Maria Molzahn
Registered Nurse
Green Bay,WI
Summary
Enthusiastic Clinical Claim Review RN eager to contribute to team success through hard work, attention to detail and excellent organizational skills. Clear understanding of clinical review and existing processes with experience in analyzing clinical data and identifying opportunities for process enhancement and training. Motivated to learn, grow and ready for a new opportunity to apply exceptional nursing skills in quality improvement and specialist setting.
Overview
14
14
years of professional experience
7
7
years of post-secondary education
3
3
Certifications
Work History
Clinical Claim Review Registered Nurse
Optum
Green Bay, WI (Remote)
01.2021 - Current
- Perform clinical reviews on Veteran Disability Benefit Questionnaires.
- Skilled and trained to review Medical Exams, Behavioral Health Exams, Behavioral Health Remand Exams and Incarcerated Exams.
- Answer practitioner phone calls and inquiries regarding Veteran Disability Exams. Skilled and trained to both Medical Phone Queue and Behavioral Health Phone Queue.
- Trained and skilled for High Risk Assessment Tasks and Phone Queue (including but not limited to suicidal and/or homicidal Veteran Risk Assessment Tasks).
- Follows all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
- Consistently meets set QA scoring and metric guidelines.
- Functions as a member of self-directed team to meet specific determinations including decisions regarding coverage guidelines and contractual limitations.
- Sustained quality standards based on routine/random audits and upholding internal and industry best practices.
- Strengthened training and nursing knowledge by taking part in continuing education programs and workshops to include, Optum Talent Education opportunities, 'Serve Each Other' Program and CareerCare.
- Work independently and collaboratively with Medical Directors and non-clinical partners.
COVID19 Call Center RN Supervisor
Remedy Staffing With LHI/Optum
Green Bay, WI (Remote)
06.2020 - 01.2021
- Supervises Clinical Operations staff to ensure that productivity and quality standards are met.
- Run queries and analyze data to determine best utilization of departmental staff resources in relation to work volume and skill sets of staff.
- Communicates productivity status and departmental concerns to Manager and provides input for recommended changes.
- Recommends process flow changes when needed.
- Acts as resource to Clinical Operations staff regarding regulatory standards and ensures adherence to regulations and contractual requirements.
- Increased customer satisfaction by resolving COVID19 result inquiries and/or issues.
- Managing calls from patients with pending, incomplete, or error results.
- Interface with patients via telephone and answer inquiries in alignment to CDC guidance.
- Maintain professional demeanor and service-oriented patient focus to prioritize patient experience.
Intake RN/Adult & AODA RN
Bellin Psychiatric Center
Green Bay, WI
12.2019 - 06.2020
- Screens information seeking calls, appropriately demonstrates understanding of levels of care.
- Works with patient, family, referral source, and physician to develop treatment course that meets presenting need for patient.
- Educates patients, families, and referral sources on levels of care and insurance coverage.
- Knowledgeable on EMTALA process, Medicare, and Medicaid benefits.
- Ability to teach and mentor staff in appropriate indications of use, proper use of equipment, and proper documentation methods when utilizing seclusion/restraint.
- Demonstrates ability to support/facilitate implementation of leadership decisions and addresses performance issues as they arise.
- Demonstrates working knowledge of EPIC documentation system.
- Knowledgeable on alcohol/benzodiazepine withdrawal assessment using: CIWA scoring guidelines and RASS, opioid withdrawal assessment using: COWS scale.
- Care of patient having ECT (before and after care), performs post-ECT cognitive monitor, administers and scores MoCA assessment and SLUMS examination.
Behavioral Health Charge Registered Nurse
Willow Creek Behavioral Health
Green Bay, WI
04.2017 - 12.2019
- Effectively respond and actively participate in psychiatric crisis to resolution.
- Complete and maintain current skills verification for "Handle with Care" (psychiatric crisis management) certification.
- Assist Director of Nursing in planning, developing, and executing patient care services to result in quality patient care.
- Closely monitor and ensure procedures intended to ensure safe milieu and account for all patients.
- Directly supervise 72 bed psychiatric hospital and nursing staff including; up to 8 RN's or LPN's and 15+ Mental Health Technicians.
- Directly communicate with physician on-call regarding new patients and obtaining orders for admission.
- Reviewing patient labs, ER notes, and diagnoses of potential admissions and directly communicating with Emergency Room staff for appropriate Nurse to Nurse report.
- Knowledgeable of human resource policies and practices.
- Correct documentation of patient orders, incident reports, and medication variances.
- Provide supervision and education when needed to unit nursing staff and Mental Health Technicians.
