Summary
Overview
Work History
Education
Skills
Yarn spinner & knitter, quilter and avid gardener.
Timeline
Hi, I’m

Deborah Sammons

Aliquippa,PA
Deborah Sammons

Summary

Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. Seeking a telecommute position which will utilize prior authorization, review expertise and incorporate comprehensive healthcare and case management experiences.

Overview

29
years of professional experience

Work History

UNITED HEALTH CARE

E&I PRIOR AUTHORIZATION NURSE REVIEWER
10.2018 - Current

Job overview

  • Successful member of E&I Prior Authorization Texas specialty Team for 4 years and Core Team for last 6 months.
  • Carried out day-day-day duties accurately and efficiently.
  • Proved successful working within tight deadlines and fast-paced atmosphere.
  • Resolved problems, improved operations and provided exceptional service.
  • Participated in team-building activities to enhance working relationships.
  • Demonstrated respect, friendliness and willingness to help wherever needed.
  • Completed training and functioned as one of three staff qualified to perform TX ABI reviews.

PARK RIDGE HOME HEALTH

PATIENT CARE SUPERVISOR & QA/PI COORDINATOR
01.2014 - 01.2018

Job overview

  • Recruited, hired and trained all staff, providing direct supervision, ongoing staff development, continuing education and competency review for employees.
  • Motivated and supervised >30 total staff, comprising an interdisciplinary care team including RN's, LPN's, PT's, OT's, ST's and Therapy Assistants in delivery of quality patient care.
  • Conducted skilled care POC and OASIS, PI/OBQI, and HCAPHS review/audit.
  • Demonstrated proficiency in ICD-10 coding and conventions, Therapy LCD's, HCPCS/CPT, and benefit coverage, payor negotiation, and appeals.
  • Developed and updated policies and procedures, maintaining compliance with statutory, regulatory and local, state and federal guidelines relating to HIPAA, benefits administration and general liability.
  • Conducted Joint Commission Accreditation survey preparation activities and participated in survey process resulting in successful re-accreditation.

PREMIER HEALTH CARE

PRIVATE DUTY SERVICES SUPERVISOR,
01.2013 - 01.2014

Job overview

  • Performed medical assessments, identified gaps or barriers in treatment, and designed/implemented comprehensive care plan.
  • Managed all clinical aspects of private duty skilled and non-skilled services for all clients.
  • Managed all administrative aspects of staff orientation, supervision, competencies, and performance evaluations.
  • Handled customer complaints and inquiries.
  • Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs, provision of staff, medical care challenges and resolving concerns.
  • Subcontracted as Humana CM.

GENTIVA HEALTH SERVICES

HOME HEALTH FIELD NURSE PRECEPTOR
01.2009 - 01.2013

Job overview

  • Efficiently and effectively managed 30-40 total patient case load.
  • Determined and addressed individual home care needs by completing detailed assessments and reviewing documentation.
  • Advised and coached patients progressing from hospitals, rehab facilities and other medical organizations to at-home treatment settings.
  • Worked with multidisciplinary team to carry out successful treatment plans for diverse acute and chronic conditions.
  • Administered different therapies and medications in line with physician orders and treatment plan, including home administration of antibiotics, specialized medications and IVIG.
  • Educated family members and caregivers on patient care instructions.
  • Certified as a Tele-monitoring specialist and trainer.
  • Served as new staff Preceptor

CAREPARTNERS HEALTH SERVICES

SKILLED SERVICES SUPERVISOR (PRIVATE DUTY)
01.1994 - 01.2009

Job overview

  • Progressed from field nurse to management over 15-year employment
  • As PDN supervisor, managed all clinical aspects of services from patient intake to implementation and oversight of total in-home skilled care for all levels of acuity and all age groups
  • Recruited, hired and trained all staff, providing direct supervision, ongoing staff development, continuing education and competency review for employees.
  • Handled customer complaints and inquiries.
  • Developed community reputation through commitment to customer satisfaction and strong client relationships.
  • Passionate about learning and committed to continual improvement

Education

Asheville Buncombe Technical Community College
Asheville, NC

ASSOCIATE DEGREE NURSING

Skills

  • Extensive knowledge of Acute, Post-acute, Rehabilitation and Home Health services
  • Prior Authorization
  • Determine Medical Necessity
  • InterQual Criteria
  • Disease Processes
  • Complex Cases
  • Accurate Documentation
  • Patient Care Oversight
  • Treatment Plan Modification
  • Specialized Healthcare Referrals
  • Clear Patient Communication
  • Flexibility
  • Detail oriented
  • Creative decision-maker and problem-solver
  • Effective coach and educator
  • High level of personal integrity and reliability

Yarn spinner & knitter, quilter and avid gardener.

Setting up for my first year of raised bed gardening and constructed a bean tee pee from bamboo!

Timeline

E&I PRIOR AUTHORIZATION NURSE REVIEWER

UNITED HEALTH CARE
10.2018 - Current

PATIENT CARE SUPERVISOR & QA/PI COORDINATOR

PARK RIDGE HOME HEALTH
01.2014 - 01.2018

PRIVATE DUTY SERVICES SUPERVISOR,

PREMIER HEALTH CARE
01.2013 - 01.2014

HOME HEALTH FIELD NURSE PRECEPTOR

GENTIVA HEALTH SERVICES
01.2009 - 01.2013

SKILLED SERVICES SUPERVISOR (PRIVATE DUTY)

CAREPARTNERS HEALTH SERVICES
01.1994 - 01.2009

Asheville Buncombe Technical Community College

ASSOCIATE DEGREE NURSING

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Deborah Sammons