KRISTI BEADLE
Columbia,SC
Summary
Compassionate Registered Nurse with 10+ years experience offering comprehensive patient care in outpatient environments. Works well with diverse patient populations and fosters trusting relationships to improve outcomes. Efficiently coordinate with healthcare professionals to advance patient care.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Nurse
SC DHEC
Columbia, SC
09.2020 - Current
- Serve as a member of the Regional Infection Control and Prevention Team
- Assist congregate facilities with recommendations and guidelines associated with COVID - 19
- Serves as a team member and conducts site assessments and work closely with facility leadership to implement CDC and DHEC guidelines and best practices
- Responsible for ensuring and evaluating infection control measures are adhered in COVID 19 response activities in assigned Region
- Assist Epidemiology department with obtaining line lists from facilities with test results
- Ensures appropriate PPE secured to maintain appropriate infection control measures
- Assist with the ordering and supply process of PPE needs for congregate facility.
Palliative Care Managed Care Coordinator II
BlueCross BlueShield/Kelly Services
Columbia, South Carolina
12.2017 - 08.2020
- Compassionately providing case management to hospice and palliative care patients throughout continuum in a variety of settings (home, inpatient, skilled nursing facilities, long term acute care)
- Providing primary and supervisory care to patients and their families, including implementation, evaluation and modification of plan of care to optimize symptom management and quality of life
- Integrating education seamlessly into care to promote comfort and confidence among patient and caregivers
- Review and evaluate medical eligibility regarding benefits and clinical criteria by applying clinical expertise, administrative policies and established clinical criteria to service requests or providing health management program interventions
- Using clinical proficiency, claims knowledge/analysis and comprehensive knowledge of health care continuum to assess, plan, implement, coordinate, monitor and evaluate medical necessity, options and services required to support members in managing their health, chronic illness or acute illness.
Appeals Analyst
BlueCross BlueShield
Columbia, South Carolina
02.2015 - 03.2017
- Perform review of provider reconsiderations and member appeals documenting the basis of the appeal in an accurate and timely manner in accordance with applicable regulations and/or standards
- Perform thorough research of the substance of service appeals by both member and provider based on clinical documentation, contractual requirements, governing agencies, policies and procedures, while adhering to confidentiality regulations regarding protected health information
- Perform appeals and retrospective reviews demonstrating ability to determine precedence of pertinent issues in application of policies and procedures to clinical information and or application to benefit or policy provision
- Performed pre-service appeals through thorough research of first denial of utilization management case
- Participated in the preceptor program to improve training and development of new staff members
- Utilize Milliman criteria to determine medical necessity of inpatient services requested
- Referred provider requests and member appeals appropriately to Medical Director when medical necessity of services are not met based on policies and procedures in place
- Provided clinical resources to referral staff
- Served as a liaison between Providers and the Medical Director
Case Manager I, Authorization
Absolute Total Care
Columbia, South Carolina
04.2013 - 02.2015
- Reviewed provider requests (inpatient, outpatient, therapy, office visits) through fax, telephone, or web to ensure medical necessity for services requiring preauthorization (initial and retro)
- Utilized Interqual criteria and/or internal policies to determine medical necessity of services requested
- Referred provider requests appropriately to Medical Director when medical necessity of services was not met based on criteria
- Communicated telephonically with provider representatives, physicians and hospitals
- Served as a liaison between Providers and the Medical Director
Senior Medical Reviewer/Team Leader
Palmetto GBA
Columbia, SC
03.2011 - 04.2013
- Served as team lead for the appeals (first level redetermination) areas by providing assistance and support to unit manager and by giving direction, guidance and training to staff
- Performed quality assurance (QA) reviews on all assigned team members
- Performed medical reviews of appealed Medicare services using clinical/medical information provided by physicians/providers and Interqual, Medicare National and Local Care Determinations (NCD or LCD’s), and/or established criteria/protocol sets or clinical guidelines
- Documented decisions using indicated protocol sets or clinical guidelines.
Registered Nurse
Hope Bridge Adult Daycare
Cayce, South Carolina
12.2009 - 03.2011
- Provided direct supervision and management to all nursing assistants to ensure clients’ medical needs were met
- Administered all medications and implemented ordered medical procedures to clients
- Performed nursing assessments
- Updated and reviewed care plans and doctors’ orders
- Documented and monitored the quality of care.
Registered Nurse
Palmetto Health Richland Heart Hospital
Columbia, South Carolina
01.2009 - 11.2009
- Responsible for daily care of assigned patients to include but not limited to 2 daily physical assessments, appropriate administration of medications, hourly telemetry monitoring, EKG strip measurements, and appropriate computer charting documenting all care administered and patient’s condition.
Education
Associate Degree in Nursing -
Midlands Technical College
West Columbia, SC12.2008
Skills
- Patient Condition Monitoring
- Community Service Participation/Volunteer
- Clear Patient Communication
- Microsoft Windows
- Microsoft Outlook
- Compassionate and Caring
- Board member of CMSA
- Immunizations and Vaccinations
- Microsoft Office
- Community Program Referrals
- Speaking
- Coordination
Certification
- Certified Case Manager
Timeline
Nurse
SC DHEC
09.2020 - Current
Palliative Care Managed Care Coordinator II
BlueCross BlueShield/Kelly Services
12.2017 - 08.2020
Appeals Analyst
BlueCross BlueShield
02.2015 - 03.2017
Case Manager I, Authorization
Absolute Total Care
04.2013 - 02.2015
Senior Medical Reviewer/Team Leader
Palmetto GBA
03.2011 - 04.2013
Registered Nurse
Hope Bridge Adult Daycare
12.2009 - 03.2011
Registered Nurse
Palmetto Health Richland Heart Hospital
01.2009 - 11.2009
Associate Degree in Nursing -
Midlands Technical College
Similar Profiles
Caroline OwenCaroline Owen
Laboratory Technician III- Specimen Gate Lead at SC Department of Public Health (Previously DHEC)Laboratory Technician III- Specimen Gate Lead at SC Department of Public Health (Previously DHEC)
Amanda SwireAmanda Swire
Administrative Support -TEMP at AppleOne-DHECAdministrative Support -TEMP at AppleOne-DHEC
Maria BrantleyMaria Brantley
WIC Nutritionist II at South Carolina DHECWIC Nutritionist II at South Carolina DHEC
Madison McWalterMadison McWalter
Medical Assistant at Hatch PediatricsMedical Assistant at Hatch Pediatrics
Sha’Miyah JonesSha’Miyah Jones
Team Lead at Pizza HutTeam Lead at Pizza Hut