Corey Zullo
Ridgeville,SC
Summary
Highly capable and detail-oriented Registered Nurse with over 8 years of experience in the healthcare industry. Highly adept in coordinating and managing multiple tasks and ensuring compliance with applicable standards and regulations. Possess an in-depth knowledge of healthcare practices, medical coding, clinical documentation review and regulatory compliance. Eager to utilize my clinical and Utilization Management background, to contribute to positive patient outcomes and the success of the organization.
Overview
9
9
years of professional experience
1
1
Certification
Work History
Telephonic Complex Case Management RN
Centene Corporation
, USA
04.2024 - 11.2024
- Reviewed patient medical records for ICD 10 codes and documentation to support enrollment into Complex Case Management program
- Identified problems/barriers to care and provided appropriate care management interventions and documented in the Electronic Health Record (EHR)
- Coordinated between the member and/or family/caregivers and provider team to ensure members are receiving adequate and appropriate services
- Ensured compliance with HIPPA
- Used data analysis to educate members on strategies to prevent worsening kidney disease and hospitalization
- Provided feedback to leadership on opportunities for quality improvement in order to enhance care delivery for members in a cost-effective manner
Utilization Review Nurse
AmeriHealth Caritas
, USA
06.2022 - 04.2024
- Reviewed and interpreted 18-20 patient case records, utilizing InterQual criteria to ensure medical necessity and appropriateness of care
- Collaborated with management and served as team lead on assistance with utilization review processes, compliance adherence and Medicaid and Medicare Policies and Procedures
- Trained new team members and implemented a knowledge database of over 20 internal training resources, improving team employee onboarding, reducing training time and enhancing team members’ ability to feel comfortable in their roles post training
- Provided timely and accurate information to healthcare professionals regarding utilization standards, quality, and data management related to Medicaid and Medicare Policies and Procedures
School Nurse
Berkeley County School District
Summerville, USA
08.2021 - 06.2022
- Implemented and individualized health care plans for students with chronic conditions
- Managed health emergencies and student medical conditions across a diverse student body, ensuring timely, appropriate care and communication with staff, parents and medical staff
- Led the update and maintenance of student health records, ensuring accuracy and compliance in line with state regulatory standards
Perioperative Nurse
Roper Hospital
Charleston, USA
02.2021 - 12.2021
- Reviewing patient medical history and surgical plans prior to procedures
- Assisted surgeons with procedures, including positioning and draping of the patient, delivering supplies and instruments, and providing suturing as needed
- Administered medications and other treatments according to established protocols
- Collaborated with other healthcare professionals to ensure the delivery of optimal patient care
RN Medical Review II
BlueCross BlueShield of SC
, USA
06.2019 - 02.2021
- Performed Medicaid medical claim reviews for medically complex services that required preauthorization/predetermination, requests for appeal or reconsideration, referral for potential fraud and/or abuse, correct coding for claims/operations
- Made reasonable charge payment determinations based on clinical/medical information and established criteria/protocol sets and clinical guidelines
- Determined medical necessity and appropriateness and/ or reasonable and necessity for coverage and reimbursement
- Educated and guided internal and external staff regarding medical reviews, medical terminology, coverage determinations, coding procedures in accordance to contractor guidelines
- Participated in quality control activities in support of the corporate and team-based objectives
Hospice RN
Lutheran Hospice
Mount Pleasant, USA
05.2018 - 06.2019
- Coordinated with physicians, hospice care team, DME providers, hospitals, and community resources to provide optimal care and support for terminally ill patients
- Helped patients and families feel comfortable during challenging and stressful situations, promoting patient comfort and reduction of symptoms
- Participated in regular team meeting to discuss patient progress and update care plans
- Instructed patients and caregivers regarding home care and medication administration in comprehensible terminology
Dialysis RN
Fresenius Medical Care NA
Summerville, USA
05.2016 - 05.2018
- Maintained accurate patient records and ensuring compliance with policies and procedures
- Collaborated with interdisciplinary team (Nephrologists, Admin, Managers, Nurses, Techs) to ensure optimal patient care
- Managed and operated dialysis machines for an average 20 patients per in high-volume dialysis center, created personalized care plans and consistent delivery of high-quality hemodialysis treatments
- Managed a caseload of 20 peritoneal dialysis patients and implemented individualized care plans and provided comprehensive education on self-care practices
- Educated and transitioned 30+ patients to home dialysis therapies over a one-year period, increased patient independence through personalized training sessions and comprehensive follow up support
- Received management recognition for exceeding expectations in patient care satisfaction
Education
RN-BSN -
Capella University
Online12-2025
Associates of Science in Nursing -
Trident Technical College
Charleston, SC05.2016
Skills
- ICD-10 coding skills
- DRG and HCPCS coding systems
- Compliance auditing
- Clinical documentation review
- Coding guidelines
- Interpersonal skills
- Attention to detail
- Critical thinking
- Problem resolution
- Adaptability
- Medical terminology proficiency
- HIPAA compliance
- Electronic health record (EHR) expertise
- Problem-solving capacity
- Quality assurance practices
- Interdisciplinary collaboration
- Strong clinical judgment
Certification
Compact RN License-Eligible to Practice in Multiple States,
SC Board of Nursing. Issued : July 07,2016
License # 235964
Renewal Date: April 2026
Certified Professional Coder (CPC), (in progress)
American Academy of Professional Coders (AAPC)
Expected date of completion: August 2025
References
References available upon request.
Timeline
Telephonic Complex Case Management RN
Centene Corporation
04.2024 - 11.2024
Utilization Review Nurse
AmeriHealth Caritas
06.2022 - 04.2024
School Nurse
Berkeley County School District
08.2021 - 06.2022
Perioperative Nurse
Roper Hospital
02.2021 - 12.2021
RN Medical Review II
BlueCross BlueShield of SC
06.2019 - 02.2021
Hospice RN
Lutheran Hospice
05.2018 - 06.2019
Dialysis RN
Fresenius Medical Care NA
05.2016 - 05.2018
RN-BSN -
Capella University
Associates of Science in Nursing -
Trident Technical College
Similar Profiles
Moana KahanaMoana Kahana
Customer Service Advocate IV at Centene CorporationCustomer Service Advocate IV at Centene Corporation
Marissa CrawhornMarissa Crawhorn
Vice President, Utilization Management at Centene CorporationVice President, Utilization Management at Centene Corporation
Janet WangJanet Wang
Senior Accountant at Centene CorporationSenior Accountant at Centene Corporation
Christiana BootyChristiana Booty
Lead Claims Analyst at Centene CorporationLead Claims Analyst at Centene Corporation
MAXIMILIAN MACLEODMAXIMILIAN MACLEOD
Acting/Backup Team Leader at Volvo Cars USAActing/Backup Team Leader at Volvo Cars USA