Ashley Thompson
Sidney
Summary
Dynamic Utilization Review Nurse with extensive experience at CareSource, excelling in clinical documentation analysis and patient care management. Proven ability to enhance compliance and optimize care plans through effective communication and organizational skills. MCG and InterQual certified, adept at navigating complex healthcare regulations to ensure quality outcomes.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Utilization Review Nurse
CareSource
06.2021 - Current
- Utilization review to evaluate patient care before, during and after treatment in hospital settings.
- MCG Certified.
- InterQual Certified.
- Facilitated communication between payers, providers and patients concerning authorization issues or concerns.
- Conducted reviews of inpatient utilization for compliance with admission criteria and concurrent review requirements.
- Evaluated clinical documentation for accuracy and completeness in order to make decisions about coverage determinations.
- Maintained up-to-date knowledge of health plan benefits, policies, procedures, regulations, coding guidelines.
MDS Coordinator
Aspire Health Partners
Covington
07.2019 - 05.2021
- Coordinated timely submission of all required documents including Minimum Data Set forms, Care Area Assessments, Quarterly Assessment Reconciliation, Annual Assessment Reconciliations and other regulatory paperwork.
- Collaborated with interdisciplinary teams to develop comprehensive care plans.
- Researched new developments in Medicare and Medicaid reimbursement policies related to long-term care facilities.
- Performed data entry functions associated with entering information into computer systems used for tracking and monitoring purposes.
- Prepared annual reviews of all residents' medical records according to federal guidelines.
- Facilitated team meetings with members from other departments such as Social Services, Dietary, Activities, Rehabilitation services, to discuss resident issues and concerns related to the MDS process.
- Monitored residents' progress and updated MDS records accordingly.
- Reviewed clinical documentation to ensure accuracy of information reported on the MDS forms.
- Conducted assessments to determine the resident's functional and cognitive abilities, as well as their level of care needs.
- Assisted in developing and implementing quality assurance programs related to MDS completion.
- Compiled reports from various systems regarding utilization review outcomes and quality indicators as requested by management staff.
- Ensured that changes made to an existing plan of care corresponded with appropriate changes made on the corresponding MDS form.
- Audited monthly MDS submissions for accuracy, timeliness, completeness and compliance with applicable regulations.
- Assisted in identifying opportunities for improvement in processes related to the completion of the MDS form.
- Interpreted physician orders for accuracy and completeness prior to submitting them electronically into the MDS system.
- Analyzed trends in data collected through the Minimum Data Set.
- Provided training and education to nursing staff on current MDS regulations.
- Developed individualized plans of care for each resident based on assessment findings.
- Participated in survey preparation activities by ensuring that all necessary documents were available during surveys conducted by state agencies or accreditation organizations.
Licensed Practical Nurse/ MDS Nurse/ Resident Care Coordinator
Indian Lake Rehab Center
Lakeview
10.2017 - 12.2018
- Coordinated timely submission of all required documents including Minimum Data Set forms, Care Area Assessments, Quarterly Assessment Reconciliation, Annual Assessment Reconciliations and other regulatory paperwork.
- Collaborated with interdisciplinary teams to develop comprehensive care plans.
- Researched new developments in Medicare and Medicaid reimbursement policies related to long-term care facilities.
- Performed data entry functions associated with entering information into computer systems used for tracking and monitoring purposes.
- Prepared annual reviews of all residents' medical records according to federal guidelines.
- Facilitated team meetings with members from other departments such as Social Services, Dietary, Activities, Rehabilitation services, to discuss resident issues and concerns related to the MDS process.
- Monitored residents' progress and updated MDS records accordingly.
- Reviewed clinical documentation to ensure accuracy of information reported on the MDS forms.
- Conducted assessments to determine the resident's functional and cognitive abilities, as well as their level of care needs.
- Assisted in developing and implementing quality assurance programs related to MDS completion.
- Compiled reports from various systems regarding utilization review outcomes and quality indicators as requested by management staff.
- Ensured that changes made to an existing plan of care corresponded with appropriate changes made on the corresponding MDS form.
- Audited monthly MDS submissions for accuracy, timeliness, completeness and compliance with applicable regulations.
- Assisted in identifying opportunities for improvement in processes related to the completion of the MDS form.
- Interpreted physician orders for accuracy and completeness prior to submitting them electronically into the MDS system.
- Analyzed trends in data collected through the Minimum Data Set.
- Provided training and education to nursing staff on current MDS regulations.
- Developed individualized plans of care for each resident based on assessment findings.
- Participated in survey preparation activities by ensuring that all necessary documents were available during surveys conducted by state agencies or accreditation organizations.
MDS Coordinator
Sidney Care Center
Sidney
09.2015 - 10.2017
- Coordinated timely submission of all required documents including Minimum Data Set forms, Care Area Assessments, Quarterly Assessment Reconciliation, Annual Assessment Reconciliations and other regulatory paperwork.
- Collaborated with interdisciplinary teams to develop comprehensive care plans.
- Researched new developments in Medicare and Medicaid reimbursement policies related to long-term care facilities.
- Performed data entry functions associated with entering information into computer systems used for tracking and monitoring purposes.
- Prepared annual reviews of all residents' medical records according to federal guidelines.
- Facilitated team meetings with members from other departments such as Social Services, Dietary, Activities, Rehabilitation services, to discuss resident issues and concerns related to the MDS process.
- Monitored residents' progress and updated MDS records accordingly.
- Reviewed clinical documentation to ensure accuracy of information reported on the MDS forms.
- Conducted assessments to determine the resident's functional and cognitive abilities, as well as their level of care needs.
- Assisted in developing and implementing quality assurance programs related to MDS completion.
- Compiled reports from various systems regarding utilization review outcomes and quality indicators as requested by management staff.
- Ensured that changes made to an existing plan of care corresponded with appropriate changes made on the corresponding MDS form.
- Audited monthly MDS submissions for accuracy, timeliness, completeness and compliance with applicable regulations.
- Assisted in identifying opportunities for improvement in processes related to the completion of the MDS form.
- Interpreted physician orders for accuracy and completeness prior to submitting them electronically into the MDS system.
- Analyzed trends in data collected through the Minimum Data Set.
- Provided training and education to nursing staff on current MDS regulations.
- Developed individualized plans of care for each resident based on assessment findings.
- Participated in survey preparation activities by ensuring that all necessary documents were available during surveys conducted by state agencies or accreditation organizations.
Education
Licensed Practical Nurse - Nursing
Upper Valley Career Center, School of Practical Nursing
Piqua, OH07.2015
High School Diploma -
Houston High School
Houston05-2000
Skills
- Clinical support
- Electronic health records
- Patient records management
- Organizational skills
- Time management
- Analysis
- Nursing expertise
- Case management
- Managed care
- Computer networking
- MDS
- Pharmaceutical administration
Personal Information
- Authorized To Work: US for any employer
- Title: LPN- MDS Coordinator RAC-CT, MCG Certified
Certification
Licensed Practical Nurse - Compact Licensure
MCG Certified
InterQual Certified
Timeline
Utilization Review Nurse
CareSource
06.2021 - Current
MDS Coordinator
Aspire Health Partners
07.2019 - 05.2021
Licensed Practical Nurse/ MDS Nurse/ Resident Care Coordinator
Indian Lake Rehab Center
10.2017 - 12.2018
MDS Coordinator
Sidney Care Center
09.2015 - 10.2017
Licensed Practical Nurse - Nursing
Upper Valley Career Center, School of Practical Nursing
High School Diploma -
Houston High School
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