observation and/or Inpatient criteria.
- Determined medical necessity and cost-effectiveness of services through utilization review processes.
- Reviewed patient admissions to determine medical necessity as directed by interqual criteria.
- Applied medical criteria and clinical judgement to researched cases to evaluate and establish determinations.
- Remained up-to-date on various benefit plans, medical policies and state-specific clinical guidelines or criteria.
ED Utilization Review Nurse
The Brundage Group
Boise, ID
12.2021 - 08.2022
- Collaborated with providers to obtain required clinical information, supporting prior authorization determinations and individual inquiries.
- Interpreted and evaluated diagnostic tests to identify and assess patient's condition.
- Kept detailed documentation on all utilization reviews by using Interqual and MCG Indicia software.
- Determined medical necessity and cost-effectiveness of services through utilization review processes.
- Maintained strict patient data procedures to comply with HIPAA laws and prevent information breaches.
- Managed departmental processes pertaining to denials and potential denials as outlined by insurance carriers.
- Referred cases to secondary review for failure to meet Interqual and/or Indicia criteria.
- Applied medical criteria and clinical judgement to researched cases to evaluate and establish determinations.
- Contacted insurance carriers to obtain authorizations for services delivered to patients.
- Achieved departmental goals and objectives by instituting new processes and standards for in-patient care.
Registered Nurse ED Case Manager/UM Reviewer
Covenant HealthCare
Saginaw, MI
03.2018 - 12.2021
- Arranged placement of admissions and transfers in accordance with clinical standards and guidelines.
- Secured insurance authorizations to rehabilitation facilities or long-term care placement.
- Assessed and reviewed patients for discharge and planning and integrated services for patients requiring home care, home infusion and durable medical equipment (DME).
- Updated and maintained discharge plan of care with physician, members of healthcare team, patients and families.
- Advocated for patients by identifying insurance coverage, communicating care preferences to practitioners and verifying interventions met patients' treatment goals.
- Collaborated with physicians on patient medications, medical needs and performance.
- Coordinated home care, home infusion and durable medical equipment, reducing patient wait times.
Mission Control Coordinator
MidMichigan Medical Center - Midland
Midland, MI
03.2013 - 03.2018
- Demonstrated strong clinical assessment skills and clinical judgement to appropriately assess patient acuity and needs, assumed principal responsibility for the coordination of acceptance, admission and transfer, and necessary communication between the referring physician, attending physician and clinical staff.
- Trained employees on best practices and protocols while managing teams to maintain optimal productivity.
- Communicated concerns regarding patients' status, care and environment to nursing supervisors and clinical care supervisors.
- Registered nurse working under direct supervision of CRM management as a patient placement coordinator performing roles for utilization management, transfer coordinator and bed placement.
- Initiated the financial clearance process via Revenue cycle Operations and/or Patient Access, and coordinated with referring ER MD's, hospitals and outpatient offices to obtain insurance authorization for patient transfer.
- Coordinated requests for inpatient bed assignments for incoming transfers in collaboration with patient placement/bed management to ensure proper patient placement.
Education
Associate of Applied Science - Registered Nursing
Delta College
Bay City, MI06.2005
Practical Nurse Certificate (LPN) - Nursing
Delta College
Bay City, MI08.2002
Skills
- Care Coordination
- Extensive Utilization Review Knowledge
- Case Management
- Homecare, Palliative, Hospice and ECF
- Mission control/bed placement/transfer coordinator
- Interqual, MCG Indicia, Cerner and EPIC software
Certification
- BLS and CPR certified
- Florida state expanded RN licensure
Timeline
Nurse Care Manager PCU/Oncology Nurse
Adventhealthcare
03.2023 - Current
RN Utilization Case Manager
Tampa General Hospital Emergency Room
09.2022 - Current
ED Utilization Review Nurse
The Brundage Group
12.2021 - 08.2022
Registered Nurse ED Case Manager/UM Reviewer
Covenant HealthCare
03.2018 - 12.2021
Mission Control Coordinator
MidMichigan Medical Center - Midland
03.2013 - 03.2018
Associate of Applied Science - Registered Nursing
Delta College
Practical Nurse Certificate (LPN) - Nursing
Delta College
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