Rachel Rotilio
Flushing,OH
Summary
Quality-focused and efficiency-driven experienced nurse. Knowledgeable in admissions and stay reviews. Considered a critical thinker and problem-solver due to dynamic patient care planning and understanding of Medicare guidelines.
Known for having great rapport with providers and insurance carriers.
I offer proven clinical knowledge, interpersonal strengths and technical abilities, and knowledgeable regarding interdisciplinary collaboration focused on optimizing patient care and support.
Overview
12
12
years of professional experience
Work History
Utilization Review Nurse
East Ohio Regional Hospital
10.2021 - Current
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Performed prior authorization review of services requiring notification.
- Performed admission reviews based for medical necessity based upon MCG/Interqual criteria.
- Obtained authorizations from multiple insurance carriers for various levels of care.
- Submitted cases for Inpatient denials and helped facilitate resolutions and approvals.
- Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
- Devise or identify solutions for irregular requests and issues.
Complex Illness Case Manager
Cigna
06.2017 - 02.2021
- Partnered with physicians, social workers, activity therapists, nutritionists, and case managers to develop and implement individualized care plans and documented patient interactions and interventions in electronic charting systems.
- Facilitated individual and group sessions to promote positive behavior change for clients.
- Developed and implemented comprehensive case management plans to address client needs and goals.
- Coordinated services with other agencies, community-based organizations, and healthcare professionals to provide useful benefits to clients.
Registered Nurse, Labor and Delivery
Ohio Valley Medical Center
09.2015 - 06.2017
- Assessed infant health directly after birth using APGAR and monitored health for specified amount of time for any changes in status.
- Coached new mothers with breastfeeding techniques, postpartum self-care and infant care to promote easier transition into motherhood.
- Supported physicians in both planned and emergency Cesarean section procedures.
- Responded to emergency situations such as pre-eclampsia, early labor, and fetal distress.
Registered Nurse, Float Pool
West Penn Hospital
11.2012 - 06.2017
- Administered medications and treatments as prescribed by physicians.
- Performed frequent checks on life support equipment and made necessary adjustments to preserve optimal patient conditions.
- Provided skilled, timely and level-headed emergency response to critically-ill patients.
- Delivered high level of quality care to diverse populations while overseeing patient admission and triaging based on acuity and appropriate department admission.
Education
Bachelor of Science - Nursing Science
Ohio University
Athens, OH08.2011
Associate of Science - Nursing Practice
West Virginia Northern Community College
Wheeling, WV05.2006
Skills
- Inpatient care reviews using MCG criteria
- Documentation And Reporting
- Physician consultations
- Interpersonal and written communication
- Discharge Planning
- Medicare knowledge
Timeline
Utilization Review Nurse
East Ohio Regional Hospital
10.2021 - Current
Complex Illness Case Manager
Cigna
06.2017 - 02.2021
Registered Nurse, Labor and Delivery
Ohio Valley Medical Center
09.2015 - 06.2017
Registered Nurse, Float Pool
West Penn Hospital
11.2012 - 06.2017
Bachelor of Science - Nursing Science
Ohio University
Associate of Science - Nursing Practice
West Virginia Northern Community College
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