Summary
Overview
Work History
Education
Skills
References
Licensescertificates
Timeline
Generic

Frances Patti

Staten Island,NY

Summary

Compassionate licensed practical nurse as a strong and seasoned professional over 25 years in the manage care industry experienced in both inpatient and outpatient prior authorization and inpatient utilization concurrent clinical review nurse known for high productivity and efficient task completion.

Background in multi-diverse nurse, known for high productivity and efficient task completion with background in emergency and critical care. Skilled in fast-paced environments, prioritizing patient needs and delivering high-quality care. Strong communication abilities ensure effective collaboration with healthcare teams. Improved patient satisfaction through attentive service and advocacy.

Highly skilled Inpatient Utilization Concurrent Review Nurse with comprehensive background in healthcare management, case coordination, and patient advocacy, in patient care management. Excel at communication, teamwork, and empathy, ensuring optimal patient outcomes and collaborative healthcare environments.

Demonstrated ability to implement effective clinical reviews, ensuring compliance with health plans and regulatory standards. Strengths include both InterQual and MCG guidelines with strong decision-making abilities, expertise in clinical documentation, and the ability to collaborate effectively with multidisciplinary teams. Previous work has contributed significantly to improving quality of patient care and optimizing processes within hospital settings.

Efficient Utilization Concurrent Review Nurse known for high productivity and ability to complete tasks efficiently. Possess specialized skills in critical thinking, patient advocacy, and regulatory compliance which contribute to effective decision-making in communication, and teamwork, adaptability, ensuring seamless collaboration with healthcare teams and positive interactions with patients.

Dedicated and well-qualified licensed practical nurse professional in the manage care industry, offering detailed-oriented, responsive, and proficient in routine care and emergency response. Experienced bringing multiple years to l in the managed care sector.

Demonstrating clinical expertise, leadership skills and technical knowledge. Proficient in updating charts, and working with the team multidisciplinary teams to optimize patient care. Quality-driven and efficient with strong interpersonal abilities.

Proactive and oriented professional with a dedication and a passion for continuous learning and innovation. Also completing lack of clinical reviews, leveraging analytical thinking and creativity to solve problems and deliver high-impact solutions in fast-paced environments quickly adapting to new challenges. Strong problem-solving abilities and a proven track record of fostering strong relationships with clients and team members. Focused on supporting team success and achieving positive results.

Hardworking employee with good customer skills, multitasking, and time management abilities. Devoted to giving every customer a positive and memorable experience.

Committed job seeker with a history of meeting company needs with consistent and organized practices. Skilled in working under pressure and adapting to new situations and challenges to best enhance the organizational brand. Highly-motivated employee with a desire to take on new challenges.

Strong work ethic, adaptability, and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.

Experienced in fast-paced environments and adaptable to last-minute changes. Thrives under pressure and consistently earns high marks for work quality and speed.

Results-driven individual with a solid track record in delivering quality work. Known for excellent communication and teamwork abilities, with a commitment to achieving company goals and delivering exceptional service. Passionate about continuous learning and professional development.

Customer-focused individual with a passion for delivering exceptional service utilizing a strong interpersonal skills with a talent for effectively addressing concerns. Committed to improving customer satisfaction and driving positive outcomes.

Dedicated and adaptable professional with a quick-learning ability and talent for adjusting to new environments with a proactive attitude and the ability to learn quickly. Strong work ethic and effective communication skills.

Eager to contribute to a dynamic team and support organizational goals. Skilled in rapidly acquiring new knowledge and applying it effectively. Driven by a passion for continuous learning and successfully navigating change.

Experienced licensed practical nurse with a strong background in technology-related roles. Proficient in system administration, and technical support. Skilled in problem-solving and optimizing performance. Capable of managing projects and collaborating effectively with teams. Committed to continuous learning and staying current with industry trends to contribute to organizational success.

An organized and motivated individual, eager to utilize time management and organizational skills across diverse settings. Seeking a mid-high level position and opportunities to enhance abilities while contributing to company’s growth.

