Summary
Overview
Work History
Education
Skills
Traveling, Reading, Writing, Cooking, Meditating Exercises
Languages
Timeline
SoftwareEngineer
Gina Delancy

Gina Delancy

North Miami,FL

Summary

Proactive Home Health LPN and Nurse Reviewer with diverse experience in patient care, prior authorization, and quality assurance. Known for compassionate care, accurate documentation, and effective collaboration with healthcare teams. Proficient in chronic disease management, medication administration, and seamless care coordination. Gifted LPN with proven skills in working with RNs in diverse settings to offer top-notch patient care and support. Vigilant, systematic and focused on delivering cost-effective, high-quality medical care. Certified in Med/Surg, Hospice Care, Quality Assurance, and Utilization Management. Smart Utilization Review Nurse considered critical thinker and problem-solver due to dynamic patient care planning and understanding of Medicare guidelines. Known for having great rapport with providers and insurance carriers. Dependable Utilization Review Nurse promoting over 24 years of expertise in healthcare industry. Knowledgeable in admissions and stay reviews. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.

Overview

24
24
years of professional experience

Work History

Home Health LPN

Healthy Milestones
05.2024 - Current
  • Enhanced patient comfort by providing compassionate care and addressing individual needs.
  • Collaborated with case managers to recommend appropriate community resources for continued patient support after discharge from home health services.
  • Consistently received positive feedback from patients and families for exceptional communication, clinical expertise, and genuine concern for their wellbeing.
  • Consistently maintained accurate records of medication administration, vital signs monitoring, and progress notes for thorough documentation purposes.
  • Played integral role in assisting patients with end-of-life care, offering comfort and support while delivering compassionate nursing services.
  • Assisted patients in achieving mobility goals through safe transfer techniques, ambulation support, and range of motion exercises.
  • Educated patients and families on disease prevention, health management, and self-care techniques for optimal wellbeing.
  • Supported patients'' emotional wellbeing through active listening, empathy, and encouragement during times of stress or illness.
  • Administered medications accurately following physician orders and nursing protocols.
  • Provided physical assessments, medication, and chronic disease management to home health patients.
  • Documented patient vitals, behaviors and conditions to communicate concerns to supervising nurse.
  • Monitored vital signs, developed and implemented care plans, and documented patient progress.

LPN Prior Authorization Nurse Reviewer

Centene Corporation
03.2024 - Current
  • Utilized time management skills to prioritize tasks effectively, allowing for efficient completion of daily responsibilities of 25 to 30 cases.
  • Maintained accurate documentation of all relevant clinical data, ensuring compliance with regulatory standards.
  • Maintained detailed records and documentation related to prior authorization requests, ensuring accurate tracking and reporting for both internal and external stakeholders.
  • Expedited urgent requests for prior authorization, ensuring timely access to critical medical treatments.
  • Demonstrated commitment to professional development by participating in ongoing training opportunities related to the field of Prior Authorization nursing.
  • Collaborated with healthcare providers to ensure accurate submission of required documentation for timely authorizations.
  • Reduced healthcare costs through efficient utilization of resources and identification of unnecessary treatments or procedures.
  • Ensured compliance with regulations and accreditation standards by maintaining accurate documentation of all utilization review activities.

Travel LPN Correction Assignment

Maxim Health Services
07.2022 - 03.2024
  • Utilized time management skills to prioritize tasks effectively, allowing for efficient completion of daily responsibilities of 300 inmates.
  • Maintained accurate documentation of all relevant clinical data, ensuring compliance with regulatory standards.
  • Implemented infection control measures, ensuring a clean and safe environment for patients and staff.
  • Managed patient care through closely monitoring respiration, blood pressure, and blood glucose levels.
  • Performed wound care treatments using sterile techniques, promoting healing and preventing complications.
  • Adhered to treatment plan instructions when administering medications and treatments to patients.
  • Demonstrated adaptability in working with diverse patient populations across various healthcare settings.
  • Used aseptic techniques to provide sterilized wound care and dressing applications.
  • Minimized staff and patient infection risk by cleaning and disinfecting equipment instruments.
  • Worked with multidisciplinary team to carry out successful treatment plans for diverse acute and chronic conditions.
  • Improved patient satisfaction by providing high-quality nursing care and addressing individual needs during travel assignments.

