MELANIEROSE S. RETIZOS
Yardley,PA
Summary
Analytical and diversely skilled healthcare professional with a background in supply chain management and global healthcare. Determined with a willingness to learn new skills and techniques. Dedicated to implementing and overseeing various projects. Adept at maintaining accuracy through astute observation and attention to detail. Strong leader with relationship-building skills. Flexible team player and excellent communicator with strong interpersonal skills and the ability to adapt to change. Organized and detail-oriented with a track record of delivering the highest quality strategic solutions to resolve challenges and propel business growth.
Overview
19
19
years of professional experience
Work History
Care Management Coordinator
Independence Blue Cross
12.2022 - Current
- Responsible for evaluating proposed plans of treatment, as defined in the precertification requirements of the group plan
- Proficient at using the medical criteria of InterQual and/or Medical Policy, to establish the need for inpatient, continued stay and length of stay, procedures, outpatient, pharmacy, and ancillary services
- Collaborates with attending physicians regarding treatment plans/plan of care and clarifies medical need for inpatient stay or continued inpatient care
- Presents cases to Medical Directors that do not meet established criteria and provides pertinent information regarding member's medical condition and the potential home care needs
- Acts as a patient advocate and a resource for members, when accessing the health care system
- Oversees and coordinates medical care provided to members, ensuring that appropriate and cost-effective care is rendered
- Delivers detail-oriented and organized clinical documentation and processes to maintain compliance with NCQA requirements
QA Nurse, Medical Information and Analysis Team
International SOS
08.2022 - 12.2022
- Responsible for researching, analyzing, reviewing, and publishing medical information for International SOS products, services, and internal resources
- Participated in 24/7 roster for monitoring and publication of information, with handover to next team member on duty
- Contributed to other International SOS medical information activities as directed by senior MInA staff
- Researched, drafted, and published medical information for International SOS information products including Location Guides, Medical Alerts, special websites
Coordinating Nurse
International SOS
05.2021 - 12.2022
- Conducted medical assessments and provides medical advice, support, and recommendations to members and clients
- Provided medical overview and guidance on travel to various locations throughout the world
- Volunteered to participate in the repatriation of a member to escort and provide medical care for a member returning to home of record
- Collaborated with global medical team to properly assess members who require medical services while abroad
- Medically assisted in arranging global medical evacuations and repatriations
- Delivered a clear analysis of a medical situation within a geographical location to aid in the development of a plan of action for a member
- Provided Gate Screen support to the MedAire team by using telephonic triage skills to assess and prevent in-flight medical emergencies
Nurse Review Coordinator
National Medical Reviews
04.2020 - 05.2021
- Collaborated with physicians, case managers, and appeals coordinators to determine the proper outcome of an appeals case
- Utilizes nursing knowledge, InterQual Criteria, medical necessity policies and guidelines to provide the proper determination regarding insurance appeals
- Handled all appeals promptly and efficiently in compliance with URAC and NCQA
- Coordinated the clinical appeal process through the collection of clinical records, consultation with Physician Advisors/Medical Director and communicates final determination to the client
- Acted as voting member during Geisinger Hospital hearings to decide the proper determination concerning their insurance appeals
- Responsible for providing and summarizing well written medical reports
Registered Nurse - Emergency Room
St. Mary Medical Center
12.2018 - 04.2020
- Experienced in the care of acute and critically ill patients pertaining to head to toe and focused assessments, administration of medications, and assisted physicians with bedside procedures
- Utilized the nursing process, assessed, planned, provided, and evaluated nursing care to adults and pediatrics based on evidence based professional practice and research
- Collaborated with other ER professionals to ensure effective and efficient patient care delivery to achieve the desired patient results
- Preceptor to new nurses within the department
Registered Nurse/Charge Nurse - PCU/Med-Surg
Abington-Lansdale Hospital
11.2017 - 12.2018
- Experienced in physical assessment, administration of medications, and assisted physicians with bedside procedures
- Offered patient and family guidance and support in illness management, homecare, medication and side effects, diet, nutrition, and exercise
- Participated in a multidisciplinary team of medical professionals to assess, evaluate, and diagnose patients and develop effective treatment plans under direction of the physician
- Acted as resource nurse for entire hospital to aid in care management and education
- Operated as charge nurse to efficiently and effectively managed assigned floor, as well as assist nursing staff with patient care
- Mentored students in clinical area
Clinical Associate
Abington-Lansdale Hospital
03.2016 - 11.2017
- Responsible for obtaining and documenting patient vitals as scheduled or ordered per physician
- Helped patients tend to personal care, activities of daily living, ambulation, and transfers/transport
- Worked cooperatively with other team members to carry out the goals and objectives of the patient
- Trained new employees and maintained effective communication with other healthcare employees
Buyer
Sears Holding Corporation
11.2007 - 06.2011
- Built an assortment for Women's Dress Footwear, Children's Athletic and Character footwear, and Fine Jewelry Fashion Diamond Collection for all season collections
- Collaborated with Buying team, Inventory team, and vendors to bring in brands sold in over 900 stores
- Managed all aspects of marketing to include advertised, unadvertised candidate selection, forecasting business performance, and consumer ad proofing for all Sears' circulars
- Analyzed and presented strong and weak sellers to top management weekly
- Partnered with vendors and sourcing team to attain products at best possible cost to achieve customer satisfaction
- Researched trends and competitive retailers to identify emerging products to translate into new and exciting items to keep in-line with market direction
- Coordinated extensively with vendors to assure on time delivery of orders and release of all new products
- Negotiated with vendors to acquire best possible cost to achieve sales and margin goals
- Merchandised items to ensure product appeal and profit growth
- Managed and supervised employees and maintained effective communication and team relationships
Inventory Analyst
Sears Holding Corporation
09.2006 - 11.2007
- Managed and maintained buys and product flow to support sales over $60 million for Fine Jewelry Gold and Silver line
- Performed and monitored replenishment to over 900 stores which included analysis of demand, fill rate, and in-stock percentages
- Lead the planning and handled the allocation of the Luke and Laura ring to ABC's General Hospital which generated $500,000 in sales in the 1st quarter
- Developed spreadsheet to record and track consignment information, which was used by the entire department and reduced recording time for all lines
Education
RN Diploma in Nursing -
Abington Memorial Hospital Dixon School of Nursing
09.2017
Bachelor of Science in Supply Chain and Information Systems -
Pennsylvania State University
12.2005
Skills
- Financial/Data analysis
- Attention to regulatory compliance
- Risk Assessment
- Proficient in medical and scientific terminology
- Extensive experience supervising and coordinating with staff
- Ability to organize and prioritize responsibilities
- Microsoft Office
- Solid written and verbal communication skills
Timeline
Care Management Coordinator
Independence Blue Cross
12.2022 - Current
QA Nurse, Medical Information and Analysis Team
International SOS
08.2022 - 12.2022
Coordinating Nurse
International SOS
05.2021 - 12.2022
Nurse Review Coordinator
National Medical Reviews
04.2020 - 05.2021
Registered Nurse - Emergency Room
St. Mary Medical Center
12.2018 - 04.2020
Registered Nurse/Charge Nurse - PCU/Med-Surg
Abington-Lansdale Hospital
11.2017 - 12.2018
Clinical Associate
Abington-Lansdale Hospital
03.2016 - 11.2017
Buyer
Sears Holding Corporation
11.2007 - 06.2011
Inventory Analyst
Sears Holding Corporation
09.2006 - 11.2007
RN Diploma in Nursing -
Abington Memorial Hospital Dixon School of Nursing
Bachelor of Science in Supply Chain and Information Systems -
Pennsylvania State University
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