Casey Berger
Powhatan,VA
Summary
Excellent ability to work under pressure both with and without supervision. Strong ability to quickly analyze and interpret data. Experience and participation in planning of care from admission to discharge and utilization review. Sound knowledge in conducting and reviewing medical necessity.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Utilization Management Nurse Consultant
Aetna/CVS
02.2023 - Current
- Evaluate guidelines and benefit coverage to determine appropriateness of services
- Performs Acute Admission/CSR and Post Acute Precert/CSR reviews for medical necessity based upon MCG/CMS criteria
- Refers reviews to Medical Directors as appropriate
- Effectively communicate w/ facilities regarding decisions, last approved day and next review date or peer to peer and appeals information
- Facilitates proactive discharge planning to promote safe transitions to alternate levels of care
- Participates in and collaborates during MD and IDT rounds
- Making appropriate referrals as needed
- Follows regulations and guidelines in accordance to control state
- Adheres to and meets strict turn around times for timely assessment completion
- Meets and exceeds productivity metrics
Registered Nurse, ICU
Bon Secours
05.2019 - 07.2020
- Maintained quality care and comfort for patients with heart failure, pulmonary hypertension and other serious conditions.
- Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing conditions.
- Monitored patient condition by interpreting and tracking EKG readings, identifying irregular telemetry readings and updating team members on changes in stability or acuity.
- Monitored patient reactions to drugs and carefully documented findings.
- Implemented medication and IV administration, catheter insertion and airway management.
- Care and respiratory management of ventilated and sedated patients.
- Care of arterial lines, PICC lines, central lines, and peripheral lines.
- Placement and care of Foley catheters, NG tubes, and OG tubes.
- Managed quality care for patients with heart failure, end-stage renal disease and coronary artery disease.
- Collected blood, point of care testing, and other laboratory specimens and prepared for lab testing.
- Managed care from admission to discharge.
Registered Nurse, Medical-Surgical Unit
Bon Secours
12.2017 - 05.2019
- Managed care from admission
- Provided direct patient care and stabilized patients.
- Orient new nurses and student nurses to achieve training outcomes.
- Trained new nurses in proper techniques, care standards, operational procedures and safety protocols.
- Maintained quality care and comfort for patients with heart failure, pulmonary hypertension and other conditions.
- Implemented medication and IV administration, catheter insertion and airway management.
- Implemented medication and IV administration, catheter insertion and airway management.
- Monitored patient condition by interpreting and tracking EKG readings, identifying irregular telemetry readings and updating team members on changes in stability or acuity.
- Educated patients, families and caregivers on diagnosis and prognosis, treatment options, disease process and management and lifestyle options.
- Administered medications and treatment to patients and monitored responses while working with healthcare teams to adjust care plans.
- Reviewed post-operative orders and continuously monitored patients' post-operative vitals, set up PCA and fluids and oriented patients to unit.
- Provide ADL care
- Manage JP and Hemovac drains posts operatively.
MDS Coordinator
Medical Facilities Of America
08.2014 - 12.2017
- Participated in weekly PPS meetings.
- Managed Case Mix Index, monitoring for potential risks and changes that could affect reimbursment. Helped raise case mix to highest score for building.
- Had no lates for each year.
- Verified prompt
- and accurate completion of MDS activities for billing.
- Completion of comprehensive plans of care via review of patient medical record, communication and observation of patient, and communication with direct care staff.
- Participated in monthly care plan meetings with interdisciplinary team, family members, and patient.
- Set schedules for staff to start and complete MDS assessments and care plan meetings.
- Completed assessments for residents admitted within set time line.
- Reviewed missing assessment reports and analyzed issues for leadership team.
- Assessed electronic medical record for required documentation to support MDS coding.
- Completed minimum data set assessments with strong collaboration across business, provider and clinical disciplines.
- Complied with federal and state regulations for completion and coordination of RAI process.
- Participated weekly utilization review to go over recent clinical activities.
- Followed up on outstanding clinical items within established timelines for optimal care delivery.
RN Charge Nurse
Medical Facilities Of America
03.2013 - 08.2014
- Worked with skilled and long term care residents.
- Managed care from admission to discharge.
- Updated patient charts with data such as medications to keep records current and support accurate treatments.
- Monitored patient reactions to drugs and carefully documented findings.
- Administered medications and treatment to patients and monitored responses while working with healthcare teams to adjust care plans.
- Advised patients and caregivers of proper wound management, discharge plan objectives, safe medication use and disease management.
- Managed and supervised CNA staff.
- Assisted with ADL care.
- Provided direct patient care, stabilized patients and determined next course of action
Education
Bachelors Of Nursing - Nursing
Western Governors University
Salt Lake City, UT01.2020
Associate Degree In Nursing - Nursing
Medical Careers Institute
Richmond, Virginia06.2011
Skills
- EMR System
- MCG/CMS Criteria Review
- ICD-10 Codes
- Acute and Rehabilitative Care, Skilled and Long Term Acute Care
- Interdisciplinary Collaboration
- Proactive Discharge Planning
- Decision Making
- Organization Skills
- Computer Proficiency
- Medical Necessity Evaluation
- Critical Thinking
- Time Management
- Utilization Review
Certification
RN License Number 0001233191
Timeline
Utilization Management Nurse Consultant
Aetna/CVS
02.2023 - Current
Registered Nurse, ICU
Bon Secours
05.2019 - 07.2020
Registered Nurse, Medical-Surgical Unit
Bon Secours
12.2017 - 05.2019
MDS Coordinator
Medical Facilities Of America
08.2014 - 12.2017
RN Charge Nurse
Medical Facilities Of America
03.2013 - 08.2014
Bachelors Of Nursing - Nursing
Western Governors University
Associate Degree In Nursing - Nursing
Medical Careers Institute
RN License Number 0001233191
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