- Knowledgeable in all ages and populations served including geriatric, adult, detox, adolescent, and pediatric patients.
- Assist nursing staff when needed in event of patient crisis or high patient acuity.
- Explained regulations, policies, or procedures to new-hires to confirm understanding and compliance.
- Inspected equipment to maintain proper functioning during peak activity.
- Resolved customer complaints or problems to decrease escalation issues to corporate.
- Trained service staff on latest policies and procedures.
- Provided observations, took measurements and performed tests at various stages according to quality control plan.
- Determined and recommended methods to address improvement opportunities.
- Negotiated agreements between employees to clarify misunderstood directions and resolve conflicts affecting performance.
- Adhered to established policies, procedures and compliance for satisfactory audit rating.
Charge Registered Nurse
Parkview Manor
Green Bay, WI
02.2016 - 08.2017
- Act in the capacity as a Team Leader in a modified primary care setting.
- Provide regular resident status updates to appropriate personal (ADON or DON).
- Supervise Nurse Techs, LPN's, and RN's and participate in their evaluation.
- Maintain ongoing communication with physicians concerning resident care.
- Complete required documentation in an accurate and timely manner.
Charge Registered Nurse
Manor Care
Green Bay, WI
10.2015 - 01.2016
- Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing conditions.
- Monitored nursing care, patient assessment processes and treatment implementations.
- Trained new nurses in proper techniques, care standards, operational procedures and safety protocols.
Correctional Registered Nurse
Green Bay Correctional Institution
Green Bay, WI
01.2015 - 10.2015
- Complied with all security regulations within prison system and administered care in safest possible environment.
- Performed mental health evaluations when warranted and recommended patients to therapists.
- Treated variety of illnesses affecting offenders in close quarters.
- Stabilized prisoners suffering from falls, stab wounds or other injuries prior to hospital transfer.
Telephone Triage Registered Nurse
Prevea Health
Green Bay, WI
07.2014 - 01.2015
- Performed additional clinic and non-triage nurse duties such as instructing patients in general and specific medical care and health issues and administering or dispensing medication and injections.
- Obtained case history and gathered triage information to determine appropriate avenue for care.
- Relayed triage information and facilitated communication between provider and patient concerning patient disposition.
- Delivered orientation and training of less experienced clinic staff in specific clinic operations and procedures.
Charge Registered Nurse
Bornemann Nursing Home Inc.
Green Bay, WI
08.2012 - 10.2014
Licensed Practical Nurse
Bornemann Nursing Home Inc.
Green Bay, WI
03.2011 - 08.2012
Certified Nursing Assistant
Bornemann Nursing Home Inc.
Green Bay, WI
06.2009 - 03.2011
Education
Associate of Science - Registered Nurse
Northeast Wisconsin Technical College
Green Bay, WI 08.2009 - 08.2012
High School Diploma -
Preble High School
Green Bay, WI 08.2005 - 05.2009
Skills
Self-motivated with high energy and initiative
Works well in a team environment
Ability to work in fast-paced, high-volume environment
Ability to help, support, and resolve queries and potential problems that may arise
Perform detailed work with high degree of accuracy
Excellent verbal and written communication skills
Knowledge of computer software
Adapts easily to change of environmentExcellent review skills
Quality assurance
Strong clinical judgment
Advanced computer skills, including Microsoft Office
Certification
Registered Nurse in Wisconsin, License number 192967-30, 2012
Timeline
Clinical Claim Review Registered Nurse
Optum
01.2021 - Current
COVID19 Call Center RN Supervisor
Remedy Staffing With LHI/Optum
06.2020 - 01.2021
Intake RN/Adult & AODA RN
Bellin Psychiatric Center
12.2019 - 06.2020
Behavioral Health Charge Registered Nurse
Willow Creek Behavioral Health
04.2017 - 12.2019
Charge Registered Nurse
Parkview Manor
02.2016 - 08.2017
Charge Registered Nurse
Manor Care
10.2015 - 01.2016
Correctional Registered Nurse
Green Bay Correctional Institution
01.2015 - 10.2015
Telephone Triage Registered Nurse
Prevea Health
07.2014 - 01.2015
Charge Registered Nurse
Bornemann Nursing Home Inc.
08.2012 - 10.2014
Licensed Practical Nurse
Bornemann Nursing Home Inc.
03.2011 - 08.2012
Associate of Science - Registered Nurse
Northeast Wisconsin Technical College
08.2009 - 08.2012
Certified Nursing Assistant
Bornemann Nursing Home Inc.
06.2009 - 03.2011
High School Diploma -
Preble High School
08.2005 - 05.2009