Carol McNasby
Media,PA
Summary
Dynamic Utilization Management Nurse at Crozer Chester Medical Center with expertise in care coordination and quality improvement. Recognized for enhancing efficiency in case management and expediting claim resolutions. Adept at maintaining patient confidentiality while mentoring peers and fostering collaborative relationships, ensuring optimal patient outcomes through effective communication and clinical assessment.
Overview
33
33
years of professional experience
1
1
Certification
Work History
Utilization Management Nurse
Crozer Chester Medical Center
05.2020 - Current
- Supported cost containment efforts by identifying overutilization trends and recommending strategies for improvement.
- Increased efficiency in case management documentation by maintaining organized records and utilizing electronic medical record systems.
- Promoted a positive work environment by mentoring new nurses and serving as a resource for clinical questions and concerns.
- Expedited claim resolution by effectively communicating clinical rationale for treatment recommendations to insurance reviewers.
- Maintained up-to-date knowledge of payer-specific guidelines to ensure accurate authorizations for medically necessary services.
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Obtained authorizations from multiple insurance carriers for various levels of care.
- Performed prior authorization review of services requiring notification.
- Performed admission reviews based for medical necessity based upon IQ/MCG specification.
RN Nurse Case Manager
Crozer Chester Medical Center
08.1992 - 05.2020
- Collaborated with interdisciplinary teams for comprehensive patient care plans, resulting in better health outcomes.
- Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing conditions.
- Developed strong relationships with patients'' families, providing emotional support while addressing concerns or questions about care plans.
- Educated patients on disease management and self-care techniques, promoting lifestyle changes for improved health.
- Managed care from admission to discharge.
Education
Bachelor of Science - Nursing
Grand Canyon University
Phoenix, AZ09-2013
Skills
- Patient confidentiality
- Clinical assessment
- Care coordination
- Quality improvement
- Healthcare regulations
- Continuing education
- Policy adherence
- HIPAA compliance
- Discharge planning coordination
- Discharge planning
- Utilization management
- Time management
Certification
Case Management Certification
Certified IQ trainer
MCG qualified
Timeline
Utilization Management Nurse
Crozer Chester Medical Center
05.2020 - Current
RN Nurse Case Manager
Crozer Chester Medical Center
08.1992 - 05.2020
Bachelor of Science - Nursing
Grand Canyon University
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