Jennifer Osburn
Huntington,WV
Summary
Experienced RN with 25 years of experience including 9 years telemetry staff nurse, 5+ years utilization review, 10 years of quality/performance improvement and 3 years case management and insurance denials and appeals. Detail-oriented individual with exceptional communication and project management skills. Proven ability to handle multiple tasks effectively and efficiently in fast-paced environments. Recognized for taking proactive approach to identifying and addressing issues, with focus on optimizing processes and supporting team objectives.
Overview
25
25
years of professional experience
1
1
Certification
Work History
Care Management Appeal & Denial Specialist
St. Mary's Medical Center
04.2025 - Current
- Conduct thorough investigations to gather necessary information to resolve denial
- Prepare and send documents for appeals
- Reviewed denial letters and Explanation of Benefits for accuracy and clarity.
- Ensured timely and accurate processing of appeals following established procedures and guidelines.
- Ensured compliance with all applicable laws, regulations and policies.
- Collaboration with other healthcare professionals to provide updates and resolve denial/appeal issues efficiently
- Maintain accurate and complete records for appeals including supporting documentation and communications
- Provide training and support to other team members on the appeals process
Care Facilitator
St. Mary's Medical Center
10.2022 - 04.2025
- Conduct assessments to identify needs and development discharge plan
- Participate in multidisciplinary rounds to discuss patient care and treatment plan
- Collaborate effectively with interdisciplinary teams to ensure seamless and coordinated care
- Coordinate and facilitate communication patients, families and healthcare providers
- Ensure timely and appropriate referrals to other healthcare professionals or agencies.
- Advocate for patient's needs and ensure they receive appropriate treatment and support
- Maintain accurate and up-to-date patient records and documentation
- Comply with relevant regulations and guidelines
Core Measures Data Abstractor
American Data Network
06.2022 - 04.2023
- Collected and abstracted data from patient medical records, especially those related to disease-specific care. This includes information on diagnoses, treatments, procedures, and outcomes.
- Ensured the accuracy and completeness of the abstracted data. This involves cross-referencing information from multiple sources within a patient's medical record.
- Adhered to specific clinical data abstraction guidelines and standards, such as those set by the Centers for Medicare and Medicaid Services (CMS) and The Joint Commission (TJC).
- Entered the abstracted data into a database or registry, often using specialized software. This includes maintaining and updating the data as necessary.
- Participated in quality assurance processes to ensure data integrity. This involves regular audits of the data or the abstraction process.
- Remains informed about developments in patient care and data management to ensure ongoing competency in the role.
Sepsis Coordinator and Data Abstractor
St. Mary's Medical Center
12.2012 - 10.2022
- Complete timely abstraction to maintain compliance with registry deadlines
- Review medical records to abstract information according to definition of various registries
- Organized and facilitated sepsis committee meetings monthly discussing current trends and sepsis mortality
- Created spreadsheets using Microsoft Excel for daily, weekly, and monthly reporting
- Led projects and analyzed data to identify opportunities for improvement
- Developed policies and procedures for evidenced based care of septic patients
- Assist in development and providing of sepsis education to nursing staff and all new medical staff
- Provide monthly readmission data based on CMS guidelines to appropriate personnel
- Data abstraction and analyzation of CMS ED Throughput Measure
- Assist in data abstraction of CMS Core Measure ED Inpatient population
RN Utilization Review
Highmark Blue Cross Blue Shield
05.2007 - 12.2012
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services
- Performed prior authorization review of services requiring notification
- Performed admission reviews based for medical necessity based upon policy specification
- Assisted in education and training of new employees
- Reviewed medical insurance claims for medical necessity
- Discussed cases not meeting medical necessity with medical director with follow-up calls and reports to provider
Staff Nurse/Charge Nurse, Telemetry
St. Mary's Medical Center
02.2002 - 07.2009
- Directly supervise nursing staff and other healthcare professional, delegating tasks and providing guidance
- Collaborate with other healthcare personnel to ensure quality care
- Continuously monitor patient's heart rhythms, vital signs and other critical parameters
- Identify and interpret EKG, recognizing abnormal rhythms and arrhythmias
- Provide direct patient care as needed, including wound care, hygiene and comfort measures
- Perform comprehensive patient assessments, including physical and mental evaluation.
- Administered medications via oral, IV, and intramuscular injections and monitored responses.
- Managed invasive lines and perform bedside procedures.
- Provide emotional support and education to patients and families regarding cardiac conditions, medications and lifestyle modifications.
- Collaborate in developing and implementing individualized care plans
Staff Nurse, Telemetry
Charleston Area Medical Center
05.2000 - 02.2002
- Continuously monitor patient's heart rhythms, vital signs and other critical parameters
- Identify and interpret EKG, recognizing abnormal rhythms and arrhythmias
- Perform comprehensive patient assessments, including physical and mental evaluation.
- Administered medications via oral, IV, and intramuscular injections and monitored responses.
- Managed invasive lines and perform bedside procedures.
- Provide emotional support and education to patients and families regarding cardiac conditions, medications and lifestyle modifications.
- Collaborate in developing and implementing individualized care plans
Education
Bachelor of Science - Nursing
Marshall University
Huntington, WV05.2000
Skills
- Proficient in task prioritization
- Critical thinking skills
- Flexible in dynamic environments
- Analytical thinking
- Appeals management
- Insurance coverage assessment
- Quality assurance of documentation
- Utilization review
- HIPAA regulation adherence
- Patient support
- Utilization management
Certification
Lean Six Sigma Black Belt, 09/01/21
Personal Information
Title: Registered Nurse
Timeline
Care Management Appeal & Denial Specialist
St. Mary's Medical Center
04.2025 - Current
Care Facilitator
St. Mary's Medical Center
10.2022 - 04.2025
Core Measures Data Abstractor
American Data Network
06.2022 - 04.2023
Sepsis Coordinator and Data Abstractor
St. Mary's Medical Center
12.2012 - 10.2022
RN Utilization Review
Highmark Blue Cross Blue Shield
05.2007 - 12.2012
Staff Nurse/Charge Nurse, Telemetry
St. Mary's Medical Center
02.2002 - 07.2009
Staff Nurse, Telemetry
Charleston Area Medical Center
05.2000 - 02.2002
Bachelor of Science - Nursing
Marshall University
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