Irene Calenzo
Forestport,NY
Overview
44
44
years of professional experience
1
1
Certification
Work History
Clinical Reviewer
CareCentrix
04.2021 - 09.2023
- Performed home care services utilization review for Blue Cross Blue Shield of Michigan Medicare
- Collaborated with healthcare providers to ensure optimal patient care, addressing any discrepancies or concerns.
- Used medical and clinical review guidelines and parameters to maintain consistency in MD review process, appropriate utilization levels and compliance with policies and procedures. Proficient in Interqual criteria.
- Supervisor - Terry Shultis 813-35-6214
RN Care Manager
Excellus Blue Cross Blue Shield
09.2004 - 10.2020
- Case manager for Federal Employees Program
- Experience in Managed Medicaid and Medicare programs and all lines of commercial insurance
- Proficient in InterQual, CarePlanner, VITAL and Clinical Care Advance documentation systems
- Performed Utilization Management for all lines of business the first two years of employment
- Devised individualized care plans tailored to each patient''s unique situation, optimizing clinical outcomes.
- Educated patients, families and caregivers on diagnosis and prognosis, treatment options, disease process, and management and lifestyle options.
- Served as a liaison between physicians and patients'' families to facilitate clear communication regarding treatment options and progress updates.
Utilization Review Nurse
MVP Health Care
09.1999 - 09.2004
- Ensured compliance with regulations and accreditation standards by maintaining accurate documentation of all utilization review activities.
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Performed prior authorization review of services requiring notification.
- Improved patient care quality by conducting thorough utilization reviews and making recommendations for optimal treatment plans.
- Contributed to organizational success by providing expert advice on medical necessity criteria and evidence-based practices in utilization review nursing.
- Submitted cases for criteria failures and helped facilitate resolutions and approvals.
- Fostered a culture of continuous learning by actively participating in departmental meetings, trainings, and continuing education opportunities related to utilization review.
- Proficient in Interqual criteria and CarePlanner documentation system
Supervisor
Faxton Hospital
01.1994 - 09.1999
- Oversaw daily operations of the nursing department on assigned shift, ensuring smooth workflow and timely completion of tasks.
- Improved customer satisfaction with timely response to inquiries, addressing concerns, and finding effective solutions.
- Resolved conflicts among team members promptly, maintaining a harmonious working environment conducive to productivity.
- Collaborated with other departments to achieve organizational goals, fostering teamwork across various functions.
- Fostered a positive work environment and providing ongoing feedback to staff members.
- Conducted thorough employee evaluations to identify areas for growth and development, leading to more skilled workforce.
Staff RN
Faxton Hospital
09.1979 - 01.1994
- Assessed physical, psychological, physiologic, and cognitive status of patients.
- Collaborated with interdisciplinary teams to develop comprehensive care plans tailored to each patient''s needs.
- Implemented appropriate interventions based on assessment findings to maintain or improve patients'' health status.
- 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.
- Assisted physicians during procedures by preparing equipment, monitoring patient status, and ensuring sterile environments.
- Provided education on disease management, self-care techniques, and preventive measures to patients and families.
- Promoted patient safety by adhering to infection control protocols and conducting regular health assessments.
- Coordinated discharge planning in collaboration with case managers, social workers, and other support staff for optimal continuity of care after hospitalization.
- Served as a preceptor for new nurses, sharing knowledge, expertise, and best practices to improve their skills and confidence.
- Maintained clinical competency through ongoing professional development activities such as workshops, seminars, conferences, and certifications related to nursing practice.
- Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
Education
AAS - Nursing
Mohawk Valley Community College
Utica, NY06.1979
Skills
- Critical Care Experience (6 years)
- ICU Experience (6 years)
- Medication Administration (10 years)
- Nursing (10 years)
- EMR Systems (10 years)
- Hospital Experience (10 years)
- Case Management (10 years)
- Vital Signs (10 years)
- Nurse Management (5 years)
- Patient Care (10 years)
- Medical Records (10 years)
- Employee Orientation (10 years)
- Utilization Management (24 years)
- Venipuncture (10 years)
- Experience Administering Injections (10 years)
Certification
- Registered Professional Nurse
- License Number 321273 November 1979
- Expires July2025
- Certified Case Manager
- Certification Number 4205739 April 2013
- Expires May2028
- PAHM Designation
- Professional, Academy for Healthcare Management
- Conferred by The Academy for Healthcare Management and America's Health Insurance Plans November 2010. Does not expire.
- PHIAS Designation
- Professional, Health Insurance Advanced Studies
- Conferred by The Academy for Healthcare Management and America's Health Insurance Plans August 2011. Does not expire.
Assessments
- Customer focus & orientation — Highly Proficient
- February2021
- Responding to customer situations with sensitivity
- Full results: Highly Proficient
- Patient-focused care — Expert
- Addressing concerns and using sensitivity when responding to needs and feelings of patients
- Full results: Expert
- Electronic health records: Best practices — Highly Proficient
- Knowledge of EHR data, associated privacy regulations, and best practices for EHR use
- Supervisory skills: Motivating & assessing employees — Highly Proficient
- Motivating others to achieve objectives and identifying improvements or corrective actions
- Clinical judgment — Highly Proficient
- Assessing a patient's condition and implementing the appropriate medical intervention
- Medical billing — Proficient
- Understanding the procedures and forms used for medical billing
- Full results: Proficient
- Medical terminology — Expert
- Understanding and using medical terminology
- Verbal communication — Expert
- Speaking clearly, correctly, and concisely
- Active listening — Highly Proficient
- Actively listening and appropriately responding in conversations
- First aid — Proficient
- Treating common medical emergencies
- Case management & social work — Proficient
- March2021
- Prioritizing case tasks, gathering information, and providing services without judgment
- Indeed Assessments provides skills tests that are not indicative of a license or certification, or continued development in any professional field
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Work Preference
Work Type
Full TimePart TimeWork Location
RemoteImportant To Me
Work-life balanceFlexible work hoursWork from home optionCompany CulturePersonal development programsTimeline
Clinical Reviewer
CareCentrix
04.2021 - 09.2023
RN Care Manager
Excellus Blue Cross Blue Shield
09.2004 - 10.2020
Utilization Review Nurse
MVP Health Care
09.1999 - 09.2004
Supervisor
Faxton Hospital
01.1994 - 09.1999
Staff RN
Faxton Hospital
09.1979 - 01.1994
AAS - Nursing
Mohawk Valley Community College
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