Juanita Toussant
Alliance
Summary
A seasoned, flexible, dependable, compassionate and highly motivated LPN with over 20 years of experience in healthcare, including remote clinical review. Excellent interpersonal/ communication skills with an ability to work effectively with individuals at all levels. Experience working in a long-term care facility as well as acute care rehab. Eight years of experience with utilization management, prior authorizations, clinical guidelines, data entry, leadership and education. Proficient in reviewing against NCD/LCD and document per CMS requirements and coordination of medical services. Ability to interpret independently the most appropriate course of action. Skilled in managing communication with medical professionals and coordinating medical services determinations. Expertise in clinical chart reviews, CMS guidelines, and delivering patient-centered care. Five years of experience as quality assurance coordinator at an ISO 9000 factory. Seeking a remote LPN position to broaden my experience and continue to provide quality care.
Overview
22
22
years of professional experience
Work History
Remote Clinical Review Nurse, SME, PR Auditor
HealthHelp, WNS
01.2017 - Current
- Conducted thorough clinical chart reviews in compliance with National Coverage Determinations (NCDs), Local Coverage Determinations (LCDs), and Centers for Medicare & Medicaid Services (CMS) guidelines.
- Utilized clinical nursing skills and critical thinking expertise to support and facilitate the coordination and documentation of medical services determinations.
- Handled processing and follow-up of medical necessity requests through phone and fax, ensuring completion of medical records within deadline constraints to maintain compliance.
- Maintained effective communication with physicians and office personnel, managing call flow and identifying cases requiring elevated attention.
LPN
Aultman Hospital Community Care Center
01.2015 - 01.2017
- Provided competent nursing care in compliance with established safety standards, contributing to favorable patient outcomes.
- Monitored and accurately documented patient behaviors and symptoms, promptly communicating changes to the appropriate medical personnel.
- Assisted patients with activities of daily living, upholding their dignity and privacy.
- Worked collaboratively with multidisciplinary teams to enhance care coordination.
- Delivered high-quality nursing care, adhering to patient safety standards and protocols to ensure optimal patient outcomes.
- IV, PEG tube and Oral Medication Administration.
LPN Charge Nurse
Bel-Aire Care Center
01.2008 - 01.2015
- Overseen night shift staff to ensure patient care was provided efficiently.
- Delivered high-quality nursing care, adhering to patient safety standards and protocols to ensure optimal patient outcomes.
- Observed behavior and symptoms and reported changes in a timely manner.
- Assisted with ADLs while maintaining dignity for the individual.
- Collaborated effectively with healthcare team members to facilitate patient-centered care and communication.
- IV, PEG tube and Oral Medication Administration.
STNA
01.2004 - 01.2007
- Assisted with the execution of daily healthcare procedures, maintaining accurate patient records and contributing to a supportive care environment.
- Performed ADLs while maintaining dignity for the individual.
- Providing quality care, based on high standards of professionalism.
Education
Licensed Practical Nurse - IV Therapy Certification
Canton City Schools Practical Nurse Program
OhioSkills
- Computer Charting
- Data Entry
- Clerical Duties
- Able to thoroughly read clinical documentation
- Pain Management
- Diabetes
- Hospice and End of life Care
- Stroke Patient Care
- Culturally Sensitive
- Problem Resolution Ability
- Specimen Collection
- Geriatric Knowledge
- Companionship
- Patient Positioning Understanding
- HIPAA Compliant
- Mobility Assistance
- Emergency Response
- Prioritization
- Clinical Procedure Comprehension
- One on One care
- Professional Phone Communication
- Attention to detail
- Able to adapt to change
- NCD/LCD and Clinical Guideline Knowledge
- Microsoft Computer Knowledge
- Excel Spreadsheet Knowledge
Timeline
Remote Clinical Review Nurse, SME, PR Auditor
HealthHelp, WNS
01.2017 - Current
LPN
Aultman Hospital Community Care Center
01.2015 - 01.2017
LPN Charge Nurse
Bel-Aire Care Center
01.2008 - 01.2015
STNA
01.2004 - 01.2007
Licensed Practical Nurse - IV Therapy Certification
Canton City Schools Practical Nurse Program