Clinical Review Nurse

Jogan Healthcare Staffing
05.2022 - 07.2022
  • Demonstrated strong attention to detail by identifying discrepancies in medical records and collaborating with healthcare providers to rectify errors, ultimately enhancing the accuracy of patient information.
  • Supported accreditation efforts by ensuring compliance with regulatory guidelines during clinical review activities.
  • Maximized efficiency within the department by organizing workload according to priority level of 25 cases daily, ensuring deadlines were met consistently.
  • Enhanced interdisciplinary collaboration through regular communication with physicians, case managers, and other healthcare professionals.
  • Conducted regular audits of clinical documentation and provided constructive feedback to providers, leading to continuous improvement in the quality of patient care.
  • Served as a liaison between various departments involved in care coordination efforts, promoting seamless communication throughout the continuum of care.
  • Strengthened professional development with ongoing education in disease management, treatment protocols, and emerging trends in nursing practice.
  • Determined and authorized services for patients in accordance with guidelines and regulations.

Travel Nurse Prior Authorization Management

Favorite Healthcare Staffing
10.2021 - 04.2022
  • Maintained detailed records and documentation related to prior authorization requests, ensuring accurate tracking and reporting for both internal and external stakeholders.
  • Expedited urgent requests for prior authorization, ensuring timely access to critical medical treatments.
  • Utilized time management skills to prioritize tasks effectively, allowing for efficient completion of 20 to 30 cases per daily quota.
  • Maintained accurate documentation of all relevant clinical data, ensuring compliance with regulatory standards.
  • Improved patient satisfaction by providing clear communication regarding insurance approvals and denials.
  • Assisted in maintaining compliance with changing regulations and policies by staying up-to-date on industry trends and best practices.
  • Maintained up-to-date knowledge of industry regulations, contributing to a consistently compliant review department.
  • Managed high caseloads efficiently while maintaining strict deadlines and prioritizing urgent cases as needed.

LPN Field Nurse

Nomi Health
09.2020 - 09.2021
  • Promoted preventive health measures with extensive patient education on disease management and self-care techniques.
  • Assisted physicians in determining optimal treatment plans based on thorough assessments of patients'' needs and conditions.
  • Served as a liaison between patients, families, and healthcare providers to ensure clear communication and prevent potential misunderstandings.
  • Enhanced patient satisfaction through consistent communication with patients, families, and healthcare providers.
  • Streamlined care coordination processes by collaborating with multidisciplinary teams to ensure timely and effective care delivery.
  • Conducted regular home visits to assess safety concerns or changes in the patient's condition that could impact their overall well-being.
  • Provided compassionate end-of-life care to terminally ill patients, alleviating pain, discomfort, and anxiety during their final days.
  • Managed approximately 30 incoming calls, emails, and faxes per day from customers.'

Staff Nurse

Pinecrest Nursing and Rehabilitation Center
08.2020 - 09.2020
  • Administered medications via oral, IV, and intramuscular injections and monitored responses.
  • Performed various nursing interventions such as wound dressing, vital sign monitoring, and specimen collection.
  • Assessed physical, psychological, physiologic, and cognitive status of patients of over 40 patients in the facility.
  • Monitored patients' conditions and reported changes in physical presentation, appearance, and behavior to discuss treatment with physicians.
  • Collaborated with interdisciplinary team members for comprehensive patient assessments and treatment plans.
  • Exhibited strong critical thinking skills when assessing complex medical situations and determining appropriate interventions.
  • Administered controlled narcotics, inserted IVs, and performed catheterizations.
  • Reduced medication errors by accurately administering medications and diligently verifying patient information.
  • Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
  • Observed and documented patient factors such as diets, physical activity levels, and behaviors to understand conditions and effectively modify treatment plans.
  • Managed patient care through closely monitoring respiration, blood pressure, and blood glucose levels.

