Ellen Baccarella

• Performed prior authorization review of services requiring notification.
• Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
• Submitted cases for criteria failures and helped facilitate resolutions and approvals.
• Obtained authorizations from multiple insurance carriers for various levels of care.
• Performed admission reviews based for medical necessity based upon criteria specification.
• Supervised and maintained all utilization review documentation through Epic.

Reviewed medical records for appropriateness of admission and continued stay, utilizing InterQual Criteria. Communicate with third party payers to ensure proper level of payment. Facilitate the plan of care and discharge planning process in collaboration with clients, families, health care team, and insurance carriers, to facilitate high quality, cost effective outcomes.

Review Medical records for appropriate and continued stay.

Communicate information to third party payors to ensure proper level of payment.

Facilitate the plan of care and discharge planning process in collaboration with clients, families, health care team, and insurance carriers to facilitate high quality outcomes.

Staffing: Administration and operations of centralized staffing office and contract management of agency personnel.

Recruitment:Visited nursing schools and colleges and participated in recruitment activities. Managed hiring of per diem and float pool personnel.

Staff Nurse-Tele Unit:May 1988-January 1994

Assistant Director of Nursing:December 1987-May-1988

Head Nurse:January 1980-June 1981

Staff Nurse:June 1978-January 1980