Mary Delatorre
Summary
Caring and detail-oriented licensed practical nurse with 10+ years experience in long-term care and insurance nursing. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. Hardworking and passionate job seeker with strong organizational skills eager to secure the Nurse Researcher position. Ready to help the team achieve company goals.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Care Coordinator
Long Term Care Group (now Dba Illumifin)
09.2019 - Current
- Assess claimant eligibility by reviewing medical records from all current providers and conducting phone assessments with the claimant or legal representative. In the event of noted inconsistencies in the claimant's eligibility, coordinate a benefit eligibility assessment and/or present the case file with a consult team to make a final determination.
- In conjunction with plan language upon initial assessment and ongoing recertification, determine legitimacy and eligibility of service providers by requesting and reviewing provider licensing credentials, state-specific regulations, internet searches and phone assessments with the servicing provider.
- Effectively communicate, verbal and written, all aspects of the claim benefit determination process.
- Assist claimants with modifications to their current care plan, including changes in care needs as well as changes in provider.
- Monitor daily, weekly and monthly reports to ensure claims are handled timely and appropriately.
- Attend case conferences, internally and with the client, to present claim recommendations.
- Meet quality and production metrics as established and communicated by the department and other duties as assigned.
- Familiar with Word, Excel, policy and procedure locating on WWW.CMS.COM, WWW.Medicare.Gov, and locating licensing of providers on various state websites.
Floor Nurse
Harvest Manor
11.2023 - 08.2024
- Performed various nursing interventions such as wound dressing, vital sign monitoring, and specimen collection.
- Directed patient care by initiating and following through with plan of care, continuing care, and discharge instructions.
- Monitored patients' conditions and reported changes in physical presentation, appearance, and behavior to discuss treatment with physicians.
- Assessed physical, psychological, physiologic, and cognitive status of patients.
- Educated patients, families and caregivers on diagnosis and prognosis, treatment options, disease process, and management and lifestyle options.
- Administered medications via oral, IV, and intramuscular injections and monitored responses.
Wound Care Nurse
Harvest Manor
01.2018 - 12.2019
- Following TAR to treat wounds in the long-term care setting.
- Maintained comprehensive understanding of genitourinary, gastrointestinal and integumentary systems and provided treatment for wounds impacting them.
- Treated and carefully tended to vascular and diabetic ulcers.
- Documented and examined patient recovery and reported progress to doctors for effective management.
- Collaborated with healthcare team to implement interventions for wound healing and skin breakdown prevention.
- Implemented plans to prevent pressure ulcers and other wound developments.
- Managed patients recovering from medical or surgical procedures.
Floor Nurse
Landmark of Baton Rouge
03.2015 - 06.2016
- Admit and discharge residents and ensure accuracy of orders
- Communicate effectively with staff, supervisor, patients, their families and physicians
- Manage day to day care and medication administration for patients.
Floor Nurse
Golden Age
10.2012 - 08.2013
- Admit and discharge residents and ensure accuracy of orders
- Communicate effectively with staff, supervisor, patients, their families and physicians
- Manage day to day care and medication administration for patients.
Education
Licensed Practical Nurse (LPN) -
Delta College
Baton Rouge, Louisiana08.2012
Skills
- Nursing background
- Claims Processing
- Decision making
- Communication
- HIPAA Compliance
- Critical Thinking Skills
- Organizational Skills
- Documentation
- Patient Care
Certification
- Licensed Practical Nurse (LPN), True, 1/2025
- Basic Life Support (BLS), True, 12/2025
Languages
Spanish
Professional Working
Timeline
Floor Nurse
Harvest Manor
11.2023 - 08.2024
Care Coordinator
Long Term Care Group (now Dba Illumifin)
09.2019 - Current
Wound Care Nurse
Harvest Manor
01.2018 - 12.2019
Floor Nurse
Landmark of Baton Rouge
03.2015 - 06.2016
Floor Nurse
Golden Age
10.2012 - 08.2013
Licensed Practical Nurse (LPN) -
Delta College
- Licensed Practical Nurse (LPN), True, 1/2025
- Basic Life Support (BLS), True, 12/2025
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