Concurrent Review Nurse

Meridian HealthCare
10.2018 - 04.2019
  • Managed 20 to 30 complex cases effectively, coordinating with multidisciplinary teams to ensure seamless delivery of care across the continuum on a daily basis.
  • Increased compliance with regulatory standards through meticulous documentation of clinical decisions and interventions.
  • Served as a liaison between healthcare providers, insurers, patients, and families to facilitate communication and resolve issues related to care coordination or coverage determinations.
  • Expedited patient throughput within the hospital setting by identifying barriers to timely discharges or transfers and working collaboratively with stakeholders to address them.
  • Optimized resource utilization by assessing the appropriateness of medical treatments and making recommendations for alternative courses of action when necessary.
  • Implemented quality improvement initiatives within the concurrent review process, leading to more accurate and efficient decision making.
  • Streamlined the utilization review process for more efficient case management and improved resource allocation.

Prior Authorization Nurse Reviewer

Centene, Superior Health Services
01.2018 - 10.2018
  • Demonstrated commitment to professional development by participating in ongoing training opportunities related to the field of Prior Authorization nursing.
  • Worked closely with case managers to facilitate appropriate utilization of healthcare resources through the prior authorization process.
  • Developed strong relationships with insurance representatives, facilitating effective communication and expediting resolution of issues.
  • Improved patient satisfaction by providing clear communication regarding insurance approvals and denials.
  • Collaborated with healthcare providers to ensure accurate submission of required documentation for timely authorizations.
  • Enhanced patient care by assessing insurance coverage and obtaining prior authorization for medical procedures by processing 20 to 30 cases daily per quota.
  • Provided exceptional customer service to both patients and healthcare professionals, addressing concerns related to the prior authorization process.

Clinical Care Reviewer

Molina Healthcare
12.2016 - 09.2017
  • . Maintained strong attention to detail while reviewing numerous documents daily, ensuring consistent quality and accuracy of 19 to 25 case quotas daily .
  • Maintained strict confidentiality with sensitive client information, adhering to industry standards and company policies.
  • Reduced turnaround time for reviews by effectively prioritizing tasks and managing deadlines.
  • Ensured consistency across multiple review projects by maintaining strict adherence to established protocols and procedures.
  • Increased review accuracy by implementing a comprehensive training program for new reviewers.
  • Served as a resource for both internal staff and external partners regarding medical policies and procedures within the review process.
  • Actively participated in performance improvement initiatives, helping reduce hospital readmissions through targeted interventions.
  • Interpreted and correctly applied benefits, networks and product variances and clearly communicated such to members, providers and internal departments.
  • Made accurate, timely and consistent coverage determinations for patients.
  • Conducted regular audits of clinical reviews to ensure accuracy, consistency, and alignment with organizational goals.

Nurse Navigator

Evolution Health
06.2015 - 11.2016
  • Coordinated appropriate and efficient delivery of healthcare services to promote optimal outcomes by assessing and matching unmet needs with referrals and support services.
  • Served as a liaison between patients, families, and healthcare providers to ensure seamless communication and continuity of care.
  • Scheduled appointments, educational meetings, and follow-ups for patients and family members.
  • Built partnerships with local agencies and groups to assist with patient care, support or educational needs.
  • Counseled patients via telephone according to established guidelines and protocols, advising on provider-established plans of care.
  • Relayed triage information and facilitated communication between provider and patient concerning patient disposition.
  • Advised patients on pre- and post-operative instructions, medication administration and symptoms indicating emergency care.
  • Responsible for triaging calls and requests from patients, families, and caregivers according to established procedures.
  • Maintained accurate documentation of all relevant clinical data, ensuring compliance with regulatory standards.
  • Provide medical advice and clinical support for tele-monitoring, telehealth, tele-presence and telemedicine devices, and platform in accordance with protocols.
  • Managed sometimes over 40 incoming calls, emails, and faxes per day from customers.

