Christina Verly
Apopka,FL
Summary
To leverage my extensive nursing experience and clinical skills as a Registered Nurse in the Appeals Nurse Consultant position, ensuring accurate processing of Medicare appeals while providing exceptional support to patients and healthcare providers
Overview
15
15
years of professional experience
Work History
Concurrent Review Nurse
Centene
St Louis, MO
04.2020 - Current
- Conducted initial reviews of medical records to determine appropriateness of requested services.
- Collaborated with physicians and other healthcare providers to ensure accurate coding and billing practices.
- Evaluated patient charts for accuracy, completeness, and compliance with established standards.
- Assessed patients' eligibility for coverage according to insurance guidelines.
- Interpreted clinical data from medical records and applied evidence-based criteria in order to make decisions regarding the appropriateness of care provided.
- Performed concurrent review activities to ensure that treatments are medically necessary and meet quality standards.
- Researched complex cases involving multiple diagnoses or treatments requiring coordination among multiple providers.
- Reviewed requests for prior authorization by gathering pertinent information from medical records, insurance policies, provider notes., in order to make an informed decision about treatment plans.
- Advised physicians on appropriate documentation required for appropriate reimbursement under various payer sources.
Registered Nurse Care Coordinator
Children Medical Services
Orlando, FL
02.2017 - 04.2020
- Conducted assessments of patients to determine their medical, functional, and psychosocial needs.
- Provided patient education on disease processes, treatment plans, medications, and lifestyle modifications.
- Coordinated referrals for specialty services and provided follow-up with providers as needed.
- Developed comprehensive care plans that addressed the physical, mental health, social service and discharge planning needs of each patient.
- Assisted with discharge planning by coordinating post-acute care services such as home health care or skilled nursing facility placement.
- Identified potential barriers to effective care delivery and developed strategies to address them.
- Process eligibility and redetermination for over 400 patients, ensuring compliance with medical necessity.
Pediatric Clinical Case Manager
Rescare Homecare
Orlando, Florida
05.2016 - 11.2016
- Evaluated and updated care plans, ensuring adherence to treatment protocols and patient safety.
- Trained new nursing staff on best practices and patient care strategies.
- Provided education and support to patients and facilities, enhancing health promotion and emergency management.
Licensed Practical Nurse, Home Care
PSA Healthcare
Orlando, Florida
01.2010 - 03.2015
- Provided nursing care to patients in their homes, including wound care, administering medications, and monitoring vital signs.
- Assessed patient needs and developed individualized plans of care to meet those needs.
- Collaborated with physicians and other healthcare professionals to ensure optimal patient outcomes.
- Performed physical assessments of patients in home settings.
- Educated patients and families about health maintenance and disease prevention techniques.
- Evaluated the effectiveness of treatments and interventions based on patient responses.
- Assisted with activities of daily living such as bathing, dressing, grooming, ambulation, positioning, feeding.
- Responded to emergency situations quickly while maintaining composure under pressure.
Education
Master of Science - Leadership And Management
Western Governors University
Salt Lake City, UT05-2021
Bachelor of Science - Nursing
University of South Florida
Tampa, FL05-2017
Associate of Science - Nursing
Valencia College
Orlando, FL08-2015
Skills
- Interdisciplinary Collaboration
- HIPAA Compliance
- Utilization review
- Medicare/Medicaid knowledge
- Clinical assessment
- Discharge Planning
- Quality Improvement
- Medical record review
- Managed care
- Prior authorization processing
- Insurance Verification
Timeline
Concurrent Review Nurse
Centene
04.2020 - Current
Registered Nurse Care Coordinator
Children Medical Services
02.2017 - 04.2020
Pediatric Clinical Case Manager
Rescare Homecare
05.2016 - 11.2016
Licensed Practical Nurse, Home Care
PSA Healthcare
01.2010 - 03.2015
Master of Science - Leadership And Management
Western Governors University
Bachelor of Science - Nursing
University of South Florida
Associate of Science - Nursing
Valencia College