Joyce Young Buchanan
Baton Rouge,Louisiana
Summary
Seasoned nursing professional offering proven clinical knowledge, natural interpersonal strengths and technical abilities. Knowledgeable about EMR charting, medication administration and interdisciplinary collaboration focused on optimizing patient care and support. Quality-focused and efficiency-driven leader.
Overview
32
32
years of professional experience
Work History
Registered Nurse Clinical Coordinator
Evicore / Cigna Evernorth
04.2025 - Current
- Coordination of services for members transitioning to Post Acute Care
- Home Health, Durable Medical Equipment, Manage support services for complex patients
- Work in Collaboration with Case managers, social workers, healthcare providers in-patient and community care, insurance precertification to ensure timely receipt of services to decrease risk of hospital readmissions
- Communicate and educate the members, family, POA, for appropriateness of home setting at discharge, communicate before and after discharge until ordered services/ DME are in place to promote healing and recovery, decreasing risk of acute care readmission
- Serve as a point of contact for members and family during transition between levels of care
- Telephonic and electronic communication
- Proficient Microsoft office: Word, Excel, One Note, PowerPoint, Outlook, Webex
- Coding: HCPS, ICD-10,
Utilization Analyst/ Clinical Reviewer
eviCore Healthcare
12.2015 - 04.2025
- Pre-certification of radiology imaging requests (MRI, PET, CT, ultrasound, nuclear medicine, angiography) for commercial insurances, Medicaid, and Medicare
- Remote position processing telephonic requests speaking with office staff, nurses, physicians, patients, and imaging sites; also processes requests made via fax and Website, using standards of Care protocol
- Assess pre-certification requests for medical necessity and authorize, if unable to authorize would forward for physician review, or place on hold and request additional clinical documentation
- Document appropriate ICD 10 and CPT codes
- Primarily incoming calls, made outbound calls as necessary/ correspondence to requesting providers
- Cross trained and worked- med-surg, ortho-spine, case management, and worked special projects
- Maintain company production standards while maintaining accurate clinical decisions
- Utilization management, URAC and NCQA principles, Adherence to HIPAA
- Cross trained and worked as Case Manager at the height of COVID
Clinical Documentation Specialist
Our Lady of the Lake RMC
03.2014 - 02.2016
- Ensure the integrity of the medical record with the most accurate, complete documentation and DRG code assignment
- Acute inpatient concurrent review and assessment of the electronic and traditional medical record hospital wide ICU, telemetry, medical-surgery, hematology-oncology, and nephrology units
- Query providers for specification and clarification of entries in the medical record
- Experience with Electronic Medical Report, 3M-CDI software, Microsoft Word, Outlook, Excel, CPT and ICD-10 coding
- Strong open communication and education with providers, physician extenders, nursing staff, dieticians, case managers, and coders regarding translation of clinical to coding terminology
- Carefully reviewed patient files for clarity on diseases, diagnoses and procedures to determine quality of care.
- Audited and reviewed patient information via EMR management to verify accuracy and completeness.
Cardiovascular Thoracic -ICU staff and charge nurse
Our Lady of the Lake RMC
08.2012 - 03.2014
- Recovered fresh cardio-thoracic surgery patients after coronary bypass, heart valve replacements, hypothermic care for neurologically impaired patients
- Preceptor, Charge Nurse on 24 bed unit
- Managed all aspects of critically ill patients(ventilator depend, critical infusions, renal replacement therapy, chest tubes, managed pulmonary artery catheters)
- Assisted doctors with intubation, bedside bronchoscopy/ endoscopy, invasive and non-invasive procedures.
- Daily huddle/meeting with physician and inter-disciplinary team
- CCRN, ACLS, BLS, AACN previously certified /membership
Telemetry Staff Nurse
Our Lady of the Lake RMC
08.2008 - 08.2012
- Preceptor, Charge Nurse on 35 bed unit
- Direct patient care
- Medication administration, telemetry interpretation, monitoring/ assessing patients, documentation, wound care
- Set up and assisted with electro- cardioversions
- Communicate the providers, team members, patients, and family members
LPN Agency Nurse
Premier Healthcare Staffing
04.2006 - 08.2008
- Per Diem –acute (neurology/ telemetry/ same day surgery (pre and post operative), outpatient care (pediatrics, primary care, pulmonology, cardiology, GYN), LTAC
Practice Administrator
I tax- CHD Meridian
09.2004 - 04.2006
- Set up new site- primary and occupational care, lab, and pharmacy
- Supervised/ hired 13 staff members
- Conducted staff meetings and training
- Prepared monthly financial, QI, and utilization reports
- Chaired QI and UR committees
- Setup on and off site health fairs
- Managed the facility budget
- Liaison for contracted company
- Oversaw accounting, budgeting, and financial reporting.
Referral Coordinator/ Case Manager
I - tax CHD Meridian
08.2001 - 04.2005
- Set up/ scheduled out of facility provider consults
- Contacted insurance company for specialist referral authorizations
- Set up DME equipment authorization
- Arrange physician peer to peer reviews outpatient ICD-9 / CPT coding
- Conducted small groups of patient education on chronic diseases such as DM, HTN...
- Ensured patient preventive health work up was ordered/ performed in compliance with national standards of care
- Monthly utilization and QI of off-site referrals
Education
Associate of Science - Registered Nurse
Excelsior College
Albany, NY01.2008
Technical College diploma - License Practical Nurse
Louisiana Technical College, Sullivan Campus
Bogalusa, LA01.1993
Technical diploma - Computer Operations
Louisiana Technical College, Sullivan Campus
Bogalusa, LA01.1989
Timeline
Registered Nurse Clinical Coordinator
Evicore / Cigna Evernorth
04.2025 - Current
Utilization Analyst/ Clinical Reviewer
eviCore Healthcare
12.2015 - 04.2025
Clinical Documentation Specialist
Our Lady of the Lake RMC
03.2014 - 02.2016
Cardiovascular Thoracic -ICU staff and charge nurse
Our Lady of the Lake RMC
08.2012 - 03.2014
Telemetry Staff Nurse
Our Lady of the Lake RMC
08.2008 - 08.2012
LPN Agency Nurse
Premier Healthcare Staffing
04.2006 - 08.2008
Practice Administrator
I tax- CHD Meridian
09.2004 - 04.2006
Referral Coordinator/ Case Manager
I - tax CHD Meridian
08.2001 - 04.2005
Technical College diploma - License Practical Nurse
Louisiana Technical College, Sullivan Campus
Technical diploma - Computer Operations
Louisiana Technical College, Sullivan Campus
Associate of Science - Registered Nurse
Excelsior College
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