LPN Concurrent Review Nurse

Magellan Health
03.2015 - 05.2015
  • Utilized time management skills to prioritize tasks effectively, allowing for efficient completion of daily responsibilities.
  • Maintained accurate documentation of all relevant clinical data, ensuring compliance with regulatory standards.
  • Implemented infection control measures, ensuring a clean and safe environment for patients and staff.
  • Managed complex cases effectively, coordinating with multidisciplinary teams to ensure seamless delivery of care across the continuum.
  • Increased compliance with regulatory standards through meticulous documentation of clinical decisions and interventions.
  • Implemented quality improvement initiatives within the concurrent review process, leading to more accurate and efficient decision-making.
  • Improved patient outcomes by conducting thorough concurrent reviews and recommending appropriate care plans.

Quality Assurance Nurse Reviewer

Broadspire, a Crawford
04.2014 - 02.2015
  • Streamlined communication between healthcare professionals by implementing efficient reporting systems for quality assurance findings.
  • Conducted root cause analyses to identify factors contributing to adverse events, enabling timely corrective action and reducing future risks.
  • Contributed to the development of clinical pathways for common medical conditions, ensuring a standard approach to care was consistently applied across all units within the organization.
  • Reviewed case records and reports, collected and analyzed data, evaluated client's medical status, and defined needs and problems to provide proactive case management services.
  • Responsible for editing workman's compensation claims dictated by the physician to review claims for various assigned states i.e. (California, New York, Massachusetts, Florida, Texas, Tennessee, and Louisiana).
  • Responsible for ensuring reports met state and federal medical necessity criteria, client specifications, and company protocols.
  • Prepared and responded to client inquires, identifying areas for confirmation and clarity.
  • Monitored file activity to ensure timeline requirements were met accordingly.
  • Managed approximately 30 incoming calls, emails, and faxes per day from customers.

Quality Assurance Nurse

Jackson Memorial Hospital Health Plan
09.2010 - 03.2014
  • Streamlined communication between healthcare professionals by implementing efficient reporting systems for quality assurance findings.
  • Reduced patient safety incidents by providing comprehensive training on best practices in infection control and prevention.
  • Established regular performance review meetings with nursing staff members, providing constructive feedback on areas requiring improvement while recognizing and celebrating achievements in quality assurance efforts.
  • Enhanced compliance with regulatory standards through diligent monitoring of nursing procedures and protocols.
  • Responsible for concurrent reviews and Utilization case management.
  • Preformed auditing of Provider's Medical charts that served members of (PSN, CMS, Medicaid/Medicare) as well as Commercial members.
  • Participate in both pre-release and post-release audit reviews.
  • Utilize audit reviews and reports to identify performance issues with a focus on continuous quality improvement.
  • Responsible for identifying documenting and recommending training of processes or techniques to meet accuracy requirements.
  • Managed approximately 40 incoming calls, emails and faxes per day from customers.'

Home Health LPN

Express Home Health
06.2004 - 09.2011
  • Enhanced patient comfort by providing compassionate care and addressing individual needs.
  • Demonstrated strong critical thinking skills in identifying changes in patient conditions and taking appropriate actions accordingly.
  • Provided skilled tracheostomy care for ventilator-dependent patients within their homes for improved quality of life while reducing risk factors associated with institutional settings.
  • Administered medications accurately following physician orders and nursing protocols.
  • Assisted patients in achieving mobility goals through safe transfer techniques, ambulation support, and range of motion exercises.
  • Supported patients'' emotional wellbeing through active listening, empathy, and encouragement during times of stress or illness.
  • Skillfully performed wound care procedures to promote healing and prevent infections.
  • Provided physical assessments, medication, and chronic disease management to home health patients.
  • Assisted patients with activities of daily living to promote independence.
  • Monitored vital signs, developed and implemented care plans, and documented patient progress.
  • Administered medications and treatments as prescribed by physicians.
  • Administered medications and injections to patients.
  • Reviewed patient history to verify conditions and current medications.
  • Helped long-term care residents with bathing, dressing, feeding, and other daily living activities.

