Neva McMullen

• Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
• Submitted cases for criteria failures and helped facilitate resolutions and approvals.
• Performed admission reviews based for medical necessity based upon Type specification.
• Facilitated workgroup meetings with medical personnel to find effective solutions to issues.

• Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
• Facilitated workgroup meetings with medical personnel to find effective solutions to issues.
• Submitted cases for criteria failures and helped facilitate resolutions and approvals.
• Obtained authorizations from multiple insurance carriers for various levels of care.
• Supervised and maintained all utilization review documentation through Software.
• Performed prior authorization review of services requiring notification.
• Devise or identify solutions for irregular requests and issues.
• Performed admission reviews based for medical necessity based upon Type specification.
• Established and maintained effective communication with staff, physicians and community organizations to promote high quality patient care.
• Implemented successful healthcare program through professionalism, quality of care, medical teaching and patient satisfaction.
• Defined testing protocols, quality assurance initiatives and clinic policies and procedures.
• Developed and updated policies and procedures, maintaining compliance with guidelines relating to HIPAA, benefits administration and general liability.
• Liaised with other healthcare professionals to develop comprehensive patient care plans and provide highest quality of care.
• Spearheaded and implemented new projects to expand scope of engagement.
• Created customized care plans, working with hospital staff and families to assess and meet individual needs.

• Administered medications via oral, IV, and intramuscular injections and monitored responses.
• Remained calm during high-stress, critical situations, demonstrating sustained focus and problem-solving in real-time.
• Performed routine wound care and dressing changes on schedule.
• Advised patients and caregivers of proper wound management, discharge plan objectives, safe medication use, and disease management.
• Documented treatments delivered, medications and IVs administered, discharge instructions, and follow-up care.
• Recorded details regarding therapies to keep patient charts updated.
• Explained course of care and medication side effects to patients and caregivers in easy-to-understand terms.
• Participated in evidence-based practice project implementation, nursing competency development and nursing simulation activities.
• Performed frequent checks on life support equipment and made necessary adjustments to preserve optimal patient conditions.
• Evaluated patient histories, complaints, and current symptoms.
• Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
• Used first-hand knowledge and clinical expertise to advocate for patients under care and enacted prescribed treatment strategies.
• Reported findings to quality departments after conducting routine restraint audits and worked with team to devise corrective actions for deficiencies.
• Educated family members and caregivers on patient care instructions.
• Monitored patient reactions after administering medications and IV therapies.
• Led teams in driving successful patient outcomes by prioritizing standard of care and best practices.
• Communicated with healthcare team members to plan, implement and enhance treatment strategies.
• Facilitated therapeutic communication, conflict resolution and crisis intervention by redirecting negative behaviors and helping patients regain or improve coping abilities.
• Leveraged feedback and process improvement opportunities to create safer and healthier environment and increase patient satisfaction.
• Equipped patients with tools and knowledge needed for speedy and sustained recovery.
• Collaborated with leadership to devise initiatives for improving nursing satisfaction, retention and morale.
• Quickly responded to situations impacting safety and security to unit, actualizing crisis prevention interventions to control and de-escalate situations.
• Performed triage on incoming patients and determined severity of injuries and illnesses.
• Conveyed treatment options, diagnosis information and home care techniques to patients and caregivers to continue care consistency.
• Provided skilled, timely and level-headed emergency response to critically-ill patients.
• Implemented care plans for patient treatment after assessing physician medical regimens.
• Conducted ongoing monitoring and evaluations of behaviors and conditions, and updated clinical supervisors with current information.

Investigated and resolved issues affecting hospital operations and patient care.

Office Manager 87-91 when merger occurred, then Insurance Manager verified coverage, obtain authorizations for procedures, insurance billing and posting payments, troubleshooting when needed, patient billing and collections,