Summary
Overview
Work History
Education
Skills
Timeline
Generic

JENNIFER DAVIS

Pickerington,OH

Summary

As a Nurse Appeal Consultant, I consistently achieve high performance ratings, earning a score of 4 for the 2023 end-of-year evaluation. My track record demonstrates an ability to not only meet but exceed goals and expectations. I possess a strong proficiency in reviewing both pre-service and post-service appeals, utilizing various resources such as MCG, Clinical Policy Bulletins, pharmacy guidelines, eviCore imaging criteria, and plan documents. In addition to core responsibilities, I actively seek opportunities to contribute more by volunteering for extra responsibilities, including expedited triage, providing assistance and guidance to new team members, and participating in special projects aimed at improving inventory management. Additionally, I was recently awarded the June 2024 ACS Celebrate Excellence Award.

Overview

19
19
years of professional experience

Work History

Nurse Appeal Consultant

Aetna a CVS company
11.2015 - Current
  • Responsible for the review and resolution of clinical appeals
  • Review and analyze medical information and interpret data obtained from clinical records
  • Gather data through multiple system applications
  • Condense complex information into clear and concise clinical picture
  • Apply appropriate clinical criteria and policies with regulatory and accreditation requirements for both member and provider appeals.
  • June 2024 ACS Celebrate Excellence Award

Care Management Nurse

Aetna a CVS company
10.2013 - 11.2015
  • Responsible for telephonically assessing, planning, implementing and coordinating all case management activities with members to evaluate the medical and disability needs of the member to facilitate the member's overall wellness and appropriate and timely return to work
  • Address issues presented to enhance the short and long term outcomes as well as opportunities to enhance a member's overall wellness through integration
  • 2015 AWEA Silver award winner for Caring.

Staff Nurse Post Partum/Infant Triage

The Ohio State University
06.2009 - 10.2013
  • Assisted new mothers and their families with the care of themselves as well as their new babies
  • Coordinated care with multiple disciplines to achieve desired patient outcomes
  • Extensive patient and family teaching to ensure the desired care for the patient and newborn
  • Assessed for changes in patient condition and communicates changes with physicians
  • Cared for drug addicted newborns and their families.

NICU Staff Nurse/Clinical Research Coordinator

Nationwide Children's Hospital
06.2005 - 06.2009
  • Responsible for the care of critically ill neonates and toddlers
  • Duties included Charge nurse for a 44 bed level III NICU unit, using critical thinking skills, clinical judgment and leadership in the anticipation and planning for the care of the patient
  • Also served as Research Coordinator for NICU patients as well as clinical study patients
  • Responsible for sedating patients under supervision and performing infant pulmonary function testing
  • Duties included writing IRB proposals, managing and monitoring complex ventilator patients under sedation, explaining testing and obtaining consents from parents, staff education and extensive record keeping of studies.

Education

Bachelor of Science (B.S.) in Nursing -

Mount Carmel College of Nursing
05.2005

Skills

  • Excellent Communication
  • Positive Attitude
  • Dependable and Reliable
  • Time Management
  • Goal-Oriented
  • Clinical Documentation
  • Team Player
  • Utilization Review/ Claims

Timeline

Nurse Appeal Consultant

Aetna a CVS company
11.2015 - Current

Care Management Nurse

Aetna a CVS company
10.2013 - 11.2015

Staff Nurse Post Partum/Infant Triage

The Ohio State University
06.2009 - 10.2013

NICU Staff Nurse/Clinical Research Coordinator

Nationwide Children's Hospital
06.2005 - 06.2009

Bachelor of Science (B.S.) in Nursing -

Mount Carmel College of Nursing

Similar Profiles

CREATE PROFILE
JENNIFER DAVIS