Quality Assurance Nurse

Patient Resource Company
06.2009 - 06.2010
  • Streamlined communication between healthcare professionals by implementing efficient reporting systems for quality assurance findings.
  • Reduced patient safety incidents by providing comprehensive training on best practices in infection control and prevention.
  • Responsible for chart audits for quality assurance.
  • Documented and report quality related concerns to management.
  • Participated in both pre-release and post-release audit reviews.
  • Utilized audit reviews and reports to identify performance issues with a focus on continuous quality improvement.
  • Responsible for identifying, documenting, and recommending training of processes or techniques to meet accuracy requirements.
  • Collected and reported data to the required agencies.

Staff LPN

Whitehall Boca
11.2007 - 03.2009
  • Assisted physicians during examinations by gathering equipment needed for specific procedures or tests.
  • Educated patients and their families on disease management, medication administration, and self-care techniques.
  • Provided emotional support and therapeutic communication to patients and their families during difficult times, promoting healing and resilience.
  • Documented all aspects of patient care accurately, maintaining thorough records for legal compliance and effective communication among team members.
  • Managed wound care effectively by cleaning wounds, applying dressings, monitoring healing progress, and updating treatment plans accordingly.
  • Administered vaccinations to protect patients from infectious diseases.
  • Assessed patients'' needs and developed individualized care plans in collaboration with interdisciplinary healthcare teams.
  • Assisted with admissions, appointments, transfers, and discharges.
  • Cared for wounds, provided treatments, and assisted with procedures.
  • Implemented infection control measures to maintain a safe environment for patients, staff, and visitors.
  • Enhanced patient care by administering medications and treatments according to physician orders.
  • Documented accurate and complete patient information to address patient problems and expected outcomes.
  • Administered controlled narcotics, inserted IVs, and performed catheterizations.
  • Used aseptic techniques to provide sterilized wound care and dressing applications.
  • Evaluated patients to identify and address wounds, behavioral concerns, and medically relevant symptoms.
  • Administered medications and injections to patients.
  • Monitored patient health conditions to report changes to assigned physician.
  • Reviewed patient history to verify conditions and current medications.
  • Delivered emotional support to patients and families during challenging times.
  • Helped patients complete bathing, dressing and eating.
  • Helped long-term care residents with bathing, dressing, feeding, and other daily living activities.

Agency Licensed Practical Nurse

Staffing Agency
11.2007 - 03.2009
  • Implemented interventions in response to changes in patient conditions promptly after notifying supervising RNs or physicians as appropriate under scope practice limitations set forth by state licensure regulations.
  • Supported patients'' emotional well-being with empathetic communication and active listening skills.
  • Administered medications and treatments safely and accurately to ensure optimal patient recovery.
  • Participated in quality improvement initiatives by identifying areas for potential enhancement and collaborating on the development of action plans to achieve desired outcomes. sup
  • Basic health monitoring of Senior adults with mental illnesses. living in residential treatment programs.
  • Responsible For Private casework
  • Medication administration.
  • Scheduled patient admission and discharges.
  • Assess patient status and notify physicians of clinical changes.
  • Provided support self-care intervention to participants and made substantial nursing judgments through regular home visits, follow-up calls and alert calls

