Krista Fisher
Spring Hill,FL
Summary
Accomplished RN with a proven track record at Conifer Health Solutions, excelling in clinical documentation and insurance appeals. Demonstrates critical thinking and effective communication, adept at navigating complex healthcare systems like Epic. Achieved a high case resolution rate, showcasing exceptional ability to collaborate with teams and advocate for patient care.
Overview
14
14
years of professional experience
1
1
Certification
Work History
RN Appeal Nurse
Conifer Health Solutions
01.2023 - Current
- Reviewed insurance denials, including but not limited to, medical necessity denials, patient status denials, level of care denials, length of stay denials, readmissions denials, experimental denials, and authorization denials
- Completed clinical summaries, including but not limited to, argued against an insurance denial, confirmed an insurance denial, or reviewed a clinical determination
- Reviewed and utilized clinical criteria, including but not limited to, InterQual, Milliman Care Guidelines, Up ToDate, Medicare Policies, and State Specific Clinical Criteria
RN POSTPARTUM NURSE
Oak Hill Hospital
Brooksville, FL
11.2020 - 12.2022
- Monitor, record, and report symptoms or changes in patients' conditions
- RN, women's health unit, post-surgical women's care, with a transfer into postpartum care
- Catching, recovering and maintaining a safe environment for patients and their new family members
- Sterile OR cesarean catches as well as plenty of opportunity to float to NICU to assist and train with non-well babies
RN Case Manager/ Utilization Review
Conifer Health Solutions
10.2016 - 08.2020
- Responsible for patient admissions, payer notification, portal entry, and Concurrent review
- Ability to navigate Interqual, Midas, Allscripts, OneNote, and Epic, along with multiple Microsoft systems, along with ICD 10 codes medical and surgical cases
- Production averaging between 40-50 cases in an 8-hour day
- Ability to multitask and switch into different databases as needed
- Worked on a Triple screen, with phone, balancing case review, staff meetings, and near constantly changing case review criteria
Registered Nurse
Oak Hill Hospital
Spring Hill, FL
11.2015 - 07.2016
- Intermediate care, within the ICU, triaging patients into higher and lower levels of care
- Assisted in stabilizing patients and preparing them for procedures
- Physical therapy education with positive interactions, for new diagnosis, medications, and treatment plans
- Discharge planning and coordination for patients with newly diagnosed acute conditions
- Updated plan of care and coordinated outpatient services
CNA/LPN/RN
Bayfront Spring Hill Hospital
Spring Hill, FL
08.2011 - 08.2013
- Provided direct hands on patient care, Observation, and treatment of acute patient illness, and advocating for patients in hospital, and home environments
- Coordinated patient care in a team work environment to complete patient, and staffing goals
- Maintained strong and effective relationships among the multiple levels of patient support
- Monitored labs, vitals, and patient complaints
Education
Associate of Applied Sciences - Nursing
Pasco Hernando Community College
Florida05-2014
Some College (No Degree) - Emergency Medical Technician
Fayetteville Technical Community College
North CarolinaSkills
- Clinical documentation
- Utilization review
- Insurance appeals
- Epic charting
- Familiarity with InterQual and MCG
- Effective communication
- Critical thinking
- Team collaboration
Certification
- RN, 9415317, Current
- BLS, 2022
- ACLS, 2021
- LPN, 2013
References
References available upon request.
Timeline
RN Appeal Nurse
Conifer Health Solutions
01.2023 - Current
RN POSTPARTUM NURSE
Oak Hill Hospital
11.2020 - 12.2022
RN Case Manager/ Utilization Review
Conifer Health Solutions
10.2016 - 08.2020
Registered Nurse
Oak Hill Hospital
11.2015 - 07.2016
CNA/LPN/RN
Bayfront Spring Hill Hospital
08.2011 - 08.2013
Associate of Applied Sciences - Nursing
Pasco Hernando Community College
Some College (No Degree) - Emergency Medical Technician
Fayetteville Technical Community College
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