Nancy Coyne
Massapequa
Summary
Dedicated Utilization Review Nurse with proven expertise in documentation, case management, and multidisciplinary coordination, ensuring optimal patient care and regulatory compliance.
Overview
2027
2027
years of professional experience
1
1
Certification
Work History
Utilization Review Nurse
Mount Sinai Health System
Oceanside, NY
05.2006 - Current
- Evaluated clinical documentation for accuracy, ensuring alignment with regulatory requirements and best practices.
- Developed and maintained relationships with healthcare providers to facilitate effective communication regarding patient needs.
- Ensured compliance with regulations and accreditation standards by maintaining accurate documentation of all utilization review activities.
- Maintained professional competence by staying current on industry trends, best practices, and regulatory requirements specific to utilization review nursing.
- Assisted discharge planning efforts through prompt identification of medically stable patients who were ready for transition to alternate levels of care.
- Supervised and maintained all utilization review documentation through Xsolis and Palentir.
- Optimized hospital stays by monitoring admissions for appropriateness based on established clinical guidelines while considering each patient''s unique circumstances.
- Ensured timely patient discharges by coordinating with healthcare teams, optimizing bed availability.
- Improved patient outcomes by meticulously reviewing patient records to ensure appropriate care levels.
- Used first-hand knowledge and clinical expertise to advocate for patients under care and enacted prescribed treatment strategies.
Case Manager/Behavioral Health Case Manager
Mount Sinai Health System
Oceanside, NY
2012 - Current
- Assessed client needs and developed tailored care plans to enhance patient outcomes.
- Coordinated multidisciplinary team meetings to ensure comprehensive service delivery for clients.
- Monitored client progress and adjusted care strategies based on evolving health conditions.
- Facilitated access to community resources and support services for clients and families.
- Assessed client needs and developed customized care plans to promote mental well-being.
- Prepared reports to summarize clients' mental health status and treatment progress.
- Implemented case management software for tracking patient interactions and improving data accuracy.
- Maintained accurate documentation on all cases, ensuring compliance with regulations and confidentiality requirements.
- Collaborated with physicians and other healthcare providers to ensure appropriate resource utilization for complex cases.
- Evaluated healthcare needs, goals for treatment, and available resources of each patient and connected to optimal providers and care.
- Streamlined care coordination processes to reduce hospital readmissions and emergency department visits.
- Effectively communicated with physicians regarding patient needs, performance, medications and changes.
- Completed initial assessments of patients and family to determine and address individual home care needs. ·
- Developed professional relationships with community partners to enhance available support services for patients transitioning from acute care settings.
- Worked with suppliers and vendors on provision of medical equipment, items and services.
Intake Coordinator
Mount Sinai Health System
Oceanside, NY
04.2006 - Current
- Coordinated patient intakes, ensuring efficient processing of personal and medical information.
- Monitored compliance with regulatory standards during the intake process to maintain quality assurance.
- Provided excellent customer service to patients, family members, and healthcare providers during the intake process.
- Completed intake assessment forms and filed clients' charts.
- Collaborated with healthcare professionals to ensure patients received appropriate services and resources.
- Collaborated with multidisciplinary teams to develop personalized care plans for clients.
Education
Bachelor of Science - Nursing
State University of New York
NY05-1983
Skills
- Case management
- Documentation and reporting
- InterQual criteria
- Utilization Review
- Discharge planning
- Home Health Care
- Milliman guidelines
- Medicare
- Electronic health records
Certification
- Registered Nurse BSN- May 1983
- Certified Case Manager -May 2016
- PRI/ Screen
Timeline
Utilization Review Nurse
Mount Sinai Health System
05.2006 - Current
Intake Coordinator
Mount Sinai Health System
04.2006 - Current
Case Manager/Behavioral Health Case Manager
Mount Sinai Health System
2012 - Current
Bachelor of Science - Nursing
State University of New York