Summary
Overview
Work History
Education
Skills
Accomplishments
Timeline
Generic

Dana Nash

Title: RN, BSN, ACM-RN, CRCA

Summary

Dynamic healthcare professional with extensive experience in medical management, excelling in utilization review, and patient advocacy. Proven track record in regulatory compliance and quality assurance, effectively managing clinical denials and appeals. Skilled in medical coding and care coordination, driving improvements in patient outcomes and operational efficiency.

Overview

31
31
years of professional experience

Work History

Denial - Appeal Lead / Clinical Denials Manager / Case Management Analyst

Self Regional Healthcare
01.2004 - Current
  • Utilization Review, review medical records for medical necessity for all clinical denials (commercial insurance, Medicare, Medicaid, RAC, etc.), apply screening criteria to determine medical necessity, determine appropriate level of care, refer appropriate records to the Physician Advisor for 2nd level review, research and devise appeal letters, interact with Physician Advisor for concurrent review of cases and the denial / appeal process, knowledgeable of CPT codes and claims processing, in-depth communication with payer representatives, follow-up on submission of abstracted clinicals to ensure days approved, in-depth knowledge of Medicare's Inpatient Only list, NCD's, LCD's, Conditions of Participation (COP), and MAC rules and regulations, RAC (Probe and Post-Payment) audits; as well as commercial Medical / Reimbursement Policies / Clinical Guidelines, participation in the Denials Committee Team, report denial statistics, supervision of denial team members. Daily use of multiple software systems, including Careport, EPIC, and CorroHealth Escort.

Pre-Access / ECC Case Manager II

Self Regional Healthcare
01.2009 - 01.2010
  • Review records for admission medical necessity (includes all service areas: Med / Surg, Telemetry, LDRP / Post-Partum, Orthopedics, surgery, critical care, normal newborn / NICU, obtain prior authorizations for surgeries / procedures, continued stay reviews, taking admission calls via the Physician Referral Center.

Nursing Care Coordinator

Self Regional Healthcare
01.2004 - 01.2009
  • Coordinate care between the family practice facility and other facilities, telephone triage (all ages), payroll, employee scheduling, Pap-Smear tracking, indigent medication assistance, process CMN's, transcribe physician orders.

Charge Nurse

Gambro Healthcare
Greenwood
01.1999 - 01.2004
  • Supervise patient care, team-leading, manage all aspects of the dialysis process, operate all associated dialysis machinery, Reuse, lead physician rounds, computer documentation with extensive PC use, Anemia Management, coordinate team Care Plan meetings, water purification system monitoring, maintain personnel records, payroll, cardiac monitoring, delegation, counseling employees, employee in-services, Quality Assurance / Infection Control, assist Center Director in all duties.

Clinical Manager

Gambro Healthcare
Abbeville
01.1997 - 01.1999
  • Inventory, payroll, Infection Control, TB Management, employee personnel / health files, managing DHEC inspections, billing, Workman's Compensation records, emergency evacuation process, OSHA logs, physician care plan meetings, Anemia Management / Quality Assurance.

Head Nurse

Gambro Healthcare
Greenwood
01.1996 - 01.1997
  • Quality Assurance, care-plans, preceptor for new team members, medical record management, supervision of clinical team.

Staff Nurse

Gambro Healthcare
Greenwood
01.1995 - 01.1996
  • Direct patient care, IV therapy, assessments, medication administration, dialyzing acutely ill patients in ICU / CCU setting.

Staff Nurse

Self Memorial Hospital
01.1994 - 01.1995
  • Team nursing, care plans, assessments, standard nursing practice.

Education

Certified Revenue Cycle Associate -

CRCA
01.2021

Bachelor's Degree - in Nursing (BSN)

Western Governor's University
01.2016

National Case Management Certification -

ACM-RN
01-2012

Registered Nurse, South Carolina, Active, Multi-St
05-1994

Associate Degree - in Nursing (ADN)

Piedmont Technical College
01.1994

Skills

  • Utilization review
  • Medical coding
  • Patient advocacy
  • Regulatory compliance
  • Care coordination
  • Quality assurance

Accomplishments

  • 1994, Lambda Chi Nu Nursing Honor Society
  • 1994, Presidential Foundation Scholarship recipient (Piedmont Technical College)
  • 1994, President's Award for Professionalism (Piedmont Technical College)
  • 2005, MCFM Nurse of the Year
  • 2012, National Case Management Certification (ACM-RN)
  • 2016, WGU's Excellence of Writing Award for exemplary work on 'Evidence Based Practice and Applied Nursing Research'
  • 2016, WGU's Excellence of Writing Award for exemplary work on 'Professional Portfolio'

Timeline

Pre-Access / ECC Case Manager II

Self Regional Healthcare
01.2009 - 01.2010

Denial - Appeal Lead / Clinical Denials Manager / Case Management Analyst

Self Regional Healthcare
01.2004 - Current

Nursing Care Coordinator

Self Regional Healthcare
01.2004 - 01.2009

Charge Nurse

Gambro Healthcare
01.1999 - 01.2004

Clinical Manager

Gambro Healthcare
01.1997 - 01.1999

Head Nurse

Gambro Healthcare
01.1996 - 01.1997

Staff Nurse

Gambro Healthcare
01.1995 - 01.1996

Staff Nurse

Self Memorial Hospital
01.1994 - 01.1995

Certified Revenue Cycle Associate -

CRCA

Bachelor's Degree - in Nursing (BSN)

Western Governor's University

National Case Management Certification -

ACM-RN

Registered Nurse, South Carolina, Active, Multi-St

Associate Degree - in Nursing (ADN)

Piedmont Technical College

Similar Profiles

CREATE PROFILE