LPN Staff Nurse, Night Supervisor, MDS Coordinator

Fair Haven Center
12.2001 - 05.2004
  • Utilized time management skills to prioritize tasks effectively, allowing for efficient completion of daily responsibilities.
  • Maintained accurate documentation of all relevant clinical data, ensuring compliance with regulatory standards.
  • Managed patient care through closely monitoring respiration, blood pressure, and blood glucose levels.
  • Assisted with admissions, appointments, transfers, and discharges.
  • Adhered to treatment plan instructions when administering medications and treatments to patients.
  • Reduced medication errors by accurately administering medications and diligently verifying patient information.
  • Set schedules for staff to start and complete MDS assessments and care plan meetings.
  • Ensured timely completion of all MDS assessments, maintaining full compliance with federal and state regulations.
  • Maintained up-to-date knowledge on CMS guidelines and changes to ensure accuracy in reporting and reimbursement processes.
  • Enhanced patient care quality by implementing comprehensive MDS assessments and care plans.
  • Verified prompt and accurate completion of MDS activities for billing.
  • Assessed electronic medical record for required documentation to support MDS coding.
  • Collaborated closely with therapy departments to accurately capture rehabilitation needs within MDS documentation, supporting appropriate resource allocation for residents'' needs.
  • Monitored changing regulations related to RAI/MDS requirements, keeping staff informed about updates that impact their daily work routines.
  • Implemented interdisciplinary meetings focused on individualized care plan development, resulting in more targeted interventions and improved resident outcomes.
  • Led weekly utilization review to go over recent clinical activities.
  • Reduced errors in data collection by streamlining the MDS process and improving communication among interdisciplinary teams.
  • Conducted audits of current MDS records to identify discrepancies and improve record accuracy, enhancing reimbursement rates for the facility.
  • Provided guidance to nursing staff on accurate completion of Section GG assessments, enhancing overall documentation quality and supporting appropriate Medicare/Medicaid reimbursement rates.
  • Complied with federal and state regulations for completion and coordination of RAI process.
  • Trained staff in correct techniques for completing and signing MDS assessments.
  • Collaborated with daytime supervisors to develop strategies for improved efficiency across all shifts.
  • Facilitated smooth shift transitions by maintaining open communication between day and night teams.
  • Enhanced workplace safety by implementing and enforcing strict security protocols for night shift employees.
  • Addressed customer complaints swiftly, resolving issues in a professional manner to promote positive experiences during nighttime hours.
  • Monitored employee attendance, addressing any issues promptly to maintain optimal staffing levels on the night shift.
  • Supervised overnight staff, delegating tasks to maintain productivity levels and meet deadlines.
  • Compiled reports on production shortfalls, accidents and equipment problems.
  • Managed approximately 30 incoming calls, emails and faxes per day from customers.'

LPN Staff Nurse

Multiple Locations Via Staffing Agency
12.2000 - 06.2003
  • Utilized time management skills to prioritize tasks effectively, allowing for efficient completion of daily responsibilities.
  • Maintained accurate documentation of all relevant clinical data, ensuring compliance with regulatory standards.
  • Implemented infection control measures, ensuring a clean and safe environment for patients and staff.
  • Managed patient care through closely monitoring respiration, blood pressure, and blood glucose levels.
  • Administered controlled narcotics, inserted IVs, and performed catheterizations.
  • Obtained patient vital signs and input/output measurements from inpatients.
  • Performed wound care treatments using sterile techniques, promoting healing and preventing complications.
  • Cared for wounds, provided treatments, and assisted with procedures.
  • Reduced medication errors by accurately administering medications and diligently verifying patient information.
  • Demonstrated adaptability in working with diverse patient populations across various healthcare settings.
  • Enhanced patient satisfaction levels through effective communication and empathetic listening skills.
  • Addressed any concerns or questions posed by patients or family members promptly to maintain confidence in their care plan.
  • Offered immediate assistance in emergency and routine paging situations to evaluate needs and deliver care.
  • Comforted and counseled patients and families throughout care process.
  • Facilitated smooth transitions from acute care settings to long-term care facilities or home environments.
  • Administered medications and injections to patients.
  • Reviewed patient history to verify conditions and current medications.
  • Helped long-term care residents with bathing, dressing, feeding, and other daily living activities.
  • Administered medications via oral, IV, and intramuscular injections and monitored responses.
  • Monitored patients' conditions and reported changes in physical presentation, appearance, and behavior to discuss treatment with physicians.
  • Developed strong rapport with patients and families, fostering trust and open communication during challenging times.
  • Performed telephonic case reviews
  • Referred patients to disease or case management programs.

