Rachel Hurtt

• Conducted concurrent reviews to monitor the ongoing appropriateness of services provided to members.
• Interpreted coverage policies and benefit provisions as they relate to the clinical setting.
• Participated in interdisciplinary team meetings to discuss complex cases or those requiring an alternative treatment plan or continued stay evaluation.
• Reviewed appeals from providers regarding denied admissions or services according to organizational standards and procedures.
• Maintained accurate documentation related to all activities performed in compliance with departmental policies.
• Provided education and guidance on utilization management principles to internal staff members.
• Served as a liaison between payers, providers, patients and families concerning authorization decisions.
• Utilized decision support tools such as diagnostic coding software programs to accurately assess data elements necessary for determining eligibility criteria.
• Referred cases to secondary review for failure to meet criteria.
• Determined medical necessity and cost-effectiveness of services through utilization review processes.
• Collaborated with providers to obtain required clinical information, supporting prior authorization determinations and individual inquiries.
• Reviewed patient admissions to determine medical necessity as directed Interqual criteria.
• Contacted insurance carriers to obtain authorizations for services delivered to patients.

• Developed individualized care plans and provided health education to patients.
• Performed assessments, monitored vital signs, and administered medications to patients.
• Provided guidance to nurses and other healthcare staff members on patient care issues.
• Supervised the work of nursing personnel, including assigning tasks and evaluating performance.
• Maintained accurate medical records according to established standards and regulations.
• Acted as a role model by demonstrating professional behavior at all times.
• Monitored supplies inventory levels, ordered necessary items when needed.
• Conducted rounds on assigned units on a regular basis.
• Provided leadership during emergencies or critical situations.
• Assumed responsibility for ensuring that high standards of nursing care are maintained throughout the facility.
• Served as an advocate for patients by promoting their rights and protecting them from abuse or neglect.

• Provided comprehensive hospice care to patients and families, including assessment of physical, emotional, social, spiritual and cultural needs.
• Facilitated coordination of services with other healthcare providers and community resources.
• Developed individualized plans of care for each patient in collaboration with the interdisciplinary team.
• Educated caregivers about end-of-life issues and provided emotional support.
• Maintained accurate documentation according to agency policies and regulatory standards.
• Communicated regularly with physicians regarding changes in condition or treatment options.
• Participated in on-call rotation for after hour emergencies.
• Managed crisis intervention when necessary.
• Visited patients in their homes or other settings to provide skilled nursing assessments and treatments as appropriate.
• Conducted home safety assessments to identify potential risks, hazards to client health, safety.
• Engaged in quality assurance activities such as chart audits and performance improvement initiatives.
• Attended regular staff meetings to discuss case reviews or policy changes.
• Served as a liaison between the patient and family members and the hospice organization.
• Performed administrative duties such as filing paperwork or ordering supplies.

Managed revenue expectations while actively seeking ways to eliminate or reduce expenses.

Actively served on Utilization Review Committee by reviewing policies, patterns of providers and sanction processes.

Observed strict confidentiality and safeguarded all patient-related information.

Analyzed facility activities and data to properly assess risk management and improve services.

Carefully reviewed medical records for accuracy and completion as required by insurance companies

Acquired insurance authorizations for procedures and tests ordered by the attending physician.

Evaluated the accuracy of provider charges, including dates of service, procedures, level of care, locations, diagnoses, patient identification and provider signature.

Consistently informed patients of their financial responsibilities prior to services being rendered.

Remained up-to-date with insurance requirements, including the details of patient financial responsibilities, fee-for-service and managed care plans.

• Conducted reviews of inpatient utilization for compliance with admission criteria and concurrent review requirements.
• Provided education to providers regarding utilization management processes and protocols.

My responsibilities included the care various types of patients. I have cared for cardiac, general medical and surgical patients. Practicing nursing within my scope of practice. Working collaboratively with the healthcare team.

Provided behavioral/emotional support and supervision for those with dementia and Alzheimer's.Utilized strong assessment skills to determine necessary patient care.

• Monitored and evaluated patient's responses to medications and treatments.
• Assessed patient's cardiac rhythm and vital signs using telemetry monitoring equipment.
• Provided direct nursing care to patients in accordance with established policies, procedures, and standards of practice.

Organized and assisted with healthcare plans for patients privately in their homes.

Facilitated ADLs and assisted patients with functional mobility to increase comfort and quality of life.

• Oversaw daily operations including staff scheduling, budgeting and inventory management.
• Developed and implemented effective marketing strategies to increase sales.
• Monitored customer feedback to ensure satisfaction
• Evaluated performance of employees regularly through performance reviews, coaching sessions and feedbacks from customers.