Summary
Overview
Work History
Education
Skills
Additional Information
Timeline
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JESSICA STURCH

Steubenville,OH

Summary

Compassionate Registered Nurse with over 9 years’ experience in the medical field settings. Clinically experienced in Telemetry, Medical Surgical nursing units, as well as Clinical Review and Case Management. Skilled in performing clinical intake and reviewing prior authorizations. Ensures quality customer service between providers and administrative staff. Fluent with review in Medicare, Medicaid, and Commercial insurance. Understands important in compliance and utilization management. Analyzes appropriate care and educates patients resulting in medical cost savings for insurance companies. Displays strong leadership skills.

Overview

10
10
years of professional experience

Work History

NURSE CASE MANAGER

Cigna
05.2022 - Current
  • Collaborated with healthcare leaders and physicians to support and offer resources in performance of duties to maintain high-quality and efficient patient care.
  • Developed and modified patient care plans and assisted interdisciplinary team in identifying client needs and goals to determine priorities of care.
  • Advocated for patients by communicating care preferences to practitioners, verifying interventions met treatment goals and identifying insurance coverage limitations.
  • Educated patients on preventative care as well as collaborated with providers on appropriate testing resulting in medical cost savings for insurance.

CLINICAL REVIEW SUPERVISOR

Health Help
10.2021 - 05.2022
  • STAT/ SHORT TAT/ PRIORITY REVIEWS
  • Maintain Compliance across queue volume
  • Proficient in utilization management ensuring quality and cost efficiency
  • Reviews against medical appropriateness, clinical judgement, eligibility
  • Manage staff schedules, conduct performance reviews and corrective action plans
  • Performs day to day operations such as staff reporting, 1:1 coaching, and audits
  • Makes decisions to adequately fill clients needs
  • Makes recommendations based on appropriateness of care
  • Ensures insurance companies provide medica coverage for medical services.

TEAM LEAD

UPMC/GIESINGER- HEALTHHELP
09.2020 - 10.2021

DIAGNOSTIC IMAGING, INTERVENTIONAL PAIN

  • Review clinical information against given criteria and follows appropriate work flow
  • Understands process and procedure for reviewing Medicare, Medicaid, and
  • Commercial authorizations
  • Collaborates with clinical personnel to resolve customer concerns and complaints
  • Creates, encourages, and supports an environment that fosters team work, respect, and collaboration among nurse team.
  • Provides coaching and additional training to team members
  • Oversees and evaluates staff work assignments and makes appropriate adjustments to ensure case-specific turnaround times (TAT) related to client service level agreements and regulatory compliance requirements are met for their specified program

CLINICAL REVIEW NURSE

01.2019 - 09.2020
  • DIAGNOSTC IMAGING
  • Review prior authorizations and make appropriate clinical decisions based on medically necessary determinations
  • Proficient in reviewing diagnostic imaging including CT, MRI, PET, CNUC, and Echo
  • Refer potential denials to medical directors
  • Contribute as an active member of an interdisciplinary team
  • Special projects include UPMC soft launch, CNUC pilot, MRI Lumbar Spine Pilot, and working expired cases

CHARGE NURSE

TRINITY HEALTH SYSTEM
01.2017 - 01.2019
  • TELEMETRY/ MED SURG/ OBSERVATIONAL UNIT
  • Case management of patients from ER to units to meet admission or observation status
  • Responsible for telemetry monitored patients
  • Administration of cardiac IV medications
  • Communication with physicians regarding patient care
  • Service recovery for dissatisfied clients
  • Provide leadership for staff nurses.

REGISTERED NURSE

TRINITY HEALTH SYSTEM
01.2014 - 01.2017
  • TELEMETRY/ MED SURG/ OBSERVATIONAL UNIT
  • Provide care to post-operative cases such as orthopedic, abdominal, and cardio-thoracic
  • Monitor telemetry units and respond to codes throughout hospital
  • Assess patient conditions and administer proper medications including oral and IV administration
  • Educate families about patient conditions and provide emotional support as needed
  • Proactive in learning new procedures and treatments
  • 3

Education

DIPLOMA OF NURSING -

TRINITY SCHOOL OF NURSING

Skills

  • Medical Evaluation
  • Patient Advocacy
  • Referral Coordination
  • Patient Care Planning
  • Patient Education
  • Medical Cost Savings

Additional Information

  • ASSOCIATES OF MEDICAL ASSISTING, EASTERN GATEWAY COMMUNITY COLLEGE LICENSURE , Registered Nurse in the State of Ohio License number: RN.407791 Advanced Cardiac Life Support (ACLS) – 2019 to Present Basic Life Support (BLS) – 2020 to Present Dysrhythmia and 12-Lead EKG

Timeline

NURSE CASE MANAGER

Cigna
05.2022 - Current

CLINICAL REVIEW SUPERVISOR

Health Help
10.2021 - 05.2022

TEAM LEAD

UPMC/GIESINGER- HEALTHHELP
09.2020 - 10.2021

CLINICAL REVIEW NURSE

01.2019 - 09.2020

CHARGE NURSE

TRINITY HEALTH SYSTEM
01.2017 - 01.2019

REGISTERED NURSE

TRINITY HEALTH SYSTEM
01.2014 - 01.2017

DIAGNOSTIC IMAGING, INTERVENTIONAL PAIN

DIPLOMA OF NURSING -

TRINITY SCHOOL OF NURSING

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