Overview

26
26
years of professional experience

Work History

Inpatient Concurrent Clinical Review Nurse

NYC Health + Hospitals/Jacobi Medical Center
Bronx, NY
02.2008 - 10.2024
  • Knowledge of commercial as well as both Medicare and Medicaid Guidelines for NY
  • Utilize guidelines InterQual Criteria and MCG
  • Review and refer appropriate cases for Medical Directors review
  • Identify potential members eligible for case management services utilizing sentinel events &/or trigger diagnosis to IE Pregnancy, Premature Newborn or Newborn with Congenital Anomalies, Diabetes Mellitus, Asthma, HIV, Renal, Liver, Heart, and Chronic Obstructive Pulmonary Disease, Cancer, Organ Transplantation, Catastrophic or Life-threatening Occurrences
  • Responsible for completing all Lack of Information Denial's

Nurse Case Manager

Community Choice Health Plan
Westchester, NY
09.2007 - 01.2008
  • Health Plans Program including the following components: Population Selection with Targeting, Intervention, Quality Measurement, and Outcomes Measurement
  • Restructure and Implement Tracking Logs, Member and Provider Outreach Letters
  • Coordinate and performing discharge planning
  • Organize Care along the Continuum of Care
  • Monitor Outpatient, Ancillary, Rehabilitative Services and obtaining of Durable Medical Equipment
  • Arrange Transportation and coordinate community support services
  • Identify potential members eligible for case management services utilizing sentinel events &/or trigger diagnosis to IE Pregnancy, Premature Newborn or Newborn with Congenital Anomalies, Diabetes Mellitus, Asthma, HIV, Renal, Liver, Heart, and Chronic Obstructive Pulmonary Disease, Cancer, Organ Transplantation, Catastrophic or Life-threatening Occurrences
  • Analysis of The Health Risk Assessment, No PCP encounter > 3 months post enrollment, 3 or more ER visits in any 6-month period, high utilization or high-volume members

Inpatient Concurrent Clinical Review Nurse

HIP USA
New York, NY
08.2006 - 09.2007
  • Knowledge of commercial as well as both Medicare and Medicaid Guidelines for NY
  • Analyzing member's diagnosis, with inpatient diagnosis, medical/surgical services utilizing and applying corrective DRG, CPT and ICD Coding
  • Performs both in and out of network telephonic concurrent reviews
  • Utilize Medicare/Medicaid guidelines, policy procedures, InterQual Criteria and Milliman and Robertson guidelines approved services for members both inpatient and outpatient
  • Manage target length of stay by identifying alternate levels of care to facilitate discharge actions
  • Reviews, and assist rep negotiations toward favorable and competitive rates with providers when required
  • Responsible for assessment of hospital services and identifying discharge plan needs, management of active cases in acute and sub-acute levels of care, and coordinating delivery of health care services for members
  • Authorizing services per the contract, along with timely entry of clinical notes and referrals as required to the Medical Director
  • Interacts regularly with medical directors, clinical managers, team managers and other team members
  • Responsible for analysis of individual complex cases acting to resolve in a quality focused and timely manner, analysis of utilization patterns

Inpatient Concurrent Clinical Review Nurse

UHP of NJ
Newark, NJ
04.2003 - 08.2006
  • Knowledge of both Medicare and Medicaid Guidelines for NY and NJ
  • Performs both in and out of network telephonic concurrent reviews
  • Analyzing member's diagnosis, with inpatient diagnosis, medical/surgical services utilizing and applying corrective DRG, CPT and ICD Coding
  • Responsible with Supervisory knowledge and guidance in the Precert Department
  • Utilize Medicare/Medicaid guidelines, policy procedures, InterQual Criteria and Milliman and Robertson guidelines approved services for members both inpatient and outpatient
  • Responsible for assessment of hospital services and identifying discharge plan needs, management of active cases in acute and sub-acute levels of care, and coordinating delivery of health care services for members
  • Responsible for analysis of individual complex cases acting to resolve in a quality focused and timely manner, analysis of utilization patterns
  • Interacts regularly with medical directors, clinical managers, team managers and other team members
  • Reviews, and assist provider relations negotiations toward favorable and competitive rates with providers when required
  • Review and refer appropriate cases for denial or review for alternate level of care

