PAUL R. BUSI RN. BSN

• Responsible to review clinical claims of Medicaid members and approve/deny medical procedures and treatments according to medical necessity and AHCA/CMS guidelines
• Maintain confidentiality; communicate effectively with physicians, providers, and vendors for appropriate guidance and clinical information
• Make sure patients receive the best care possible by making proper referrals, resources, and accommodations according to Humana Medicaid guidelines.

• Responsible to review clinical claims of Medicaid members and approve/deny medical procedures and treatments according to medical necessity and AHCA/CMS guidelines
  Maintain confidentiality; communicate effectively with physicians, providers, and vendors for appropriate guidance and clinical information
  Make sure patients receive the best care possible by making proper referrals, resources, and accommodations according to Humana Medicaid guidelines.

Worked as a case manager in Advent Health hospital med-surge unit, accommodated patients with necessary referrals, finding placements after discharges, plan and coordinated discharge plans with relevant physicians, and worked with vendors, families and nursing staff for patient's comfort and better outcomes.

• Responsible for reviewing of medical records of Medicare recipients to determine medical necessity, appropriate care, and quality of services provided by healthcare organizations
• Responsible for accurate review of medical records according to CMS guidelines and communicate effectively and timely to physicians
• Responsible for working with health care providers to initiate, monitor, and report quality improvement activities and quality care concerns
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• Provided individualized care to neuro-surgical patients according to clinic policies and worked closely with surgeon to follow post-op procedures.
• Performed ongoing pre-op and post-op assessments, coordinated care with other physicians for follow up and , provided education to patients and families.

• Responsible for obtaining referrals, coordinated services between pharmacy, and home health agencies to provide delivery of IV drugs and nursing services at home
• Maintained effective communication between the patients, families, and the home health nurses to ensure prompt delivery of drugs and safe nursing services at home
• Maintained professional relationship with Case Management, Liaisons, and Home Health Agencies, and record keeping.

• Provided direct patient care to in patients which includes conducting admissions, discharges, assessments, triage interventions, blood products and chemotherapy infusions, and medication administration
• Participated in patient and family education, unit base and hospital wide quality improvement projects, and maintain electronic documentation.

• Provided direct patient care to head-injury and trauma patients according to rehabilitative guidelines.
• Provided education and support to families during patient's inpatient stay.
• Provided rehabilitative care to patients while providing medical care.

Unit Manager to Medicare Wing:

Supervised staff, worked with physicians in assessments, medication orders and medical recommendations.

Assist staff in rehabilitative activities and wellness activities.

• Rehabilitative institute for correctional incarcerated individuals
• Provided direct patient care, intervene crisis situations, provided rehab activities.
• Worked with physician to follow recommendations in treatment and rehabilitation.