Summary
Overview
Work History
Education
Skills
Timeline
Generic

Kimberly Ascenzo

Huntington,WV

Summary


I am a seasoned license practical nurse with over 20 years of various clinical experience. I have worked with various EMR systems. I am proficient in Microsoft Word, Excel, Outlook, and Microsoft Teams. I am knowledgeable in all things clinical, technologically inclined and proficient, a strong leader, and an effective communicator. I have strong IT competence, am self motivated, detail oriented, I utilize time management effectively, am able to work independently and am disciplined. I am very passionate about what I do. I am looking to obtain a position as a review nurse, where my skills can be used to their fullest potential and to ensure patients receive the best possible care.

Overview

16
16
years of professional experience

Work History

Utilization Review Nurse

HealthHelp
06.2014 - 01.2025
  • Knowledge of regulations and accreditation requirements by state and specific markets and apply appropriate LCD/NCD, HealthHelp or Client’s medical policy guidelines.
  • Perform utilization review of cases (such as DI, Cardiac and sleep) to determine if the request meets criteria.
  • Facilitates resolution of escalated cases that may require special handling.
  • Perform clinical intake and utilization review according to the policies and procedures of HealthHelp for markets and cases requiring expedited turnaround times.
  • Perform quality audits on peer reviews to assure the accuracy and appropriateness of HealthHelp's policy guidelines.
  • Refer cases to a Physician Reviewer or Specialty Medical Director per guidelines
  • Assist Physician Reviewer Medical Directors as necessary to ensure timeframe compliance.
  • Maintain written documentation according to HealthHelp’s documentation policy.
  • Ensure consistency in implementation of policy, procedure and regulatory requirements in collaboration with Nursing Management.
  • Adheres to all HIPAA, state and federal regulations pertaining to the clinical programs
  • Provide quality customer service through interaction with providers, administrative staff and others.
  • Adheres to both URAC & NCQA standards.
  • Perform multiple tasks simultaneously, prioritize projects, work independently under pressure, and meets critical deadlines.
  • In depth understanding of healthcare regulations and compliance, and proficient in insurance guidelines.
  • Maintained professional competence by staying current on industry trends, best practices, and regulatory requirements specific to utilization review nursing.
  • Contributed to organizational success by providing expert advice on medical necessity criteria and evidence-based practices in utilization review nursing.

Hospice Nurse

Amedysis Hospice
01.2009 - 06.2014
  • Provide excellent direct patient care.
  • Collaborate with a full Hospice interdisciplinary team to implement and deliver nursing care as outlined in a patient specific care plan.
  • Assess, monitor, document and report progress of patient’s health condition within the established timelines.
  • Participates as a member of the interdisciplinary team and attend patient care conferences to maintain continuity of care.
  • -Conducted pt. chart audits ensure criteria was met to receive care under Hospice guidelines, proper documentation was used and adequate care was provided.
  • Managed pain effectively by closely monitoring symptoms and adjusting medications accordingly.
  • Improved patient comfort by providing compassionate end-of-life care and symptom management.
  • Coordinated with physicians to adjust medications as needed for optimal palliative care outcomes.
  • Offered listening ear to both patients and loved ones to meet emotional and mental, as well as physical needs.
  • Promoted a peaceful and supportive environment for patients and their families during the end-of-life transition.
  • Advocated for patients'' wishes regarding medical treatment options, respecting cultural beliefs and values throughout the decision-making process.
  • Assisted in training new hospice nurses, sharing expertise in end-of-life care best practices.
  • Facilitated smooth transitions from acute hospital settings to home-based hospice care environments, promoting continuity of care.
  • Maintained up-to-date knowledge of current research findings in palliative care nursing practice through ongoing professional development opportunities.
  • Increased patient satisfaction by addressing emotional, spiritual, and physical needs holistically.

Education

IV Certification -

Rio Salado Community College
01.1999

LPN- Multistate License 22336 -

BM Spurr School of Practical Nursing
GlenDale, WV
08.1997

Skills

  • Strong prioritization and organization
  • Utilization review, Denial Management
  • Quality/Review Integrity
  • Ability to manage multiple assignments effectively
  • Ability to maintain high quality work while meeting strict deadlines
  • Clinical Chart Review
  • Critical Thinking
  • Documentation and reporting
  • Physician consultations
  • Prior authorization
  • HIPAA compliance
  • Insurance verification
  • Quality improvement
  • Healthcare regulations
  • Utilization management
  • Performing assessments, Patient care plans, Plan of care support, Discharge planning coordination
  • Direct patient care- Medication and IV administration, Intravenous therapy, Blood draw and sample collection, Monitoring vital signs, Physical assessment, Patient education
  • Medication administration, Pain management, Palliative care, Active listening

Timeline

Utilization Review Nurse

HealthHelp
06.2014 - 01.2025

Hospice Nurse

Amedysis Hospice
01.2009 - 06.2014

IV Certification -

Rio Salado Community College

LPN- Multistate License 22336 -

BM Spurr School of Practical Nursing

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