Jacqueline Whooley

• Contacted insurance carriers to obtain authorizations for services delivered to patients.
• Assessed patient conditions, monitored behaviors and updated supervising physicians with observations and concerns.
• Executed appropriate steps for patient treatment following careful review of physician medical regimen.
• Participated in continuing education programs and ACMA workshops to enhance training and nursing knowledge.
• Utilized computerized Resource and Patient Management System (RPMS) and Electronic Health Record (EHR) system.
• Advocated for patient needs with interdisciplinary team and implemented outlined treatment plans.
• Maintained strict patient data procedures to comply with HIPAA laws and prevent information breaches.
• Helped patients and families feel comfortable during challenging and stressful situations, promoting recovery and reducing compliance issues.
• Referred cases to secondary review for failure to meet Interqual and Indica criteria.
• Remained up-to-date on various benefit plans, medical policies and state-specific clinical guidelines or criteria.
• Reviewed patient admissions to determine medical necessity as directed by medical policy, interqual criteria.
• Applied medical criteria and clinical judgement to researched cases to evaluate and establish determinations.
• Determined medical necessity and cost-effectiveness of services through utilization review processes.
• Collaborated with providers to obtain required clinical information, supporting prior authorization determinations and individual inquiries.
• Kept detailed documentation on all utilization reviews by using EMR. Interqual, medical policies.

Preparation for and response to emergencies. Specialists develop plans and procedures for responding to natural disasters and other emergencies and help lead the response during and after the emergency.

Deliver patient-centered nursing care to a diverse group of patients across the acute care surgical unit, which includes managing cases, performing assessments, and delivering care based on age, risk factors, and cultural needs

• Strengthened relationships between EMS providers and local hospitals with clear communication channels aimed at enhancing patient outcomes.
• Increased patient comfort during transport by providing compassionate care and addressing individual needs.
• Improved patient care by efficiently assessing and stabilizing patients during medical emergencies.
• Facilitated timely patient transfers to specialized facilities for advanced care when necessary.