Sarah Rumore
Hudson,FL
Summary
Passionate and dedicated Registered Nurse with a strong desire to apply knowledge, education, and skills effectively. Proficient in computer skills, highly organized, adept at time management, detail-oriented with a knack for analyzing data and processes to streamline tasks. Graduated with a Bachelor of Science in Nursing from the University of South Florida in 2014 after obtaining RN License from Pasco Hernando State College in 2012.
Overview
12
12
years of professional experience
Work History
Utilization Management RN
Humana
01.2018 - Current
- Call providers to obtain medical records and additional information as needed for review.
- Perform medical necessity review for Medicare and commercial members by obtaining and applying criteria from MCG, NCD/LCD’s and member policy information.
- Extract pertinent information from records to write up reviews for the medical director as necessary.
- Work in multiple different inventories to include: subacute reviews (SNF, LTAC and Inpt Rehab), outpatient retrospective reviews, macess reviews, inpatient admission reviews, provider dispute second level reviews and genetics requests.
- Maintain 95% or higher in quality standards with weekly audits and exceed weekly production standards.
RN Clinical Advisor/Review & Appeals
Humana/Care Plus
02.2014 - 01.2018
- Review claims from doctor’s offices, hospitals and various other health care provider facilities.
- Review LCD/NCD’s and MCG to determine whether a service is medically necessary and covered.
- Review codes through Encoder to verify that proper codes are being used and are billable together.
- Write up second level reviews for the Medical Director and participate in conference calls to explain rationale used for claims denied on the nurse level.
- Transferred internally
Assistant Director of Nursing
Mobile Personal Services
12.2013 - 02.2014
- Case manage patients and supervise field staff to ensure that charting is completed in a timely manner and necessary information is relayed to the office.
- Process referrals from insurance companies and reach out to the ordering provider or patient for any additional information needed prior to scheduling visits.
- Audit field nurse’s documentation to ensure they remained in compliance with start of care, recertification and discharge timeframes.
- Review field nurse’s oasis’, notes, orders and plan of cares using quality improvement measures while making sure that patient meets homebound guidelines for homecare.
Registered Nurse/Case Manager
ACE Homecare
02.2013 - 12.2013
- Case manage Medicare patients following a developed plan of care to prevent hospitalizations and promote best outcomes.
- Supervises LPN’s and HHA’s to ensure personalized plan of cares are being followed and updates are being made as needed.
- Perform thorough assessments to determine patients’ needs at home and within the community.
- Determining where knowledge deficits are present to educate patients and caregivers.
- Admit new patients using the Oasis and communicate with doctors to receive orders for developing plan of care and initiating discharge planning.
- PRN
Registered Nurse
Comprehensive Home Care
07.2013 - 11.2013
- Develop patient specific plan of care to prevent hospitalizations and promote best outcomes.
- Perform thorough assessments and complete computerized documentation.
- Assess patients’ knowledge deficits and provide education to both patients and caregivers.
- Admit new patients and communicate with doctors to receive orders for developing plan of care and initiating discharge planning.
- Case manage patients in the community following a developed plan of care to prevent hospitalizations and promote best outcomes.
- PRN
Regional Medical Center Bayonet Point
01.2013 - 03.2013
- Worked on Neuro/Spine, Trauma Step Down unit caring for a variety of patients including post-operative patients, stroke patients, trauma patients and dementia patients.
- Communicate pertinent information and changes in patient’s condition to doctors and other medical personnel while completing thorough computerized documentation.
- Perform medication passes and dressing changes, monitor patients pain levels and educate patients on the recovery process.
- Work as part of a team and keep organized to get tasks done in a timely manner.
Education
Bachelors of Science - Nursing
University of South Florida
08.2014
Associates of Science - undefined
Pasco Hernando Community College
05.2012
Skills
- Effective leadership
- Active listening and clear communication
- Quick learner
- Collaborative team member
- Demonstrate a professional attitude
- Detail-oriented efficiency
- Continuous improvement initiatives
- Research-driven decision making
- Effective clinical decision-making
- Proficient in EMR software
- Clinical judgment
Timeline
Utilization Management RN
Humana
01.2018 - Current
RN Clinical Advisor/Review & Appeals
Humana/Care Plus
02.2014 - 01.2018
Assistant Director of Nursing
Mobile Personal Services
12.2013 - 02.2014
Registered Nurse
Comprehensive Home Care
07.2013 - 11.2013
Registered Nurse/Case Manager
ACE Homecare
02.2013 - 12.2013
Regional Medical Center Bayonet Point
01.2013 - 03.2013
Associates of Science - undefined
Pasco Hernando Community College
Bachelors of Science - Nursing
University of South Florida
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