Lovie Zago
East Liverpool,OH
Summary
Experienced Ohio Registered Nurse (RN) with expertise in insurance precertification for Diagnostic Imaging (CT, MRI, PET/CT, etc.), Medical Oncology (IMRT, 2D3D, SBRT/SRS), Chemotherapy Medications, and supportives. Skilled in reviewing Biopsy/Surgical services (Prostatectomy, Lung wedge resections, Mastectomy, Lumpectomy) and various Ablations (Cryogenic, Radiofrequency, Microwave, Waterjet). Proficient in ICU/CCU unit nursing, Urgent care, Dialysis, CPR, and EKG. Conducts thorough utilization reviews to ensure efficient resource use and optimal patient care. Utilizes clinical judgment for assessing and recommending appropriate treatment plans. Ensures compliance with healthcare regulations while striving to improve patient outcomes.
Overview
10
10
years of professional experience
Work History
Case Management/Discharge Planner/Utilization Review Nurse
East Liverpool City Hospital
11.2024 - Current
- Improved patient satisfaction by carefully evaluating their needs and developing personalized discharge plans.
- Advocated for patients'' best interests, working closely with healthcare providers to develop appropriate treatment plans and interventions.
- Coordinated timely discharges by effectively communicating with physicians, nurses, social workers, and other relevant stakeholders.
- Established strong relationships with community agencies, enabling effective coordination of post-discharge support services.
- Solved problems related to abrupt changes in discharge, coordinated updates and communicated discharge plans.
- Contributed to organizational success by providing expert advice on medical necessity criteria and evidence-based practices in utilization review nursing.
- Submitted cases for criteria failures and helped facilitate resolutions and approvals.
Utilization Review Nurse
WNS Global/HealthHelp
01.2019 - 07.2024
- Build and/or review cases per NCD/LCD and NCCN guidelines depending on hierarchy. Conduct a thorough review of medical records to assess safety and medical necessity. Utilize clinical knowledge and evidence-based guidelines to make recommendations, approve or deny requested services.
- Contributes to the development and implementation of utilization review policies and procedures.
- Collaborate with Healthcare providers and staff to gather additional information and documentation discrepancies.
- Reduced healthcare costs through efficient utilization of resources and identification of unnecessary treatments or procedures.
- Ensured compliance with regulations and accreditation standards by maintaining accurate documentation of all utilization review activities.
- Maintained professional competence by staying current on industry trends, best practices, and regulatory requirements specific to utilization review nursing.
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
Dialysis Nurse
Davita Dialysis
10.2017 - 10.2019
- Enjoyed and thrived in this fast-paced outpatient environment.
- Shift charge Nurse maintaining patient safety and administering prescribed pre and post treatment medications.
- Programmed and set up machines to MD specifics for each patient. (32-36 each day)
- Canulated fistulas and initiated treatment through tunneled cuff catheters.
- Disinfected and broke down all machines.
- Maintained updated records on all patients.
- Lead educational trainings daily for patients regarding infections and fluid intake.
- Analyzed emergency situations and took prompt action to save lives.
- Collaborated with interdisciplinary team members to develop individualized care plans for dialysis patients, resulting in improved overall health and wellbeing.
- Upheld regulatory compliance within the facility by staying current on industry standards and adapting practices accordingly.
- Contributed to the successful accreditation of the dialysis center by maintaining accurate documentation of patient assessments, treatments, and outcomes.
Nurse
MedExpress Urgent Care
05.2015 - 12.2018
- Gather information and documents to support between 40-80 patient visits per day.
- Maintain complete, timely and accurate clinical documentation for each patient.
- Room patients, take vitals and health history, document in electronic medical record.
- Injections administration, assist with minor procedures, venipuncture for blood draws and IV insertion.
- Complete plan of care.
- Executed nursing interventions by collaborating with interprofessional team to incorporate standards of care, practice and patient outcomes.
- Educated patients on proper aftercare procedures, potential complications, and necessary follow-up appointments to promote long-term health and recovery.
Education
Associate Degree - Applied Science with concentration in Nursing
West Virginia Northern Community College School of Nursing
Weirton, WV01.2016
Skills
- HIPAA compliance
- Healthcare systems navigation
- Patient support
- Medication reconciliation
Timeline
Case Management/Discharge Planner/Utilization Review Nurse
East Liverpool City Hospital
11.2024 - Current
Utilization Review Nurse
WNS Global/HealthHelp
01.2019 - 07.2024
Dialysis Nurse
Davita Dialysis
10.2017 - 10.2019
Nurse
MedExpress Urgent Care
05.2015 - 12.2018
Associate Degree - Applied Science with concentration in Nursing
West Virginia Northern Community College School of Nursing
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