Experienced with patient care, clinical assessments, and medical documentation in many work settings. Utilized strong interpersonal skills to foster patient trust and enhance care delivery. Track record of maintaining accurate health records and implementing effective care strategies.
Work History
Quality Compliance Assistant
FLOYD MEMORIAL HOME HEALTH CARE
New Albany, IN
1993 - 1997
Assisted in conducting compliance audits to ensure adherence to regulations and company policies.
Supported development and implementation of compliance training and infection control programs for staff.
Monitored regulatory changes and assessed impact on organizational practices and procedures.
Collaborated with cross-functional teams to identify compliance risks and recommend mitigation strategies.
Wrote and implemented infection control policies and procedures.
Home Health Nurse
Floyd Memorial Hospital
New Albany, IN
1991 - 1993
Telephone Triage RN
OPTUM HEALTHCARE
Minneapolis, MN
01.2023 - 12.2024
Worked as Telephone Triage RN. Took incoming calls for a hospital system in Pennsylvania to triage patients' symptoms and guide them to the appropriate level of care. Handled call for both adult and pediatric patients. Utilized Epic and Cerner medical record programs to access medical records, communicate with physicians and office staff, schedule appointments.
Covid Nurse
CHANGE HEALTHCARE
Nashville, TN
06.2022 - 01.2023
Became full time employee of Change Healthcare, after working for them as a temporary employee – see last listing for Signature Staff Resources.
Covid Nurse
SIGNATURE STAFF RESOURCES
Rockwall, TX
01.2021 - 06.2022
Hired as temporary employee working for the New York City Department of Health. Telephonic outreach program to deal with COVID 19 questions, encourage testing and vaccinations. Made 50-75 outreach calls daily in a 12-hour shift. Took incoming phone inquiries about COVID and provided telephone triage and advice.
Telephonic Case Manager
CAREWISE HEALTH
Louisville, KY
01.2017 - 12.2019
Started as a temporary employee and hired full-time after 3 months. Interacted with multiple clients to teach and support lifestyle changes. Provided education about new and changed disease processes to maximize compliance with medical plan of care. Utilizing InterQual, reviewed and authorized transplants of all kinds, serving as department liaison with transplant centers.
Hedis Review Nurse
WELLCARE
Louisville, KY
02.2016 - 05.2016
Performed chart review for HEDIS data collection in a temporary position.
Rapid Response Case Manager
PASSPORT HEALTH PLAN
Louisville, KY
01.2011 - 05.2015
Responded to urgent/emergent needs of plan members ranging from medication problems to DME needs. Managed some members for compliance, arranging transportation and home health services. and navigating a path through the system to meet the member's needs.
Medical Review Nurse
NATIONAL GOVERNMENT SERVICES
Louisville, KY
06.2002 - 10.2010
Performed pre-pay and retrospective medical record audits to trigger fraud and abuse investigations and determine compliance with Medicare regulations. Educated healthcare providers and their staff, facilitating improved billing practices and timely payment. Initiated recoupment of payments not supported by medical records. Performed inter-rater reliability audits with peers.
Clinical Manager
VISITING NURSE ASSOCIATION
Louisville, KY
05.1999 - 06.2002
Managed nurses and personal care attendants providing private duty home care. Performed intake assessments and periodic updates. Managed payroll data to ensure timely and correct payment for staff. Taught orientation classes and provided periodic updates. Served as contact for patients and families to coordinate care.
Oversaw office operations for six-month period while Director was on medical leave.
Supervised office staff of five and clinical staff of more than thirty.
Case Manager
HUMANA INC.
Louisville, KY
09.1997 - 05.1999
Coordinated care and services for health plan members telephonically while hospitalized. Supported delivery of quality, cost effective and medically appropriate health care. Maintained close and effective working relationships with hospital discharge planners.
Nurse Case Manager & Compliance Training Manager at Marin City Health and Wellness CenterNurse Case Manager & Compliance Training Manager at Marin City Health and Wellness Center
Medical Student Clinical Compliance Coordinator at Florida Atlantic University, Schmidt College of MedicineMedical Student Clinical Compliance Coordinator at Florida Atlantic University, Schmidt College of Medicine