Heather Proco
Belleview,FL
Summary
Self -motivated, efficient, resourceful and reliable. Excellent communication and interpersonal skills. Confident in interactions with individuals at all levels. Resourceful in the completion of tasks with ability to multi-task efficiently. Function effectively as a team player as well as working independently. Possess strong problem solving skills. Excel in fast paced environments.
Overview
22
22
years of professional experience
Work History
Clinical Reviewer/Clinical Appeals Nurse
Centene
Ocala, FL
01.2022 - Current
- Reviews clinical information submitted by providers to the appropriate InterQual Criteria and makes decision to issue a determination or send to physician review
- Maintains HIPPA, State and Federal regulations
- Serves as a resource for members, peers and providers calling for assistance.
- Built relationships, gained alignment for clinical support and articulated questions to receive appropriate level of support from superiors and peers.
- Used medical and clinical review guidelines and parameters to maintain consistency in MD review process, appropriate utilization levels and compliance with health plans policies
Senior Clinical Review Nurse
Encompass Health Rehabilitation Hospital
Ocala, FL
04.2015 - 01.2022
- Assess patients status and notify physician of clinical changes
- Interact with departments regarding patient care
- Educate patient/families on health care needs, conditions, options, etc.
- Maintained patient charts and confidential files
- Evaluated patient histories, complaints, and current symptoms.
- Collaborated with leadership to devise initiatives for improving nursing satisfaction, retention and morale.
- Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
- Used first-hand knowledge and clinical expertise to advocate for patients under care and enacted prescribed treatment strategies.
- Investigated and resolved issues affecting hospital operations and patient care.
- Provided exceptional care to high-acute patients needing complex care such as ventilator management, extensive wound care and rehabilitation.
- Communicated with healthcare team members to plan, implement and enhance treatment strategies.
- Promoted patient and family comfort during challenging recoveries to enhance healing and eliminate non-compliance problems.
- Leveraged feedback and process improvement opportunities to create safer and healthier environment and increase patient satisfaction.
- Offered exceptional care and support to individuals recovering from acute incidents and dealing with chronic conditions.
- Led teams in driving successful patient outcomes by prioritizing standard of care and best practices.
- Educated family members and caregivers on patient care instructions.
Staff Nurse
Munroe Regional Medical Center
Ocala, FL
04.2002 - 04.2015
- Monitored patients' conditions and reported changes in physical presentation, appearance, and behavior to discuss treatment with physicians.
- Educated patients, families and caregivers on diagnosis and prognosis, treatment options, disease process, and management and lifestyle options.
- Updated patient charts with data such as medications to keep records current and support accurate treatments.
- Assessed physical, psychological, physiologic, and cognitive status of patients.
- Performed various nursing interventions such as wound dressing, vital sign monitoring, and specimen collection.
- Administered medications via oral, IV, and intramuscular injections
- Equipped patients with tools and knowledge needed for speedy recovery
- Evaluated patient histories, complaints, and current symptoms.
- Educated family members and caregivers on patient care instructions.
- Delivered high level of quality care to diverse populations while overseeing patient admission and triaging based on acuity and appropriate department admission.
- Promoted patient and family comfort during challenging recoveries to enhance healing and eliminate non-compliance problems.
Education
Bachelor Of Science - Nursing
College of Central Florida
Ocala, FL01.2019
Licensed Practical Nursing License - Nursing
Central Florida College
Ocala, FL05.2002
Skills
- Clinical Documentation
- Clinical Interventions
- Interpersonal and Written Communication
- Clinical Interviewing
- Clinical Judgment
- Customer Inquiries
- Client Support
- Customer Satisfaction
- Community Resources
- Benefits Review
- Medicare Regulation
- Sourcing and Compiling Information
- Determine Medical Necessity
- Familiar with Fraud Statutes
Timeline
Clinical Reviewer/Clinical Appeals Nurse
Centene
01.2022 - Current
Senior Clinical Review Nurse
Encompass Health Rehabilitation Hospital
04.2015 - 01.2022
Staff Nurse
Munroe Regional Medical Center
04.2002 - 04.2015
Bachelor Of Science - Nursing
College of Central Florida
Licensed Practical Nursing License - Nursing
Central Florida College
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