Karissa Martin

.

• Perform critical review and analysis of initial medical records for each claimant.
• Provide quality investigations of medical information utilizing the resources available.
• Consult with clinicians to devise and manage ongoing care plans for at-risk patients.
• Enhanced interdisciplinary collaboration through effective communication with physicians, pharmacists, and other healthcare professionals.
• Identify insurance coverage limitations with thorough examinations of claims documentation and related records.
• Analyze information gathered by investigation and report findings and recommendations.
• Document information gathered in field and upload data to company database for efficient processing using Caseworks and Risxfax software programs.
• Establish productive working relationships with physicians and healthcare organizations.
• Maintain contact with claimants, employers, adjustors and attorneys to determine treatment status.
• Review and evaluate Independent Medical Examination (IME) reports and Functional Capacity Evaluation (FCE) reports.
• Research claims and incident information to deliver prompt scheduling and resolve problems.
• Analyzed information provided by medical records and reported findings and recommendations utilizing ODG Guidelines.
• Help claims adjustors increase knowledge of medical terminology and conditions through regular communication.
• Assist with the development of return-to-work plans
• Continue to research medical conditions and be knowledgeable on the tools necessary to perform this research.
• Communicate biweekly and as needed both verbally and in writing with providers, subscribers, adjustors, attorneys, and other appropriate contacts in a professional and effective manner, resolving discrepancies and clarifying medical information, including diagnosis, treatment planning, prognosis, restrictions, limitations, and duration of conditions related to work injury parameters , length and severity of medical condition related to injury and return to work.
• Participate in triage and multi-disciplinary meetings to provide expertise on medical issues
• Current RN license, CCM certification, BSN.
• 10 years of nursing experience in hospital clinical setting.
• Participate in townhall industry meetings.
• Experience in utilization review/health care industry insurance.
• Strong research, analytical, critical thinking, problem solving and decision-making skills.
• Excellent verbal and written communication skills.
• Ability to work well in remote and/or team environment, ability to initiate and prioritize regular work duties and projects, detail oriented, organized, strong ability to multi-task, and excellent time management skills
• Synthesize data into comprehensive monthly written reports for management.
• Ability to initiate and prioritize regular work duties and projects.

Medical Surgical Floor RN bedside nurse, most recent clinical experience. Also worked as RN 1995-2001 in various inpatient hospital settings.