Juliette T. Beynon
Miami,FL
Summary
Diligent [Desired Position] with solid background in utilization review and patient care coordination. Proven ability to streamline processes and enhance patient outcomes through efficient resource management. Demonstrated expertise in case management and regulatory compliance.
Overview
20
20
years of professional experience
Work History
Utilization Review Nurse, OBSERVATION AND ALL ICU
NORTHSHORE MEDICAL CENTER
MIAMI FL
02.2023 - Current
- Performed in-depth assessments of patient medical records to guarantee adherence to utilization management protocols.
- Collaborated with multidisciplinary teams to optimize patient care plans and resource allocation.
- Analyzed clinical documentation for accuracy and adherence to regulatory standards, enhancing overall quality assurance processes.
Nurse Case Manager, Telemetry Unit
North Shore Medical Center
Miami, FL
10.2015 - Current
- Assess patient and family needs for appropriate coordination of care and discharge planning.
- Collaborate with care providers, insurances, physicians and other medical professionals assessment Planning and facilitation of care coordination to promote quality, cost-effective outcomes and achieve client Wellness.
- Utilization review for quality medical and cost effective outcomes.
- Precertification for post hospitalization dc placement.
- Insurance appeals when inpatient admission denied by insurance.
- Payor request to change status from inpatient to observation and observation to inpatient.
- Patient advocacy.
Concurrent Review Nurse/OB Telephonic Nurse Case Manager
SIMPLY HEALTHCARE (HEALTHCARE BENEFITS PLAN/HMO)
MIAMI, FL
11.2014 - 02.2015
- Reviewed inpatient admissions to assure appropriate level of care, and coordinated delivery of patient care With physicians staff and facilities.
- Monitored clinical activities related to care and discharge plans.
- Identified cost-effective protocols and alternative levels of care when requested care was not covered.
- Conducted daily concurrent review with Medical Director to determine medical necessity of admission, continued Stay and discharge planning.
Community Liaison
CATHOLIC HOSPICE
MIAMI LAKES, FL
04.2012 - 10.2014
- Resolve customer complaints regarding service.
- Oversee regional and local sales managers and their staffs.
- Plan and direct staffing, training, and performance evaluations to develop and control sales and service programs.
- Review operational records and reports to project sales and determine profitability.
- Monitor customer preferences to determine focus of sales efforts.
- Confer with potential customers regarding needs potential hospice related needs of patients and advise on types of service options.
- Develop territory business plan to increase admissions and referrals from nursing facilities, physician offices, hospitals and staff.
Nurse Case Manager Founder's Unit/Cardiac ICU
MT SINAI MEDICAL CENTER
MIAMI BEACH, FL
01.2006 - 03.2012
- Monitored care for up to 50 or more patients in most hospital units.
- Quality Assurance/Utilization Review
- Discharge planning
- Interqual Reviews
- Reviewed all admissions for appropriate level of care and coordinated dc with patient and families and physicians.
Education
Candidate for Registered Nurse(RN) Degree -
Miami Dade Community College
Miami, FLLicensed Practical Nurse(LPN) Degree - undefined
Miami Lakes Technical School
Miami Lakes, FL01.1991
LPN -
Miami Lakes Technical Institute
Miami Lakes, Fl12-1991
Skills
- Customer Service
- Benefit Coordination
- Detailed and Organized
- Benefit Plan Coordination
- Utilization Review
- Medical Terminology
- Interqual/Encoding
- Discharge Planning
- Proficient in Microsoft Office
- Allscripts, Ecin, Cerner, Morrisey programs
- Bilingual Spanish and English
- Certified CPR and First Aid
Languages
English
Native or Bilingual
Spanish
Native or Bilingual
French
Limited Working
Timeline
Utilization Review Nurse, OBSERVATION AND ALL ICU
NORTHSHORE MEDICAL CENTER
02.2023 - Current
Nurse Case Manager, Telemetry Unit
North Shore Medical Center
10.2015 - Current
Concurrent Review Nurse/OB Telephonic Nurse Case Manager
SIMPLY HEALTHCARE (HEALTHCARE BENEFITS PLAN/HMO)
11.2014 - 02.2015
Community Liaison
CATHOLIC HOSPICE
04.2012 - 10.2014
Nurse Case Manager Founder's Unit/Cardiac ICU
MT SINAI MEDICAL CENTER
01.2006 - 03.2012
Licensed Practical Nurse(LPN) Degree - undefined
Miami Lakes Technical School
Candidate for Registered Nurse(RN) Degree -
Miami Dade Community College
LPN -
Miami Lakes Technical Institute