RACHEL BALZ
Lindenhurst,NY
Summary
Certified Ambulatory Care Nurse with experience facilitating high quality care while managing cost-effectiveness. Experience in care coordination, triage, assessing medical necessity and identifying potential improvement opportunities.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Registered Nurse
Northwell Health Physician Partners
04.2017 - Current
- Performed utilization, prospective, concurrent and retrospective reviews.
- Manage denials and appeals through analysis, summarization and interpretation of medical records to support coverage decisions for imaging, medication, surgical procedures and durable medical equipment.
- Transition of Care Management for patients transitioning from acute / subacute care settings into community to improve patient outcomes and reduce hospital admissions.
- Triage emergency phone calls to ensure appropriate level of care is provided.
- Serve as primary contact for patients with health-related concerns, to review test results and plan of care for patients and families as directed by provider.
- Educate patients on chronic disease management, medication, treatment plans, preventative care and screening to increase patient compliance.
- Provide direct nursing care as prescribed by physician.
Registered Nurse – Resident Care Director
Sunrise Senior Living (Dignity Home Care)
09.2011 - 07.2017
- Coordinated and managed nursing care for geriatric patients in 94 bed assisted living facility.
- Conducted monthly quality assurance meetings with all disciplines, planning corrective actions and measured outcomes to ensure regulatory compliance with Department of Health.
- Achieved zero deficiencies in annual surveys for three consecutive years under DOH standards, reduced overtime, and employee turnover to less than 10% by structuring nursing staff workload.
- Responsible for recruitment, hiring, training, new employee orientation, unit staffing, and coordination of in-services for all clinical staff, to include performance management and evaluations.
- Performed comprehensive community assessments to determine care needs and develop individualized care plans.
- Managed admissions and discharges, DME's, participated in market strategy meetings, and new policy implementation.
Registered Nurse
Good Samaritan Hospital Medical Center
07.2016 - 04.2017
- Managed case load of up to 7 patients on medical surgical / cardiac monitoring unit
- Performed on-going assessments to determine patient care needs and provided quality nursing care while carrying out physician orders in accordance with hospital policy and procedures.
- Educated patients on health promotion, disease management, medications, recovery and community resources.
- Documented patient assessments, treatments, medications, discharge instructions in EPIC.
Education
Bachelor of Science in Nursing -
State University of New York at Delhi
Delhi, New York01.2016
Associate of Science in Nursing -
Nassau Community College
Garden City, New York05.2010
Skills
- Care Coordination
- Disease Management Programs
- Patient Discharging
- Patient Education
- Telephone Triage
- Symptom Assessment
- Community Program Referrals
- Patient Management
- Patient Health Information Access
- Operational Procedures
- Team Supervision
- Medical Data Analysis
Certification
- 633103, New York State License
- 2020043678, Certified Ambulatory Care Nurse
References
References furnished upon request
Timeline
Registered Nurse
Northwell Health Physician Partners
04.2017 - Current
Registered Nurse
Good Samaritan Hospital Medical Center
07.2016 - 04.2017
Registered Nurse – Resident Care Director
Sunrise Senior Living (Dignity Home Care)
09.2011 - 07.2017
Bachelor of Science in Nursing -
State University of New York at Delhi
Associate of Science in Nursing -
Nassau Community College
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