Danielle Dove
Williamstown,NJ
Summary
Outcomes-focused nursing professional with over 28 years of experience in hospital, rehab, and home care settings working with varied patient populations to include Neuro, Cardiac, Post-surgical, Ortho, GI, Women's Health and Oncology. Expertise in care coordination of complex patients, medical necessity, resource utilization, and discharge planning. Offering extensive clinical knowledge with the ability to engage physicians and collaborate with team members to ensure continuity of care. Excited for a new position that involves identifying and advocating for patients needs while successfully maintaining clinical practice guidelines. Motivated by the opportunity for continued professional growth and leadership.
Overview
21
21
years of professional experience
1
1
Certification
Work History
RN, Initial Clinical Reviewer II
Evolent Health
Remote , NJ
2022.08 - 2024.03
- Analyzed clinical records in order to accurately approve or deny imaging requests as part of Radiology Benefits Management in accordance with member-specific health plan guidelines while meeting established determination goal of 14.5 records/hour.
- Promoted a supportive team approach by interacting with medical call center staff and obtaining additional pertinent clinical history/information in order to reach a determination.
- Notified requester of case approval with supporting clinical rationale while maintaining health plan specific timeframes.
- Referred all cases in which an approval could not be rendered due to outlined missing clinical information to the Physician Clinical Reviewer per NJ State requirements.
- Maintained the principles of utilization management in adherence with policies/procedures and participated in training programs to ensure quality performance in compliance with applicable standards and regulations.
RN, Home Care Coordinator
Virtua Health System
Voorhess , NJ
2016.05 - 2021.05
- Collaborated with interdisciplinary health care team including nursing, PT/OT, respiratory, outcomes management, and physicians to establish Plan of Care and to ensure quality of care.
- Anticipated patient needs and planned accordingly to facilitate timely discharges in order to decrease Length of Stay and to reduce 7-day and 30-day readmission rates.
- Advocated for patients by supporting and respecting basic rights while providing education about home care services in order to promote safe transition to home.
- Obtained physician orders and authorizations for skilled home care services and arranged for all DME, ostomy care, PCN tubes, tracheostomies, VACs, and JP drains.
- Responded to all consults and developed Plan of Care for all referrals entered daily, reviewed chart to appropriately identify ICD.10 for PDGM reimbursement, and coordinated all services needed by patient in order to ensure safe, timely discharge.
RN, Clinical Manager
Bayada Home Health Care, ESA
Sewell , NJ
2003.06 - 2015.11
- Performed initial comprehensive clinical assessments/admission to home care services and implemented Plan of Care.
- Supervised 80 staff members and provided monthly performance evaluations to include Skills Checklist.
- Managed clinical operations and procedures and enforced compliance with local, state, and federal healthcare regulations, including Medicare and Medicaid requirements, HIPAA, CHAP and JCAHO.
- Obtained authorizations of Medicaid hours through MLTSS program.
- Facilitated implementation of company-wide Performance Improvement project to ensure ongoing quality of care.
Education
Some College (No Degree) - RN To BSN Program
Wilmington University
New Castle, DE2012
Associate of Applied Science - Nursing
Gloucester County Community College
Sewell, NJ05.1995
Skills
- Comprehensive Patient Assessment
- Team Collaboration
- Care Coordination/Referral Management
- Medical Necessity
- Resource Utilization
- Interpersonal Skills
- Patient Advocate
- Clinical Expert
- Problem Solving
- Discharge Planning
- Patient Education
- Communication/Documentation Skills
Certification
- New Jersey Registered Prof Nurse License #26NO11107700, Expires May 2026
- Basic Life Support (BLS) Certification, American Heart Association, Expires January 2024
Skills
Epic I Microsoft Office I Soarian I QliqSOFT I Netsmart I SharePoint I Survey Monkey
Timeline
RN, Initial Clinical Reviewer II
Evolent Health
2022.08 - 2024.03
RN, Home Care Coordinator
Virtua Health System
2016.05 - 2021.05
RN, Clinical Manager
Bayada Home Health Care, ESA
2003.06 - 2015.11
Some College (No Degree) - RN To BSN Program
Wilmington University
Associate of Applied Science - Nursing
Gloucester County Community College
- New Jersey Registered Prof Nurse License #26NO11107700, Expires May 2026
- Basic Life Support (BLS) Certification, American Heart Association, Expires January 2024
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