LPN Staff Nurse Med Surge Unit

Mercy Hospital South Miami
10.2000 - 12.2001
  • Utilized time management skills to prioritize tasks effectively, allowing for efficient completion of daily responsibilities.
  • Maintained accurate documentation of all relevant clinical data, ensuring compliance with regulatory standards.
  • Implemented infection control measures, ensuring a clean and safe environment for patients and staff.
  • Managed patient care through closely monitoring respiration, blood pressure, and blood glucose levels.
  • Assisted with admissions, appointments, transfers, and discharges.
  • Performed wound care treatments using sterile techniques, promoting healing and preventing complications.
  • Performed accurate documentation of patient assessments, interventions, and outcomes in compliance with regulatory standards.
  • Administered medications via oral, IV, and intramuscular injections and monitored responses.
  • Remained calm during high-stress, critical situations, demonstrating sustained focus and problem-solving in real-time.
  • Implemented infection control measures that significantly reduced hospital-acquired infections.
  • Utilized strong clinical judgment in prioritizing patient needs during high-stress situations, ensuring optimal outcomes.
  • Assisted physicians in performing diagnostic tests and procedures to facilitate prompt diagnosis and treatment.
  • Streamlined communication between patients, families, and healthcare providers to ensure comprehensive understanding of care plans.
  • Monitored patient reactions after administering medications and IV therapies.
  • Offered exceptional care and support to individuals recovering from acute incidents and dealing with chronic conditions.
  • Performed triage on incoming patients and determined severity of injuries and illnesses.
  • Conducted ongoing monitoring and evaluations of behaviors and conditions, and updated clinical supervisors with current information.
  • Evaluated patient histories, complaints, and current symptoms.
  • Documented treatments delivered, medications and IVs administered, discharge instructions, and follow-up care.
  • Educated patients on disease management, self-care techniques, and wellness strategies to improve long-term health outcomes.
  • Performed routine wound care and dressing changes on schedule.

Education

License Practical Nursing Certification - Practical Nursing

Mercy Hospital School of Practical Nursing
South Miami, FL
07.2000

No Degree - Nursing

Miami Dade Community College
Miami, FL
08.1991

GED -

Lindsey Hopkins Technical School
Miami, FL
06.1991

Skills

  • InterQual Criteria
  • HIPAA Compliance Knowledge
  • CPT coding knowledge
  • Retro-Authorizations
  • Utilization Review Experience
  • Quality Assurance Practices
  • Clinical Documentation Improvement
  • Adaptability and Flexibility
  • Documentation And Reporting
  • Clinical assessment
  • Prior Authorization
  • Insurance Verification
  • Medicare knowledge
  • Medicaid knowledge
  • Healthcare regulations
  • Utilization Management
  • Medical Coding
  • Milliman Guidelines
  • Telephonic Nursing
  • Case Management
  • Multitasking
  • Microsoft Office
  • Analytical Thinking
  • Project Collaboration
  • Video Conferencing Software
  • EMR Systems
  • EMR Software
  • EMR Documentation
  • Trucare System
  • Medical Appeals Handling
  • Medical Terminology
  • Prior Authorization Process
  • Vital signs monitoring
  • Geriatric Nursing
  • Catheter Care
  • Tracheostomy Care
  • Diabetes management
  • End of life care
  • Rehabilitation Nursing
  • Post Operative Care
  • Psychiatric Nursing
  • Home healthcare
  • Hospice Care
  • Behavioral Health
  • Wound Care
  • Direct Patient Care
  • Physical Assessment
  • EMR / EHR
  • Chronic Disease Management
  • Inpatient Care
  • Behavioral assessment
  • Medical Records Management
  • Certified in CPR/AED
  • Patient Charting
  • Intravenous Medications

Traveling, Reading, Writing, Cooking, Meditating Exercises

 Traveling: Traveling allows me to step out of my everyday routine and immerse myself in new environments. It offers a chance to experience different cultures, meet diverse people, and see the world from fresh perspectives. This exploration can be incredibly fulfilling, sparking curiosity and expanding your understanding of the world.

