Melissa Jaegers

Worked remotely, reviewed charts and documentation regarding inpatient denial. Completed written appeals, uploaded to insurance portals. Followed up on submitted appeals within payer time frame to explore possibility of filing 2nd level of appeal.

• Collaborated with providers to obtain required clinical information, supporting prior authorization determinations and individual inquiries.
• Applied medical criteria and clinical judgement to researched cases to evaluate and establish determinations.
• Remained up-to-date on various benefit plans, medical policies and state-specific clinical guidelines or criteria.
• Reviewed patient admissions to determine medical necessity as directed by criteria.

• Worked with Insurance denials
• Corrected claims to prepare for billing
• Full time employment
• Provided technical support in the development of user manuals, instructions, and other related documents.
• Conducted periodic audits of documents to ensure compliance with established standards.

• Physicians Nurse
• Case Manager for Radiation patients
• Monthly audits for 10 clinics
• Ordering and monthly audits for all medical supplies
• Observed, recorded and reported patients' conditions and reactions to drugs and treatments.
• Prepared patient rooms for visits by cleaning, sanitizing equipment and stocking supplies.
• Instructed patients and family members on medication and treatment instructions to promote adherence to guidelines.
• Coordinated timely refills for patients' prescriptions by obtaining authorizations and transmitting paperwork.
• Used Epic to update electronic medical records with relevant patient information, laboratory test results and clinician orders.
• Full time employment

• Member of Readmission Team
• Followed all Chronic Disease patients that discharged from 2 hospitals
• Made in person visits to local Long Term Care facilities to follow up with patients
• Helped patients and families feel comfortable during challenging and stressful situations, promoting recovery and reducing compliance issues.
• Coordinated with healthcare team to establish, enact and evaluate patient care plans.
• Liaised between patients and families by providing health information and addressing questions and concerns.
• Observed and interpreted patients' symptoms, devised individualized care plans, delivered best and most suitable care and advice and communicated to nursing staff and physicians.
• Audited and completed charts, evaluations and medical forms.
• Cultivated positive relationships with patients and families, addressed concerns or complaints, monitored patient satisfaction survey data and maintained confidentiality of patient information.
• Full time employment

• Assisted Long Term Care facilities in developing computer programs
• Worked remotely with facilities
• Flew to facilities for Go Live Date
• Less than full time employment

• Managed comprehensive, interdisciplinary assessments for patient admissions and annual reviews.
• Coordinated completion of resident assessments in accordance with current federal and state regulations.
• Trained and supervised health care workers conducting resident assessments.
• Reviewed and validated care plan reports and monitored follow-up actions to identify systemic deficiencies.
• Helped develop comprehensive resident assessment and care plans for 120-bed facility.
• Verified quality of assessments in accurately reflecting physical, mental and psychosocial status of each resident.
• Compiled data to enter necessary information into appropriate databases.
• Full time employment

• Facilitated communication between members of health care delivery while involving clients in decision-making processes to minimize service fragmentation.
• Liaised with multidisciplinary team to discuss barriers to discharge or concerns impacting readmission risk.
• Reviewed work list to prioritize patients and identify new admissions.
• Promoted integrations of long-term services and support to enhance continuity of care.
• Monitored vital signs and medication use, documenting variances and concerning responses.
• Used motivational interviewing to educate, support and motivate change.
• Developed and implemented care management plan to address needs and goals.
• Assisted with meal planning to meet nutritional plans.
• Full time employment

• Utilized computerized Resource and Patient Management System (RPMS) and Electronic Health Record (EHR) system.
• Selected patient samples for interview and observation
• Followed CMS guidelines and State Regulations
• Presented findings to Hospital Leadership during exit
• Wrote deficiencies and sent out to facilities.
• Full time employment

• Selected sampled residents for interview and observation
• Interviewed staff
• Observed care given by Nurses and CNA
• Interviewed families
• Reviewed all documentation for residents selected in EHR
• Met with facility leadership during exit
• Followed all CMS guidelines and state regulations
• Wrote up deficiencies and sent to facility
• Followed up with return visit on plan of corrections.
• Full time employment

• Provided direct nursing care to patients, including administering medications, wound care, and IV therapy.
• Educated patients on health maintenance, disease prevention, and treatment options.
• Performed physical examinations and assessments of patients' medical histories.
• Monitored vital signs, such as blood pressure, temperature, respiration rate, pulse rate and weight.
• Collaborated with physicians in developing patient-specific treatment plans.
• Assisted doctors during medical procedures.
• Responded quickly to life-threatening situations by providing appropriate interventions.

• Assessed patient health and developed individualized care plans accordingly.
• Provided direct nursing care to patients, including administering medications, wound care, and IV therapy.
• Educated patients on health maintenance, disease prevention, and treatment options.
• Performed physical examinations and assessments of patients' medical histories.
• Monitored vital signs, such as blood pressure, temperature, respiration rate, pulse rate and weight.
• Collaborated with physicians in developing patient-specific treatment plans.
• Responded quickly to life-threatening situations by providing appropriate interventions.
• Ensured compliance with infection control policies and procedures.
• Maintained accurate documentation of patient records in accordance with HIPAA regulations.
• Advised family members on the best course of action for their loved ones' healthcare needs.
• Provided emotional support to families facing difficult decisions about a loved one's care.
• Worked closely with other healthcare professionals to coordinate patient care.
• Carried out physician orders regarding tests or medication administration accurately and safely.