Years of professional nursing experience
Hi, I’m
Kelly Smith
Registered Nurse
Haw River,USA
Summary
Extremely experienced, knowledgeable, versatile and talented Registered Nurse with over 8 years of extensive nursing background at a world-renowned tertiary teaching hospital. My CV reflects strong nursing skills demonstrated in a highly intensive inpatient hospital environment. In addition, I have also performed Team Lead roles, developed onboarding training materials as well as developed and delivered ongoing staff education. I assisted with the creation and editing of a hospital’s CDI Handbook for physicians. Additionally, I worked closely with the Centers for Medicare & Medicaid (CMS) regarding ICD-10 guidelines and policies. In this position, I created and implemented policies for Medical Necessity chart review for commercial and government contracts that fit the utilization management (UM) criteria required by CMS. I am seeking remote opportunities that will allow me to grow my future while working at home. My education, qualifications, skills set and employment background makes me an ideal candidate. My contact information is noted above. I look forward to communicating with hiring managers.
Overview
8
4
years of post-secondary education
Work History
SSI Select Source International (w/BCBS)Minnetonka, Minnesota
RN, Episodic Care Manager/UM Nurse
03.2023 - Current
Job overview
- As an RN, this role requires Utilization Management skills to act as an advocate to promote and coordinate quality and cost-effective healthcare services based on medical necessity through the use of medical policies and contractual plan benefits
- My role as an Episodic Care Manager/UM Nurse is to coordinate with providers and healthcare consumers to support the delivery of high-quality care
- It requires the nurse to use a problem-solving approach and effective organizational skills
- Responsibilities for this role include performing prior authorizations as well as the facilitation and coordination of care delivery across the health care continuum to ensure access to continuity of care and in-network exceptions
- The Episodic Care Manager/UM Nurse utilized detailed clinical knowledge to summarize the clinical review and compare this information against guidelines and criteria to provide information necessary for the MD’s review
- Referral for secondary care review for denials are an important part of this role
- The ultimate goal is to help patients improve their quality of life.
Cotiviti Healthcare AnalyticsAtlanta, GA
Registered Nurse (RN), Operations Coordinator
06.2018 - 02.2023
Job overview
- Building on previous RN experience, this role required a nurse that was team focused with a strong clinical background in nursing
- I was charged with creating and implementing policies for Medical Necessity chart review for commercial and government contracts that fit the utilization management (UM) criteria required by Centers for Medicare & Medicaid (CMS)
- I developed and maintained a client-driven communication database
- In addition, I lead biweekly client-specific meetings for CMS
- I was the team representative for overseeing, organizing and maintaining CMS’s national documentation code committee
- I also created onboarding training material for new hires and conducted staff training as needed
- I oversaw prioritization meetings for departmental IT projects
- I created and submitted monthly business reports and performed monthly accuracy studies
- I was responsible for creating educational materials and training for Concept Development Analysts on reporting confidence level and concept performance leading to increased revenue generation potential
- I maintained CMS-approved New Issues website and setup the structure for our team’s SharePoint site
- Finally, I created, tracked, communicated, followed-up, and then distributed results from an external research team.
Duke University HospitalDurham, NC
Registered Nurse (RN), Cardiothoracic ICU Stepdown
08.2015 - 06.2018
Job overview
- RN required position: Provide direct quality care to a variety of cardiothoracic patients (heart and lung transplant, LVAD, CABG)
- Collaborate with interdisciplinary team members to ensure safe environment
- Monitor and evaluate response to prescribed treatment plan
- Document assessment results, medication administration, interventions and changes in care plan as necessary
- Provide supportive atmosphere for patient care, as well as for patient and family education.
Duke Heart Center/Duke University Health SystemDurham, NC
Administrative Assistant
08.2008 - 01.2010
Job overview
- Assistant to the Left Ventricular Assist Device (LVAD) Program Coordinator of the Duke Heart Center
- Perform a wide variety of administrative duties related to the program operations
- Participated in FDA and Joint Commission audits
- Assisted with Thoratec new product rollout for the HeartMate II
- Coordinated protocols and infection control for physician group
- Designed, created and implemented a Device Accountability Implant Excel database
- Provide ongoing computer teaching to LVAD Program Coordinator, office and clinical staff.