Inpatient Concurrent Clinical Review Nurse

AmeriChoice of NJ
Newark, NJ
05.2000 - 04.2003
  • Performs both in and out of network telephonic pre-cert and concurrent reviews
  • Approve services utilizing clinical knowledge, Millman & Robinson and InterQual
  • Analyze member's diagnosis, with inpatient diagnosis, medical/surgical services utilizing and applying corrective DRG, CPT and ICD Coding
  • Lead Case Manager providing knowledge and guidance in the Prior Auth Department
  • Utilize Medicare/Medicaid guidelines, policy & procedures, InterQual Criteria and Milliman and Robertson guidelines approved services for members
  • Responsible for assessment of hospital services and identifying discharge plan needs, management of active cases in acute and sub-acute levels of care, and coordinating delivery of health care services for members
  • Reviews, and assist provider relations negotiations toward favorable and competitive rates with providers when required
  • Responsible for analysis of individual complex cases acting to resolve in a quality focused and timely manner, analysis of utilization patterns

Inpatient and Outpatient Prior Authorization Nurse

Cigna Healthcare
Jersey City, NJ
01.2000 - 05.2000
  • Responsible for accurate information regarding the medical necessity for inpatient hospitalization and selected ambulatory procedures
  • Approve services utilizing clinical knowledge, Millman & Robinson and InterQual
  • Analyze member's diagnosis, with inpatient diagnosis, medical/surgical services utilizing and applying corrective DRG, CPT and ICD Coding
  • Lead case Manager providing knowledge and guidance in the Prior Auth Department
  • Plans and coordinates complex cases with appropriate medical professionals, disease case managers, social workers, supervisor and physicians
  • Perform both in and out of network Telephonic Prior Auth reviews
  • Reviews, and assist rep negotiations toward favorable and competitive rates with providers when required

Nurse Case Manager

CORAM RNET
Whippany, NJ
10.1998 - 12.1999
  • Responsible for all intake information and initiation of services appropriately in the utilization management system
  • Obtain complete and accurate information of services
  • Initiate and continued direct communication with members, families, health care providers, other resources involved with the participants
  • Develop and document a problem list based on information obtained from the participant, family, physician and other members of the health care team
  • Facilitate the development and communication of an action plan, which recognizes the participant's needs as well as benefit and plan limitations, includes assisting the participant, family needs or home care provider, in accessing community support systems, and government resources
  • Document any plan limitations and monitor claims accumulations to facilitate continuity of care

Education

Nursing/LPN Diploma -

Monmouth Vocational School of Nursing
01.1990

Credit towards Nursing A.A.S. Degree -

Staten Island Community College
06.1978

Skills

  • Inpatient Telephonic Concurrent Review Nurse
  • Inpatient and outpatient Prior authorization
  • Analyzing member's diagnosis
  • Inpatient diagnosis
  • Medical-surgical nursing
  • Corrective DRG
  • Maternal care and child health nursing
  • High-risk pediatrics
  • Pediatric home care
  • Urban community care nursing
  • Clinical decision-making
  • Organization and Coordination
  • Prior authorization
  • Group and individual instruction

References

Available Upon Request.

Licensescertificates

  • New York and New Jersey Licensor as a Licensed Practical Nurse.
  • CPR Basic Life Support.
  • Diabetic Treatment certified.
  • Phlebotomy certified.

Timeline

Inpatient Concurrent Clinical Review Nurse

NYC Health + Hospitals/Jacobi Medical Center
02.2008 - 10.2024

Nurse Case Manager

Community Choice Health Plan
09.2007 - 01.2008

Inpatient Concurrent Clinical Review Nurse

HIP USA
08.2006 - 09.2007

Inpatient Concurrent Clinical Review Nurse

UHP of NJ
04.2003 - 08.2006

Inpatient Concurrent Clinical Review Nurse

AmeriChoice of NJ
05.2000 - 04.2003

Inpatient and Outpatient Prior Authorization Nurse

Cigna Healthcare
01.2000 - 05.2000

Nurse Case Manager

CORAM RNET
10.1998 - 12.1999

Nursing/LPN Diploma -

Monmouth Vocational School of Nursing

Credit towards Nursing A.A.S. Degree -

Staten Island Community College
Frances Patti