Kelly Rasmussen
Webster,NY
Summary
Self-directed, dedicated professional nurse with 16 years of healthcare experience in a variety of medical settings including medical/surgical units, care of surgery patients, circulating and scrub nurse in the operating room, utilization management and most recent clinical review nurse with demonstrated proficiency in complex medical review determinations. Superior at multitasking, organization and prioritization of daily tasks. Quality-focused and efficiency driven leader.
Overview
7
7
years of professional experience
Work History
Clinical Review Nurse II
National Government Services
03.2022 - Current
- Render complex medical necessity determinations in accordance with regulations, guidelines, and coverage criteria
- A mentor for team members, responsible for analyzing documentation assigned to peers and guiding final review determinations when questions arise, pertaining to reasonable and necessary services and technical requirements
- Partnered with project supervisor and senior nurses to develop and implement review worksheet, guidelines and resources
- Served in leadership roles as subject matter expert in high priority CMS projects.
Clinical Review Nurse I
National Government Services
05.2018 - 03.2022
- Developed a solid foundation for Medicare and Medical Review knowledge with a strong basis for fundamentals
- Rendered medical necessity determinations in accordance with regulations, guidelines and coverage criteria
- Proven ability to excel by demonstrating top quality assurance scores of 100%.
- Mentored newly hired peers
- Assisted in the PI Hospice work stream when needed due to high project volume and deadlines
- Conducted Discussion and Education sessions with providers regarding claim determinations and clinical documentation improvements for future reviews.
Utilization Management Registered Nurse
Strong Memorial Hospital, University Of Rochester
09.2017 - 05.2018
- Review clinical documentation utilizing evidence-based criteria to support medical necessity and appropriate level of care for services provided
- Collaborate with health information management department, financial counselors, physicians, social workers, and insurance companies to ensure prompt outcomes
- Utilize strong computer skills including proficiency in Microsoft Word, Office and Excel with excellent documentation and navigation within electronic medical record.
Education
Bachelor of Science - Nursing
St. John Fisher College
Rochester, NY06.2007
Skills
- Highly motivated and skilled Clinical Review Nurse II with demonstrated proficiency in medical review and making complex medical determinations
- Ability to readily adapt to new situations and problem solve while maintaining prioritization of daily tasks
- Manage timely deadlines in a fast-paced work environment with a calm and positive attitude
- Willingness to always help with project needs along with helping newly hired staff
- Continually maintain strong and effective communication between project leads, seniors, and supervisors while maintaining HIPAA compliance
- Microsoft Office & Excel proficiency
Timeline
Clinical Review Nurse II
National Government Services
03.2022 - Current
Clinical Review Nurse I
National Government Services
05.2018 - 03.2022
Utilization Management Registered Nurse
Strong Memorial Hospital, University Of Rochester
09.2017 - 05.2018
Bachelor of Science - Nursing
St. John Fisher College
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