Summary
Overview
Work History
Education
Skills
Phone
Referencesavailable
Yearsmarried
Children
Attributes
Personal Information
Timeline
Generic

Rosemarie Evans

Coxsackie,NY

Summary

Seasoned nursing professional offering proven clinical knowledge, natural interpersonal strengths. Efficient and quality-focused.

Overview

12
12
years of professional experience

Work History

Senior Quality Nurse

Healthhelp
01.2018 - 06.2024
  • Performed approximately 150 clinical review nurse audits per month to determine appropriateness of authorized procedures.
  • Developed several QIPs that were successfully implemented.
  • Supported clinical reviewers and management when needed.
  • Addressed complaints: i.e. egregious, abusive, and Member/Plan complaints.

Clinical Nurse Reviewer

Healthhelp
01.2014 - 01.2018
  • Managed requests averaging 40-50 cases efficiently while maintaining strict confidentiality of sensitive information per HIPAA regulations.
  • Adhered to strict timelines for case completion while maintaining a high level of accuracy and attention to detail during the review process.
  • Contacted providers to obtain information and records needed to conduct comprehensive clinical review of case and final determination.
  • Supported continuous improvement initiatives by contributing to the development of policies, procedures, and training materials related to clinical review processes.
  • Determined and authorized services for patients in accordance with guidelines and regulations.

Case Manager

The Reed Group
01.2012 - 01.2014
  • Oversee all aspects of the short disability process from initial introductions, dealing with healthcare providers and the employer to manage an employee’s treatment, recovery and return to work
  • Case management of approximately 40-50 members which included injuries and illness, in addition to behavioral health and alcohol/substance abuse diagnoses
  • Responsible for analysis of documentation to determine eligibility for benefit
  • Recognized for superior phone skills, customer service, and attention to detail.

Education

BSN coursework - BSN

Syracuse University
Remote, Endicott NY

RN A.A.S. - Nursing

Columbia Memorial Hospital School of Nursing
Hudson,NY
01.1985

Skills

  • Clinical Documentation
  • Licensed by NY nursing board
  • Patient Education
  • Clinical judgment
  • Mental health care

Phone

Home: 518-731-5555 Cell: 518-227-6374

Referencesavailable

Amanda Guevara, former manager: 832-768-9594


Pheary Zimmerman, former manager: 832-270-7812


Barbara Landreth,former manager: 903-253-6888

Yearsmarried

32

Children

Two grown children

Attributes

  • Attention to detail
  • Strong Organizational Skills
  • Excellent Communicator
  • Computer Skills
  • Self Starter
  • Adapt Well
  • Quick Learner

Personal Information

Marital Status: Married

Timeline

Senior Quality Nurse

Healthhelp
01.2018 - 06.2024

Clinical Nurse Reviewer

Healthhelp
01.2014 - 01.2018

Case Manager

The Reed Group
01.2012 - 01.2014

BSN coursework - BSN

Syracuse University

RN A.A.S. - Nursing

Columbia Memorial Hospital School of Nursing

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Rosemarie Evans