Melissa Jaegers RN

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 the possibility of filing a 2nd level of appeal.

• Collaborated with providers to gather clinical information, supported prior authorization determinations and individual inquiries to enhance approval outcomes.
• Reviewed patient admissions to determine medical necessity as directed by criteria.
• Collaborated with providers to obtain required clinical information, supporting prior authorization determinations and individual inquiries.
• Reviewed patient admissions to determine medical necessity based on established criteria.
• Processed adjustments for cases where denials were upheld, ensuring compliance with company policies.
• Engaged in full-time employment, contributing to team goals and workflow efficiency.

• Collaborated on resolving insurance denials to facilitate timely claim approvals.
• Corrected and resubmitted claims, ensuring accuracy for seamless billing process.
• Engaged in full-time employment, contributing to team objectives and productivity.
• Provided technical support in the development of user manuals, instructions, and other related documents.
• Conducted periodic audits of documents, verifying compliance with established standards and improving audit readiness.
• Employed full time, actively collaborating with colleagues to achieve goals.

• Case Manager for Radiation patients
• Physicians Nurse
• Observed, recorded and reported patients' conditions and reactions to drugs and treatments.
• Instructed patients and family members on medication and treatment instructions to promote adherence to guidelines.
• Monitored and documented patients' conditions and responses to medications and treatments, ensuring timely communication with healthcare team.
• Educated patients and families on medication and treatment protocols to enhance understanding and adherence to care plans.
• Facilitated prescription refills by managing authorizations and paperwork, ensuring continuity of care for patients.
• Prepared patient rooms for visits by cleaning, sanitizing equipment and stocking supplies.
• Managed full-time employment responsibilities

• Contributed to the Readmission Team by collaborating with healthcare professionals to improve patient outcomes.
• Followed all Chronic Disease patients who discharged from 2 hospitals
• Facilitated comfort for patients and families during challenging situations, promoting recovery and enhancing compliance.
• Coordinated with healthcare team to develop and assess patient care plans, ensuring alignment with patient needs.
• 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.
• Fostered positive relationships with patients and families, addressed concerns, and monitored patient satisfaction to improve care quality.
• Engaged in full-time employment within a healthcare setting, supporting patient care.

• Collaborated with Long Term Care facilities to develop tailored computer programs
• Collaborated remotely with facilities to address their needs and enhance service delivery.
• Traveled to facilities to oversee the Go Live Date and ensure smooth implementation.
• Engaged in part-time employment to balance work commitments and personal responsibilities.

• 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 in conducting thorough resident assessments to ensure compliance and quality.
• Reviewed and validated care plan reports while monitoring follow-up actions to address systemic deficiencies.
• Helped develop comprehensive resident assessment and care plans for 120-bed facility.
• Verified assessment quality to ensure accurate reflection of residents' physical, mental, and psychosocial statuses.
• Compiled data to enter necessary information into appropriate databases.
• Full time employment

• Facilitated communication among health care delivery members and engaged clients in decision-making to reduce service fragmentation.
• Liaised with multidisciplinary team to identify discharge barriers and address concerns impacting readmission risk.
• Liaised with multidisciplinary team to discuss barriers to discharge or concerns impacting readmission risk.
• Promoted integration of long-term services and support to improve continuity of care.
• Reviewed work list to prioritize patients and identify new admissions.
• Monitored vital signs and medication use, documenting variances and concerning responses.
• Used motivational interviewing to educate, support and motivate change.
• Assisted with meal planning to meet nutritional plans.
• Worked in full-time position, ensuring consistent engagement with team and responsibilities.

• Leveraged computerized Resource and Patient Management System (RPMS) and Electronic Health Record (EHR) system to enhance data accuracy and accessibility.
• Wrote deficiencies and sent out to facilities.
• Followed CMS guidelines and State Regulations
• Selected patient samples for interview and observation
• Documented deficiencies and communicated them to facilities to promote corrective actions.
• Worked full time in healthcare administration.

• Selected residents for interviews and observations to assess care quality
• Observed care provided by nurses and CNAs to evaluate compliance with standards
• Reviewed all documentation for residents selected in EHR
• Met with facility leadership during exit
• Followed all CMS guidelines and state regulations
• Documented deficiencies and communicated findings to facility for corrective action
• Followed up with return visit on plan of corrections.
• Worked full-time to support organization objectives

• Provided direct nursing care to patients, including administering medications, wound care, and IV therapy.
• Educated patients on health maintenance and disease prevention to empower informed health choices.
• Performed physical examinations and assessments of patients' medical histories.
• Educated patients on health maintenance, disease prevention, and treatment options.
• Collaborated with physicians to develop and implement patient-specific treatment plans, enhancing care continuity.
• Assisted doctors during medical procedures.
• Responded swiftly to life-threatening situations, delivering critical interventions to stabilize patients.

• Provided direct nursing care to patients, including administering medications, wound care, and IV therapy.
• Assessed patient health and developed individualized care plans accordingly.
• Educated patients on health maintenance and disease prevention, enhancing their understanding of treatment options.
• Monitored vital signs, such as blood pressure, temperature, respiration rate, pulse rate and weight.
• Collaborated with physicians in developing patient-specific treatment plans.
• Collaborated with physicians to create tailored treatment plans, ensuring comprehensive patient care.
• Educated patients on health maintenance, disease prevention, and treatment options.
• Ensured compliance with infection control policies and procedures.
• Provided emotional support to families navigating difficult healthcare decisions, fostering trust and comfort during critical times.
• Worked closely with other healthcare professionals to coordinate patient care.
• Carried out physician orders regarding tests or medication administration accurately and safely.

• 1993-1994 Dean's List

• 1983-1985 Honor Roll