 Reading: Reading provides an escape into different worlds, ideas, and experiences. It stimulates the imagination and can be both a source of knowledge and a way to understand the human experience. Whether delving into fiction or non-fiction, reading can deepen your empathy, challenge your thinking, and offer new insights.

Writing: Writing is a powerful form of self-expression and creativity. It allows you to articulate your thoughts, explore your feelings, and communicate your ideas to others. The process of writing can be therapeutic and fulfilling, as it helps clarify your thoughts and share your unique voice with the world.

 Cooking: Cooking is both an art and a science, and it can be immensely satisfying to create something delicious from scratch. It involves experimentation, creativity, and a sense of accomplishment. Cooking also allows you to nurture yourself and others, making it a deeply rewarding and often social activity.

 Meditation: Meditation helps cultivate mindfulness and inner peace. Engaging in meditation exercises can provide a space for relaxation, reflection, and mental clarity. It supports emotional well-being, reduces stress, and enhances overall balance in your life.

Together, these activities offer a balanced mix of exploration, creativity, personal development, and relaxation. They reflect a desire to engage with the world in diverse ways, enrich my life experiences, and foster a deeper connection with myself and others.

Languages

French
Professional Working

Timeline

Home Health LPN

Healthy Milestones
05.2024 - Current

LPN Prior Authorization Nurse Reviewer

Centene Corporation
03.2024 - Current

Travel LPN Correction Assignment

Maxim Health Services
07.2022 - 03.2024

Clinical Review Nurse

Jogan Healthcare Staffing
05.2022 - 07.2022

Travel Nurse Prior Authorization Management

Favorite Healthcare Staffing
10.2021 - 04.2022

LPN Field Nurse

Nomi Health
09.2020 - 09.2021

Staff Nurse

Pinecrest Nursing and Rehabilitation Center
08.2020 - 09.2020

Concurrent Review Nurse

Meridian HealthCare
10.2018 - 04.2019

Prior Authorization Nurse Reviewer

Centene, Superior Health Services
01.2018 - 10.2018

Clinical Care Reviewer

Molina Healthcare
12.2016 - 09.2017

Nurse Navigator

Evolution Health
06.2015 - 11.2016

LPN Concurrent Review Nurse

Magellan Health
03.2015 - 05.2015

Quality Assurance Nurse Reviewer

Broadspire, a Crawford
04.2014 - 02.2015

Quality Assurance Nurse

Jackson Memorial Hospital Health Plan
09.2010 - 03.2014

Quality Assurance Nurse

Patient Resource Company
06.2009 - 06.2010

Staff LPN

Whitehall Boca
11.2007 - 03.2009

Agency Licensed Practical Nurse

Staffing Agency
11.2007 - 03.2009

Home Health LPN

Express Home Health
06.2004 - 09.2011

LPN Staff Nurse, Night Supervisor, MDS Coordinator

Fair Haven Center
12.2001 - 05.2004

LPN Staff Nurse

Multiple Locations Via Staffing Agency
12.2000 - 06.2003

LPN Staff Nurse Med Surge Unit

Mercy Hospital South Miami
10.2000 - 12.2001

License Practical Nursing Certification - Practical Nursing

Mercy Hospital School of Practical Nursing

No Degree - Nursing

Miami Dade Community College

GED -

Lindsey Hopkins Technical School

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Gina Delancy