Elizabeth Linell
Fairfield,CT
Summary
Dynamic and motivated professional Registered Nurse with expertise in Prior Authorization, Case Management, Quality Improvement, and Home healthcare. Specializing in utilization review , quality assurance, and medical management in an acute and post-acute setting. My personal goal is to be a part of a team that works towards maximizing the quality of life for our clients by providing them with the services, education and care they need.
Overview
38
38
years of professional experience
1
1
Certification
Work History
Preservice Review RN
Medicare and Retirement/Optum
05.2014 - 05.2023
- Determined medical necessity of prior authorization requests by applying sound clinical knowledge and the appropriate application of state and national policies while adhering to Optum standards of practice and business processes
- Successfully trained and mentored several new hire employees
- Conducted training sessions for home health processes and organizational changes.
- Cross trained and assisted Employer and Individual (E&I) with multiple lines of businesses when needed including claims and inpatient case management reviews
QUALITY IMPROVEMENT RN
Visiting Nurse & Hospice Of Fairfield County
Wilton, CT
01.2010 - 01.2014
- Accountable for quality reviews of OASIS and 485 to ensure accuracy, best practices, and compliance with Medicare guidelines.
- Ensured overall quality improvement, compliance, and risk management expectations were met clinically.
- Evaluated competency, accuracy, and completeness of documentation and educated clinicians to improve deficiencies identified.
- Assured appropriateness and timeliness with pay source regulations.
- Participated in Performance improvement projects to identify performance trends and implemented recommendations
TELEHEALTH RN CLINICAL COORDINATOR/Field Nurse Case Manager
Visiting Nurse & Hospice Of Fairfield County
Wilton, CT
01.1995 - 01.2014
- Responsible for the remote care management and oversight of home health care clients with a focus on improved clinical outcomes and decreased hospitalizations.
- Performed proactive client assessments to determine patient needs, clinical options, medication refills, test results and referrals via telehealth equipment.
- Provided client education emphasizing prevention of exacerbations, disease progression, and complications utilizing evidence-based best practice guidelines and clinical knowledge
- Collaborated with MD’s, case managers, MSW and skilled therapists to identify/address plans of care, client needs, and potential health problems.
- As a Field Nurse for many years, provided full assessments , created care plans with established goals, provided education complex disease management and medications , collaborated with patient , Caregivers, MDs and HHC staff to provide safe discharge plan.
RN Supervisor
Visiting Nurse Association of Fairfield County
Wilton, CT
01.1998 - 01.2000
- Served as a team lead for the supervision of team of up to 12 home health RNs.
- Supported, educated and collaborated with RNs as evidenced by weekly team meetings to ensure quality care and a compassionate work environment .
- Effectively established individualized client goals with focus on the coordination of safe and effective discharge planning for individuals with chronic complex medical conditions.
ACUTE REHABILITATION NURSE/MED-SURG RN
Norwalk Hospital Credit Union
Norwalk, CT
07.1986 - 02.1995
- Performed comprehensive physiologic and psychological assessments for clients on both a medical surgical floor and on a acute rehab floor while providing the needed skilled nursing care to treat/stabilize active comorbidities including spinal cord injury, traumatic brain injury, CVA, CHF, DM +
- Educated caregivers and clients with attention to preventative care and adverse signs and symptoms to provide a safe discharge plan.
- Created individualized interdisciplinary (IDT) plans of care in collaboration with the MD, PT, OT, Case management and the patient .
Home Health Care Coordinator (HHCC)
Home and Community/Optum
06.2023 - Current
- Reviews the clinical documentation from home health providers and evaluates the medical necessity for services using CMS and nationally recognized standards.
- Collaborates with Optum Medical Directors, home health staff and Health Plan Care Management Team to determine the most appropriate course of action for a member based on clinical factors
- Coordinates member care in the home setting to ensure members are getting the services they need and the services that are no longer needed are discontinued.
Education
Bachelor of Science - Registered Nurse
Fairfield University
Fairfield, CT06-1986
Skills
- In depth familiarity with disease processes and progression
- Comprehensive experience with Home health and Case Management
- Compassionate, attentive listener and supportive educator
- Excellent written, verbal, telephone and interpersonal communication skills
- Integrity-driven with respect and education on multicultural diversity
- Team player
- Highly Innovative and creative
- Organized, efficient, and excellent multitasker
- Detailed documentation and assessment skills
Certification
- REGISTERED NURSE
- License Number: E49561 State of Connecticut/Current
References
References available upon request.
Timeline
Home Health Care Coordinator (HHCC)
Home and Community/Optum
06.2023 - Current
Preservice Review RN
Medicare and Retirement/Optum
05.2014 - 05.2023
QUALITY IMPROVEMENT RN
Visiting Nurse & Hospice Of Fairfield County
01.2010 - 01.2014
RN Supervisor
Visiting Nurse Association of Fairfield County
01.1998 - 01.2000
TELEHEALTH RN CLINICAL COORDINATOR/Field Nurse Case Manager
Visiting Nurse & Hospice Of Fairfield County
01.1995 - 01.2014
ACUTE REHABILITATION NURSE/MED-SURG RN
Norwalk Hospital Credit Union
07.1986 - 02.1995
Bachelor of Science - Registered Nurse
Fairfield University
Similar Profiles
Gwendolyn MehanGwendolyn Mehan
Physician and Hospital Claims Processor at United Healthcare Medicare and RetirementPhysician and Hospital Claims Processor at United Healthcare Medicare and Retirement
Dorota KulachDorota Kulach
Advocate4Me Representative in Customer Service at United Healthcare Medicare and RetirementAdvocate4Me Representative in Customer Service at United Healthcare Medicare and Retirement
Chase OldhamChase Oldham
Senior Appeals & Grievances Coordinator at United Health Group (Medicare & Retirement)Senior Appeals & Grievances Coordinator at United Health Group (Medicare & Retirement)
David GrellaDavid Grella
Store Manager at Golf GalaxyStore Manager at Golf Galaxy
REBECCA ENILOREBECCA ENILO
Senior Accountant /Payroll Manager at TRITEC COMPANIESSenior Accountant /Payroll Manager at TRITEC COMPANIES