Kimberly Monoson R.N.

• Promoted a positive work environment by mentoring new nurses and serving as a resource for clinical questions and concerns.
• Contributed to team success by consistently meeting productivity goals while maintaining high-quality standards in job performance.
• Applied critical thinking skills to assess complex medical cases and determine appropriate levels of care in accordance with industry benchmarks.
• Cross training nurses on the PDR and PHP process.
• Cross trained to Commercial Post service, PHP retro, and AGD.

• Department Lead with a staff of 11 fulltime nurses and up to 6 contingent employees.
• Provided coverage for our Business Analyst, during a six-month LOA, by monitoring the FEP PPO Post-Service Mailbox, completing daily inventory reports in Live Facets and Topaz, and collaborating with FEP Claims to answer all questions and ensure timely processing of claims.
• Provided technical expertise for staff when experiencing system issues and submitted requests, as needed, to allow staff access to Topaz, Facets, and AuthAccel.
• Co-authored new Desk Level Procedures (DLP) for post-review.
• Developed a "live" training guide in One Note to assist staff in accurate decision making, keeping them up to date as policies and guidelines change.
• Provided training to new and existing staff to properly process claims using appropriate policies and benefits.
• Collaborated to create a comprehensive Extension of Authority (EOA) guideline for the claims department resulting in reduced inventory by providing the authority to allow identified codes based on specific criteria.
• Completion of all Mock NCQA audits for the FEP Post Service team.
• Created a process to track NCQA cases from start to completion to ensure our offshore company could send out determination letters in a timely fashion.
• Developed templates for more difficult genetic policies by collaborating with the genetic counselor and physician advisors.
• Developed guidelines for processing ambulance claims where there were none previously.
• Reduced claims inventory by assigning batch cases to staff based on their individual proficiencies resulting in increased efficiency.
• Created a process to track NCQA cases from start to completion ensuring our offshore company received determinations for letters to be sent out in a timely fashion.

• Experience with Prior Authorizations, Post Service, and Peer-to-Peer reviews. Assist with daily counts and assignments. Complete medical necessity and level of care reviews for requested services using clinical judgment and referring to Medical Directors for review dependent on case findings. Proficient in the use of Blue Shield of California proprietary software as well as Microsoft Office programs including Word, PowerPoint, Excel, Outlook, Teams, and OneNote.
• In my most recent role as a post-review nurse assigned to the Federal Employee Program (FEP), I have created and maintained procedural templates with notes and organized them within OneNote to assist in training our new and existing staff. Aided management with creating new Desk Level Procedures (DLP). Have provided technical expertise to staff when experiencing computer issues or webcam problems. Attend meetings and provide guidance when needed in genetic testing and extension of authority (EOA) decisions.

Telemetry Unit with frequent floating to Stroke and Medical Surgical floors with travel nursing company. Monitored post-op vitals utilizing Aldrete Score. Provided direct patient care; following medical orders, assigning, delegating and supervising care. Evaluate the responses of individuals or groups to nursing interventions, involving the patients family and the appropriate members of the health care team.

Level 1 trauma nurse. Experience included Stroke, Telemetry, and Cardiac Care units. Floated frequently to assist with staffing ratios. Delivered high-quality and compassionate treatment to indigent and low-income patient communities. Monitored post-op vitals, set up PCA, fluids, reviewed post-op orders and orient patients to unit. Sound, ethical and independent decision-making ability consistent with medical protocols.

I worked as both an LVN and a RN while at this company. Travel and per diem assignments in various settings. Experience includes Medical Surgical, Telemetry, Cardiac Care, Rehabilitation, Stroke, Acute Psychiatric and Chemical Dependency units.

Staff nurse on a Medical Surgical /Telemetry/Bariatric Post Op Unit. Assisted patients with healing and recovery after surgery. Acted as patient advocate and implemented total patient care through a team nursing process covering 4-8 high acuity patients per shift.