Michelle Schmidt-Wells
Brooksville
Summary
Dedicated and skilled utilization review nurse with over 10 years of experience in medical reviews, denials and authorizations. Passionate about driving quality outcomes and improving operational efficiency. Recognized as a top performer in field. Self starter with a proven track record for focusing on achieving optimal outcomes.
Overview
14
14
years of professional experience
Work History
Nurse Case Manager: Utilization Review/Authorizations/Appeals
Conifer Health Solutions
03.2015 - Current
- Specializing in Retrospective Review, Concurrent Review ,Denials & Appeals, and Authorizations.
- Top Performer for production and quality.
- Review clinical information and records to perform utilization review assessing, monitoring, and evaluating patient care for medical necessity and level of care for inpatient admissions, concurrent reviews, retrospective reviews, denials and appeals.
- Obtain prior authorizations for medical services including infusions, radiology, and radiation.
- Proficient in Cerner, Citrix, AllScripts, Interquel, EQ Health and EPIC. Familiar with Milliman, Indicia, Horizon Physicians Portal, PBAR and ACE.
Pediatric Nurse
Premier Community HealthCare Group
05.2013 - 03.2015
- Provide all aspects of care for pediatric patients and direct help for 3 providers.
- Direct patient care
- Phone Triage
- Vaccine administration and management
- Extensive documentation skills
- Medication knowledge and understanding
- Hospital Review, Scheduling, and Follow up
- EMAR (Intergy and Intergy EHR proficient)
Clinical Coordinator/Charge nurse
Ocala Family Medical Center
10.2011 - 05.2013
- Clinical coordinator and charge nurse for a 14 provider office that includes onsite lab, MRI/ CT, ultrasound, and X-ray. Manage all LPN’s and MA’s daily, QA and audits, provide and manage patient care for over 200 pt’s daily.
- Lead a team of MA’s and LPN’s
- Create and maintain work flows for staff
- Quality assurance and personnel audits
- Extensive documentation skills
- Medication knowledge and understanding
Education
Licensed Practical Nurse -
Pasco Hernando Community College
Brooksville, FLAssociates in Arts degree - Business Management
Pasco Hernando Community College
Brooksville, FLSkills
- Documentation and reporting
- InterQual criteria
- Medical necessity review
- Level of care review
- Utilization review
- Prior authorization
- Insurance verification
- Inpatient care and outpatient
Timeline
Nurse Case Manager: Utilization Review/Authorizations/Appeals
Conifer Health Solutions
03.2015 - Current
Pediatric Nurse
Premier Community HealthCare Group
05.2013 - 03.2015
Clinical Coordinator/Charge nurse
Ocala Family Medical Center
10.2011 - 05.2013
Associates in Arts degree - Business Management
Pasco Hernando Community College
Licensed Practical Nurse -
Pasco Hernando Community College
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