Summary
Overview
Work History
Education
Skills
Accomplishments
Timeline
Generic

Felicia L. Steele

Manchester,PA

Summary

Flexible Registered Nurse with 18 years of care management experience and 8 years of clinical experience. Demonstrates ability to independently manage projects and work collaboratively with colleagues and providers.

Overview

25
25
years of professional experience

Work History

Utilization Review Nurse

Wellpoint
07.2011 - 07.2023
  • Performed reviews for concurrent and retrospective inpatient requests in order to determine medical necessity and refer those requests that require additional expertise to medical director.
  • Utilized MCG and InterQual guidelines to determine medical necessity.
  • Refered patients to case management when necessary.
  • Assisted with discharge planning by reviewing and authorizing lower level of care request.
  • Organized team coverage when colleagues are out on leave.
  • Notified providers of determination of medical necessity reviews.

Appeals Review Nurse

Keystone Peer Review Organization
02.2018 - 02.2019
  • Reviewed Medicare member appeals on behalf of CMS
  • Prepared and forwarded appeals summaries to medical director for determination.
  • Communicated appeals determination results with providers, members, and insurance carriers.

Case Manager

Mercy Medical Center
05.2007 - 06.2011
  • Utilized Milliman and InterQual guidelines to determine medical necessity.
  • Performed medical necessity review for patients on assigned unit and notified attending when medical necessity was not met.
  • Provided clinical review to multiple insurance carriers.
  • Assisted with patients discharge planning.

Utilization Review Nurse

CareFirst BlueCross BlueShield
01.2005 - 02.2007
  • Performed reviews for concurrent and retrospective inpatient requests in order to determine medical necessity and refer those requests that require additional expertise to medical director.
  • Utilized Milliman guidelines to determine medical necessity.
  • Notified providers of determination of medical review.

Registered Nurse

Excel Staffing
03.2003 - 03.2006
  • Performed temporary job assignments with variety of clinical and nonclinical settlings, which included chart auditing for annual HEDIS review project.

Registered Nurse

MD Department Of Public Safety And Corrections
04.2003 - 01.2005
  • Coordinated with correctional facilities management team to carry out statewide Respiratory Protection Program interviews.
  • Performed interviews and evaluated correctional officers to determine if medical conditions were present that prevented them from safely wearing different types of respirators.
  • Coordinated travel to multiple facilities in state of Maryland in order to perform interviews.

Registered Nurse

Baltimore Veterans Affair Medical Center
04.2003 - 11.2003
  • Prepared surgical suite according to surgery and surgeon preference.
  • Adhered to AORN standards of perioperative nurse practice.
  • Assisted with Stocking supplies in operating room suites. Performed both circulatory and scrub nurse roles.
  • Monitored surgical patients and delivered quality level of care before, during and after operations to promote positive outcomes.

Registered Nurse

Durham Veteran Affairs Medical Center
03.2002 - 03.2003
  • Prepared surgical suite according to surgery and surgeon preference.
  • Adhered to AORN standards of perioperative nurse practice.
  • Assisted with Stocking supplies in operating room suites.
  • Performed both circulatory and scrub nurse roles.
  • Monitored surgical patients and delivered quality level of care before, during and after operations to promote positive outcomes

Registered Nurse

North Carolina Correctional Institute For Women
07.2000 - 03.2002
  • Updated patient charts with data such as medications to keep records current and support accurate treatments.
  • Administered medications and monitored responses.
  • Provided direct patient care and determined next course of action.

Registered Nurse

Durham Regional Hospital
08.1998 - 08.2000
  • Prepared surgical suite according to surgery and surgeon preference.
  • Adhered to AORN standards of perioperative nurse practice.
  • Assisted with Stocking supplies in operating room suites.
  • Performed both circulatory and scrub nurse roles.
  • Monitored surgical patients and delivered quality level of care before, during and after operations to promote positive outcomes.

Education

Bachelor of Science - Nursing

Hampton University
Hampton, VA
05.1998

Skills

  • Oral and Written Communication
  • Teamwork
  • Attention to Detail
  • Problem Solving
  • Critical Thinking
  • Adaptability
  • Organization
  • Independent worker
  • Willingness to learn
  • Excellent Customer Service
  • Microsoft Office
  • InterQual, MCG, EPIC, and other Electronic Medical Record Systems

Accomplishments

  • Value In Action Award presented by Anthem Inc
  • Certificate in Exemplary Service presented by Department of Public Safety and Correctional Services

Timeline

Appeals Review Nurse

Keystone Peer Review Organization
02.2018 - 02.2019

Utilization Review Nurse

Wellpoint
07.2011 - 07.2023

Case Manager

Mercy Medical Center
05.2007 - 06.2011

Utilization Review Nurse

CareFirst BlueCross BlueShield
01.2005 - 02.2007

Registered Nurse

MD Department Of Public Safety And Corrections
04.2003 - 01.2005

Registered Nurse

Baltimore Veterans Affair Medical Center
04.2003 - 11.2003

Registered Nurse

Excel Staffing
03.2003 - 03.2006

Registered Nurse

Durham Veteran Affairs Medical Center
03.2002 - 03.2003

Registered Nurse

North Carolina Correctional Institute For Women
07.2000 - 03.2002

Registered Nurse

Durham Regional Hospital
08.1998 - 08.2000

Bachelor of Science - Nursing

Hampton University

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