Duke University School of LawDurham, NC
Senior Publication Manager
05.2003 - 08.2008
Job overview
- Plan, create, implement and coordinate active student orientation to law journal publication, and continually mentor and coordinate student progression throughout this process from article submission to publication
- Manage customer service for the design, production and distribution of a variety of University publications and printed materials, including eight internationally renowned law journals publishing 18 issues annually
- Work directly with eight law journal editors to develop detailed publication specifications, including accurate deadline dates, and assist law students in journal article publication as well as planning and execution of annual Case note (journal membership) competition attracting 200 participants each year
- Establish and manage production schedules, as well as specifications for the production process to ensure quality meets established standards and guidelines.
Education
Campbell UniversityBuies Creek, NC
Bachelors of Business Administration from Dual focus in Computer Information Systems
08.1998 - 12.2002
University Overview
- Completed professional development in both Business Administration and a dual focus in Computer Information Systems.
University of North Carolina At Wilmington
Bachelors of Science in Nursing
Alamance Community College
Associates Degree in Nursing
Skills
- Professional RN for 8 years
- Episodic Care Manager/Utilization Management (UM) Nurse
- Medical Necessity Review
- CMS: created and implemented policies for Medical Necessity chart review for commercial and government contracts that fit the utilization management (UM) criteria required by Centers for Medicare & Medicaid (CMS)
- Demonstrated knowledge in quality improvement theory and practices
- Strong customer service skills with excellent attention to details
- Leadership Proven, Solid, Productive, Efficient, Organized, Reliable, Team Oriented
- Strong analytical and problem-solving skills; excellent communication skills, effective time management skills, proficient organizational and planning skills
- Adapt easily and accepting of change in the work environment
- Ability to work independently as well as part of a team
- Proficient in Microsoft Office, Excel, Pivot Tables, PowerPoint and EMR’s (eg EPIC)
- Developed onboarding training materials; Creation of CDI handbook and training materials (as noted above)
- Conducted staff training in multiple settings
- Six Sigma Yellow Belt trained
- Acknowledge that increasing diversity, inclusion and equity continues to be a struggle in many places of work I am committed to this goal due to a belief that it will result in high performance and creativity and will have a positive effect on morale and health
- Patient Management
- Culturally-Sensitive Care
- Healthcare Billing
- Wound Care
- Electronic Health Records Management
- Medical Recordkeeping
- Critical Care
- Care Planning
- Data Collection
- Medical Assessment
- Case Management
- Chronic Disease Management
- Licensed RN
- Strong Clinical Judgment
- Immunization Skills
- Feeding Assistance
- Emotional Intelligence
- Community Advocate
- Family and Patient Support
- Patient Education and Counseling
- Physical Assessments
- Complex Problem-Solving
- Patient Discharge
- Staff Development and Precepting
- Documenting Vitals
- Patient Care
- Medical Records Management
- Palliative and Pain Management
- Nursing Plan Development and Modification
- Patient and Family Advocacy
- Relationship Building
- Patient Satisfaction and Process Improvement
- Body Mechanics Knowledge
- Patient Relations
- Patient Monitoring
- Collecting Vitals
- Medical Screening
- IV and Venipuncture Certified
- Medication Administration
- Patient Care Planning
- Medisoft
- [Type] Regulatory Compliance
- Epic EHR Management
- HIPAA Education
- Clinical Information System Management
- Health and Wellness Expertise
- Family Education
- Direct Patient Care
- Patient Reaction Monitoring
- Patient Assessments
- Care Plan Development
- Professional Bedside Manner
- Managing Deadlines
- Follow-Up Calls
- Treatment Planning
- Team Coordination
- Resource Allocation
Licenses
Title: BSN, RN
Timeline
RN, Episodic Care Manager/UM Nurse
SSI Select Source International (w/BCBS)
03.2023 - Current
Registered Nurse (RN), Operations Coordinator
Cotiviti Healthcare Analytics
06.2018 - 02.2023
Registered Nurse (RN), Cardiothoracic ICU Stepdown
Duke University Hospital
08.2015 - 06.2018
Administrative Assistant
Duke Heart Center/Duke University Health System
08.2008 - 01.2010
Senior Publication Manager
Duke University School of Law
05.2003 - 08.2008
Campbell University
Bachelors of Business Administration from Dual focus in Computer Information Systems
08.1998 - 12.2002
University of North Carolina At Wilmington
Bachelors of Science in Nursing
Alamance Community College
Associates Degree in Nursing
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