Sharon Woronka
PORT SAINT LUCIE
Summary
Experienced healthcare professional prepared for role with strong background in clinical review and patient care. Expertise in evaluating medical records, ensuring compliance with regulatory standards, and facilitating effective communication between healthcare providers. Known for collaborative approach, reliability, and adaptability to changing needs. Skilled in utilization review, case management, and healthcare documentation, with focus on achieving measurable results.
Overview
15
15
years of professional experience
Work History
Clinical Review Nurse
AmeriHealth Caritas
02.2017 - Current
- Review concurrent and continued stay requests to ensure appropriate care and setting, following established guidelines and policies.
- Complete medical necessity and level of care assessments for requested services using InterQual guidelines.
- Approve services or escalate requests to the Physician or Medical Director for secondary review.
- Adhered to strict timelines for case completion while maintaining a high level of accuracy and attention to detail during the review process.
- Collaborate with staff within provider networks and the discharge planning team, both electronically and telephonically, to coordinate member care.
Utilization Review Nurse
Cognizant Technology Solutions Woodlands
09.2016 - 12.2016
- Submitted cases for criteria failures and helped facilitate resolutions and approvals.
- Optimized hospital stays by monitoring admissions for appropriateness based on established clinical guidelines while considering each patient''s unique circumstances.
- Performed admission reviews based for medical necessity based upon InterQual specification.
Discharge Coordinator
WellCare
08.2015 - 09.2016
- Collaborate with staff within provider networks and the discharge planning team, both electronically and telephonically, to coordinate member care.
- Conduct discharge planning activities to facilitate effective transitions of care.
- Promoted a collaborative environment among colleagues by sharing best practices for efficient coordination across departments involved in the discharge process.
- Collaborate with staff within provider networks and the discharge planning team, both electronically and telephonically, to coordinate member care.
Clinical Review Nurse
Aetna
04.2015 - 08.2015
- Review concurrent and continued stay requests to ensure appropriate care and setting, following established guidelines and policies.
- Maintained strict adherence to HIPAA regulations during all clinical review activities, ensuring patient confidentiality was upheld at all times.
- Improved patient care by conducting thorough clinical reviews and recommending evidence-based interventions.
Clinical Review Nurse
Canaide
08.2012 - 02.2015
- Review concurrent and continued stay requests to ensure appropriate care and setting, following established guidelines and policies.
- Maintained strict adherence to HIPAA regulations during all clinical review activities, ensuring patient confidentiality was upheld at all times.
- Managed caseload efficiently while maintaining strict confidentiality of sensitive information per HIPAA regulations.
Clinical Review Nurse
Eqhealth Solutions
04.2011 - 08.2012
- Review concurrent and continued stay requests to ensure appropriate care and setting, following established guidelines and policies.
- Approve services or escalate requests to the Physician or Medical Director for secondary review.
- Strengthened nursing practice through ongoing professional development and staying current on best practices in clinical review.
Clinical Review Nurse
KEPRO
01.2010 - 04.2011
- Review concurrent and continued stay requests to ensure appropriate care and setting, following established guidelines and policies.
- Approve services or escalate requests to the Physician or Medical Director for secondary review.
- Strengthened nursing practice through ongoing professional development and staying current on best practices in clinical review.
Education
Associate of Science - Nursing
St Charles County Community College
05-1997
Skills
- Utilization review
- Medical record review
- Strong Clinical Judgment
- Organizational Skills
- Team Collaboration
- Care Coordination
- Patient confidentiality
- HIPAA Compliance
Education
Cottleville, MO
Contact
PORT SAINT LUCIE, FL 34953
Timeline
Clinical Review Nurse
AmeriHealth Caritas
02.2017 - Current
Utilization Review Nurse
Cognizant Technology Solutions Woodlands
09.2016 - 12.2016
Discharge Coordinator
WellCare
08.2015 - 09.2016
Clinical Review Nurse
Aetna
04.2015 - 08.2015
Clinical Review Nurse
Canaide
08.2012 - 02.2015
Clinical Review Nurse
Eqhealth Solutions
04.2011 - 08.2012
Clinical Review Nurse
KEPRO
01.2010 - 04.2011
Associate of Science - Nursing
St Charles County Community College
Similar Profiles
Lisa FridayLisa Friday
Associate Relations Manager at AMERIHEALTH CARITASAssociate Relations Manager at AMERIHEALTH CARITAS
LISA RUSSOLISA RUSSO
RN Case Manager at AmeriHealth Caritas PARN Case Manager at AmeriHealth Caritas PA
Ashley WallAshley Wall
Senior Capture Planning Analyst at AmeriHealth CaritasSenior Capture Planning Analyst at AmeriHealth Caritas