April DeRossett-Watson

Provides direct nursing care to patients with behavioral health disorders based on a systematized body of knowledge. Oversees care provided by Licensed Practical Nurses and Behavioral Health Technicians. Utilizes nursing process including assessment, identification of nursing problems, planning, execution, evaluation, and modification of nursing interventions as determined by patient outcomes.

• Supervised an interdisciplinary team of Nurses, Social Workers, and non-clinical staff involved in Case Management activities for members with both Medicaid and Medicare Coverage
• Utilized multiple reports (Power Bi, Tableau, et
• Al) to ensure overall compliance with Medicaid, Medicare, and department policies.

• Supervised a team of 12 direct reports consisting of professional coders (CPC, CBCS) and Professional Nurses (LPN, RN)
• Participated in process improvement projects utilizing ABX (Achieving Business Excellence) methodologies
• Collaborated with other members of the management team to develop training materials for staff
• Successfully passed Intuitive Documentation Writing course
• Effectively utilized Microsoft suite applications
• Acted as a change management agent to assist my team and the department as a whole with the transition to CVS Health from Aetna/Coventry, and the associated reductions in force.

• Lead a team of 4 auditors, and provided thorough monthly accuracy reports and feedback to the auditors and the reviewers
• Performed extensive calibration exercises to ensure consistent quality throughout the department, and educated the staff through sharing the findings and developing training on areas in need of improvement
• Recognized trends in errors, identified root cause/solutions to ensure consistency in clinical bill reviews
• Further expanded experience/working knowledge of workers' compensation rules and regulations and CPT, NCCI, AAOS, ICD-9, ICD-10, and HCPCS
• Promoted to Supervisor.

• Performed the consistently accurate audit of greater than the required metric of Worker's Compensation bills
• Recognized and reported trends in errors and determined root cause and solutions to ensure consistency in reviews
• Demonstrated thorough knowledge of error validation/dispute process
• Promoted to Quality Review Consultant.

• Identified medical cost savings on Worker's Compensation bills due to inappropriate charges or incorrect coding on medical bills
• Assured that medical records support all codes and service levels billed
• Thorough and accurate review of Worker's Compensation bills, providing defensible reviews based upon nationally recognized clinical and coding logic utilizing CPT, NCCI, AAOS, ICD-9, and HCPCS
• Reviewed escalated bills, state dispute bills, and was actively involved in the implementation of pilot projects for large national clients
• Promoted to Coding Nurse Auditor.

• Director of the medical department of a 48 bed Department of Juvenile Justice facility
• Responsible for the total administrative functioning of the Medical Department (budgeting, ordering of supplies, staff scheduling, assuring state regulation compliance) while providing direct inmate nursing services and supervision of the facility medical department staff
• Under my direction, the medical department was recognized both locally and regionally for our exceptional internal fidelity scores, as well as our high overall State of Florida Quality Assurance scores.

• Staff Nurse in a 14-bed inpatient psychiatric unit in a Baker Act receiving facility for children 5-17 years
• Utilized the psychiatric nursing process to complete nursing admission assessments, timely and accurate medication administration, effective collaboration with the treatment team, and patient and family education
• Ensured the safety of the unit through proactively diffusing escalating behaviors, thereby preventing patient and staff injuries
• Oversaw the care provided by up to 5 Mental Health Technicians each shift.