Summary
Overview
Work History
Education
Skills
Affiliations
Timeline
Generic

Nicole Ziegler

Philadelphia,PA

Summary

Utilization Review RN with extensive experience in healthcare settings. Proven track record of consistent, positive performance reviews at Penn Medicine and Fox Chase Cancer Center. Highly adaptable and self-motivated, excelling in both independent and team environments. Committed to continuous learning and professional development.

Overview

16
16
years of professional experience

Work History

RN Case Manager

Fox Chase Cancer Center
Philadelphia, Pennsylvania
05.2022 - Current
  • Performs clinical and continued stay reviews on assigned patients.
  • Communicates reviews to insurers in a timely manner to ensure maximum reimbursement.
  • Accurately records payor information related to review, level of reimbursement and appeal decision in the electronic medical record.
  • Understands and utilizes Interqual review criteria.
  • Communicates proactively with the medical staff regarding any potential/actual altered payment situations on the same day it is identified by the Case Manager and payer.
  • Manages denials in accordance with the established protocols and procedures.
  • Coordinates Peer to Peer Reviews to establish medical necessity.
  • Collaborates with physicians and the interdisciplinary team to facilitate patient progress through the acute episode of care in an efficient and cost effective manner.
  • Monitors the level of care, initiating evidence based protocols and order sets according to the patient's admission diagnosis.

Clinical Resource Coordinator

Hospital of the University of Pennsylvania
Philadelphia, PA
11.2020 - 05.2022
  • Responsible for the coordination of a multidisciplinary plan of care that facilitates discharge and expected outcomes, utilizes appropriate and cost effective strategies, and identifies system barriers.
  • Discharge planning activities such as home care, DME, placements, hospice, community resources, and transportation. Quality data collection and risk management referrals.
  • Performed clinical and continued stay reviews on assigned patients using Interqual review criteria.
  • Interviewed and collaborated with patient/family to assess aftercare options providing guidance information and support in decision making.
  • Developed alternative discharge plans and coordinates with Team Leader, peers, and/or Social Worker as needed to facilitate resolution of problem dispositions.
  • Developed a discharge plan in a timely manner to maintain lowest cost to the hospital, while ensuring a comprehensive quality plan.
  • Accurately recorded payor information related to review, level of reimbursement and appeal decision in the electronic medical record.
  • Communicated proactively with the medical staff regarding any potential/actual altered payment situations on the same day it is identified by the Case Manager and payer.
  • Coordinated referrals to Physician Advisor and/or EHR to establish medical necessity.

Full Time Charge Nurse/Clinical Nurse- 6 Cathcart

Pennsylvania Hospital- Medical/Surgical Telemetry
Philadelphia, PA
04.2011 - 11.2020
  • Full time Charge Nurse performing duties such as preparing assignments, monitoring admissions, transfers, and discharges, coordinator of personnel on the unit, addressing unit concerns.
  • Rotated to the Observation Unit, adjunct unit to the Emergency Department.
  • Care for patients with various acute and chronic conditions, emphasis of patients with cardiac arrhythmias, congestive heart failure, COPD, peripheral arterial disease.
  • Provided recovery care for right and left heart catheterization, carotid stenting, Aortic and Mitral valve replacement, electrophysiology procedures, ICD and pacemaker insertion and excision.
  • Close monitoring and post procedural care of thoracic surgery patient population, emphasis in coronary artery bypass surgery and lobectomy procedures.
  • Cultivated working partnerships with patients and medical staff using hospital-wide nursing practice of the Relationship Based Care model to improve patient outcomes.
  • Shift Validator for staff training and educational in-services including checkoffs of unit based competencies.
  • Preceptor for orienting staff ranging from new to practice to established nurses.
  • Assessment and management of COVID-19 patient population beginning April 2020 to November 2020

Patient Care Technician- 6 Cathcart

Pennsylvania Hospital- Medical/Surgical Telemetry
Philadelphia, PA
02.2010 - 04.2011
  • Coordinated patient care needs with the healthcare team and provided assistance with activities of daily living.
  • Delivered outstanding care based on physical, psychological, educational and related criteria for the individual patient.
  • Supported nurses in daily patient care activities- vital signs, patient observations, 12 lead EKG, lab specimen collection.

Education

Bachelor of Science - Nursing

Widener University
Chester, PA
2010

Skills

  • Excellent time management skills
  • Detail-oriented
  • Effective communication
  • Strong Interpersonal Skills
  • Software proficiency
  • Epic Super User
  • Team player
  • Proactive mindset

Affiliations

  • Utilization Review Team Lead (July 2025-present)
  • Cardiac Surgery Progressive Care Group (February 2021)
  • Completed Advanced Penn Preceptor Course (January 2020)
  • Member, Academy of Medical-Surgical Nurses (January 2020)
  • Co-Chair, Night Council (July 2018-February 2020)
  • 6Cathcart Scheduling Committee (April 2017-November 2020)
  • Chair, Unit Based Shared Governance (July 2016-November 2020)
  • Achieved advancement to Clinical Nurse III (June 2015)

Timeline

RN Case Manager

Fox Chase Cancer Center
05.2022 - Current

Clinical Resource Coordinator

Hospital of the University of Pennsylvania
11.2020 - 05.2022

Full Time Charge Nurse/Clinical Nurse- 6 Cathcart

Pennsylvania Hospital- Medical/Surgical Telemetry
04.2011 - 11.2020

Patient Care Technician- 6 Cathcart

Pennsylvania Hospital- Medical/Surgical Telemetry
02.2010 - 04.2011

Bachelor of Science - Nursing

Widener University

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