Elisha Pape
Washington,MO
Summary
Professional nurse with extensive experience in utilization review. Skilled in analyzing patient care and ensuring compliance with healthcare regulations. Strong focus on team collaboration and achieving optimal patient outcomes. Adaptable and reliable, excelling in dynamic environments requiring precise decision-making and effective communication.
Overview
26
26
years of professional experience
1
1
Certification
Work History
Medical Management Nurse
Anthem
09.2019 - Current
- Assist in the promotion and maintenance of high-quality care through analysis, review, and clinical criteria as it related to patient treatment using Medicare-Milliman Clinical Guidelines
- Review cases for appropriateness of admission, continued stay and discharge planning
- Communicate with and send approvals to acute care facilities and skilled nursing facilities
- Compile medical information and send to the medical director for determination
- Fill in for team lead nurse and perform tasks such as handing out assignments to the team, reviewing spreadsheets to ensure work is being done timely and effectively and assisting staff with any questions or concerns they have
- Assist outpatient utilization review team when short staffed
- Serve as an ambassador for our team when new AI tools were implemented
Utilization Review Nurse
Christian Hospital
09.2018 - 09.2019
- Assess patients for severity of illness and appropriateness of stay and level of care.
- Complete concurrent review of patient’s clinical information for efficiency.
- Compile and organize clinical information and submit to insurance companies for authorization.
- Use InterQual criteria to determine appropriateness of level of care.
- Obtain authorization from insurance companies, document authorization and keep track of when the next clinical review is required.
- Communicate with physicians, case managers, social workers, and nursing staff to obtain information regarding care plans and ensure appropriateness of testing, procedures, level of care and continued stay.
- Communicate with insurance companies regarding denials and assist with arranging peer to peer discussions between physicians.
RN Case Manager
Christian Hospital
08.2015 - 09.2018
- Lead daily care round meetings to identify any patient needs and potential discharge barriers.
- Speak with patients and families to obtain information regarding potential discharge needs.
- Collaborate with other health care professionals to create a safe discharge plan for each patient.
- Assist with setting up home health care, home medical equipment and transportation at discharge.
RN Health Coach
Christian Hospital
05.2013 - 08.2015
- Collaborate with other health care professionals to create and implement a readmission prevention program.
- Asses potential patient needs on admission and coordinate discharge planning.
- Provide education to patients, families and caregivers regarding diagnosis, medications, diet, and overall care.
- Coordinate care of patients with physicians and other health care providers.
- Assist patients with scheduling post discharge follow up appointments.
- Assist patients in setting up transportation to appointments.
- Enter data into Excel Spreadsheets to track patient data and outcomes of program.
- Make follow up phone calls to patients after discharge, continually assessing for potential needs and reinforcing education provided in hospital.
Cardiology Nurse
St. Louis Cardiology Consultants
06.2006 - 05.2013
- Assist physicians by gathering patient data including history, lab and test results, vital signs, and cardiac rhythm to create a daily progress note.
- Provide education to patients regarding cardiac diagnosis, cardiac testing, diet, and medications.
- Prepare discharge instructions and prescriptions and set up any follow up testing and office visits.
- Facilitate communication between physicians and staff nurses.
- Perform Dobutamine stress tests in an outpatient setting.
Registered Nurse/Team Leader
Christian Hospital
05.2003 - 06.2006
- Provide direct patient care to renal and cardiac patients on a telemetry unit.
- Perform peritoneal dialysis.
- Provide education to patients and families regarding medications, diet, and diagnosis.
- Communicate any abnormal tests or findings with physicians.
- Preceptor for student nurses.
Phlebotomist
Christian Hospital
07.1999 - 05.2003
- Obtain blood samples from a variety of patients including infants and children.
- Send lab results to physician’s offices.
Education
Bachelor's Degree - Nursing
University of Missouri-St Louis
05.2003
Skills
- Direct patient care
- Patient education
- Care coordination
- Discharge coordination
- Utilization management
- Milliman guidelines
- InterQual criteria
- Electronic health records
- Critical thinking
- Attention to detail
- Licensed by Missouri nursing board
Certification
- 9/2005 Outstanding Service Christian Hospital
- 9/2018 Acceptance into Professional Development Program BJC Care Coordinator Professional Development
- 11/2018 Outstanding Professional Christian Hospital Case Management Department
- Active RN License Missouri State Board of Nursing
Hobbies and Interests
Home decorating, Gardening, Running
Timeline
Medical Management Nurse
Anthem
09.2019 - Current
Utilization Review Nurse
Christian Hospital
09.2018 - 09.2019
RN Case Manager
Christian Hospital
08.2015 - 09.2018
RN Health Coach
Christian Hospital
05.2013 - 08.2015
Cardiology Nurse
St. Louis Cardiology Consultants
06.2006 - 05.2013
Registered Nurse/Team Leader
Christian Hospital
05.2003 - 06.2006
Phlebotomist
Christian Hospital
07.1999 - 05.2003
Bachelor's Degree - Nursing
University of Missouri-St Louis
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