Reese Allen
Nurse
Charleston, SC Area,South Carolina
Summary
Experienced nursing professional bringing years of clinical expertise: ICU, ER, Transplant and, hospital leadership skills and technical knowledge. Proficient with medical history, assessments, laboratory, radiology data and complex interventions. Provided intensive care medications, IV therapy, education and led the facility ACLS code team. Strong interpersonal skill in educating patient, family and staff on disease process and management. Highly motivated nurse with a desire to take on new challenges.
Overview
25
25
years of professional experience
1
1
Certification
Work History
Clinical Nurse Reviewer
National Government Services-Elevance
, SC
04.2022 - 03.2024
- Performed clinical reviews of medical records to ensure accurate coding and compliance with Medicare regulations.
- Assessed patient data, diagnoses, treatments and outcomes to determine appropriateness of care and cost-effectiveness.
- Conducted research on new healthcare technologies and trends to inform clinical decisions.
- Developed policies and procedures for the implementation of new clinical review processes following regulatory standards.
- Analyzed claims data for accuracy, identifying discrepancies as needed for further investigation.
- Collaborated with other departments within the organization to ensure effective communication between all stakeholders involved in the clinical review process.
- Reviewed audit results, making recommendations for corrective actions when necessary.
- Educated providers on current coding guidelines and best practices for documentation accuracy.
- Facilitated training sessions for staff members on proper use of ICD-10 codes and other relevant topics.
- Maintained a working knowledge of CMS coverage determinations, LCDs and NCDs, CPT codes and modifiers.
- Interpreted laboratory results, imaging studies and other diagnostic tests used in diagnosis or treatment planning.
Nurse Consultant
The Toomey Law Firm
Fort Meyers, FL
06.2006 - 03.2022
- Reviewed medical records to identify patient care issues and evaluate the quality of care provided.
- Developed case summaries for attorneys to use as evidence during trial.
- Analyzed medical data to determine if there was a deviation from accepted standards of care.
- Prepared detailed reports outlining potential risks associated with various medical treatments or procedures.
- Assisted with deposition preparation by providing counsel with pertinent facts concerning the case.
- Collaborated with attorneys to develop effective strategies for presenting complex medical concepts in an understandable manner during trials.
Education
Bachelor of Science - Nursing
- Graduated magna cum laude
Bachelor of Arts - Philosophy
- Graduated magna cum laude
Skills
- Nursing Documentation
- Policy compliance
- Evidence-Based Practice
- HIPAA knowledge
- Healthcare regulations
- Nursing Consultation
- Patient Examination
- Student Precepting
- Trauma recovery
- Chronic Disease Management
- Infection Control
- Microsoft Office
- Accurate Documentation
- Problem-solving abilities
- Advanced Cardiovascular Life Support (ACLS)
- Adaptability and Flexibility
- Advanced Cardiovascular Life Support
- Team Collaboration
- Emergency Diagnostics
- Analytical Thinking
- Strong clinical judgment
Affiliations
- International award-winning photographer.
Certification
- South Carolina Nursing License: RN 254475
References
References available upon request.
Timeline
Clinical Nurse Reviewer - National Government Services-Elevance
04.2022 - 03.2024
Nurse Consultant - The Toomey Law Firm
06.2006 - 03.2022
Florida Atlantic University - Bachelor of Science, Nursing
Florida Atlantic University - Bachelor of Arts, Philosophy
- South Carolina Nursing License: RN 254475
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