Pamela Gaviola

• Utilized InterQual criteria for utilization review to identify severity of illness and intensity of service.
• Reviewed admissions and service requests for prospective, concurrent and retrospective medical necessity and/or compliance with reimbursement policy criteria.
• Maintained regulatory compliance by staying updated on industry standards and guidelines, implementing changes when necessary.
• Collaborated with onsite Case Manager team regarding case management and patient discharge needs.

• Participated in Ethics Committee meeting.
• Utilized InterQual criteria for utilization review.
• Maintained accurate documentation on all Case Management cases, ensuring compliance with regulations and confidentiality requirements.
• Reported care quality, safety, and length of stay metrics.

• Utilized InterQual criteria for utilization review.
• Reviewed admissions and service requests for prospective, concurrent and retrospective medical necessity and/or compliance with reimbursement policy criteria.
• Assisted departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement and claim denials/appeals.
• Collaborated with onsite Clinical Effectiveness team regarding case management and patient discharge needs.

• Accomplishments:
• Mentored new hire for utilization management position.
• Acted as resource/charge for utilization department when Director was on leave/vacation.

• Utilized InterQual criteria for utilization review.
• Maintained accurate documentation on all cases, ensuring compliance with regulations and confidentiality requirements.
• Facilitated informed decision that is link between individual, hospital, payor and community, to minimize fragmentation of health care.

Accomplishments:

• Awarded the Life Saver Recipient/Patient Safety for the hospital.
• Mentored and trained new hire for case manager position.

• Responsible for the management of nursing practice and operation in the critical care.
• Managed staffing, employee performance evaluation, clinical nursing practice, staff education, quality improvement, internal and external regulatory survey requirement.
• Attended to all Blue Alert, Brain Attack, Rescue Alert in the hospital.
• Collaborated with multiple professionals to support and coordinate management of patient care.

Accomplishments:

• Awarded as ICU Patient Safety Winner.
• Awarded Customer Service Excellence.
• Passed Critical Care Registered Nurse Certification (CCRN) certification.

• Delivered outstanding patient care in critical care units.
• Participated in quality improvement initiatives to enhance overall efficiency and effectiveness of the Critical Care unit.

Accomplishments:

• Awarded Patient Safety Star for ICU.
• Served as mentor for new ICU staff.

• Assisted in procedures such as intubation, thoracentesis, insertion of pacemaker, IABP, CVVHD.
• Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing conditions.
• Improved patient outcomes by providing high-quality nursing care and implementing evidence-based practices.

• Took care of critically ill patients on a ventilator, balloon pump, IV vasopressors, continuous venous-to- venous hemodialysis (CVVHD).
• Participated in quality care committee and unit-based performance initiative.
• Assisted physicians with bedside procedures, ensuring timely intervention and accurate documentation of results.

• Assisted in procedures such as intubation, bedside thoracentesis, tracheostomy, insertion of pacemaker, balloon pump.
• Improved patient outcomes by implementing evidence-based nursing practices and providing high-quality care in the ICU setting.

• Recognized and responded to emergency situations promptly, initiating appropriate interventions as per established guidelines within the telemetry setting.
• Assisted with diagnostic testing and assessments, contributing to accurate diagnoses and appropriate treatment plans.

• Improved patient outcomes by providing timely and accurate assessments, triage, and intervention in high-stress emergency situations.
• Served as a reliable resource for colleagues seeking advice on complex cases or best practices within the emergency department setting.