Shelley LaMacchia

Conducting clinical review of pre and post claim denials and utilized evidence based medicine, nursing experience, state and federal insurance guidelines, hospital patient care policies and protocols to determine medical necessity appropriateness of appeals.

Collaborating with Denial Recovery team members, Financial Services, Medical Directors, patient care providers, and insurance provider representatives in denial management.

Identifying process improvements in managing inpatient denials in an attempt to minimize or eliminate denials.

Working with patients in the appeal process and providing education on the appeal process.

Attending webinars and educational sessions to enhance my ability to identify, appeal and minimize denials.

Conducting clinical review of patient charts and utilized evidence based medicine, nursing experience, state and federal insurance guidelines, hospital patient care policies and protocols to determine medical necessity to ensure appropriate reimbursement.

Collaborating with Utilization Management team members, Financial Services, Medical Directors, patient care providers, and insurance provider representatives for the purpose of ensuring appropriate level of care and obtain authorization for inpatient hospital stays.

Attending webinars and educational sessions to enhance my ability to ensure appropriate level of care and claim reimbursment.

Preparing Pediatric patients from 0-17 years of age for surgery through physical assessment, patient education, ensuring IV access where appropriate and medication management.

Providing monitoring, assessment, surgical site management, medication management and airway management of postoperative Pediatric patients in the Recovery Room.

Transporting patients to inpatient nursing units and providing communication to the receiving nurse regarding the management of the patient in the Recovery Room.

Preparing Pediatric patients for discharge through assessment of appropriate discharge, patient and parent/guardian education, pain management and surgical site management.

Managing Pediatric patients receiving moderate sedation undergoing procedures including lumbar punctures, intrathecal chemotherapy administration, Botox administration, MRI and CT scans.

Performing duties of a Charge Nurse including managing staff assignments, patient acuity, patient transfers from nursing units and the Emergency Department preoperatively and coordinating with the Operating Room for patient readiness for surgery.

Managing treatments, assessments and medications of 2-4 acute Pediatric patients.

Providing education to patients and care givers on patient illness, medications, treatments and discharge needs.

Conducting comprehensive assessments of Pediatric patients upon admission and creating an individual nursing care plan.

Providing patient and caregiver centered care with compassion and fostering healing both physically and emotionally.

Collaborating with case managers, social workers, physicians, pharmacists and other nurses in caring for patients on a 10 bed acute care Pediatric unit.

Floating to the Neonatal Intensive Care Unit as well as the Maternity unit to care for patients.

Managing treatments including dressing changes, chemotherapy administration, blood transfusions, central venous access device care, peritoneal catheter drainage as well as assessments, monitoring and medication administration of 10-12 acute adult hematology/oncology patients.

Providing education to patients and care givers on patient illness, medications, treatments and discharge needs.

Conducting comprehensive assessments of adult hematology/oncology patients upon admission and creating an individual nursing care plan.

Providing patient and caregiver centered care with compassion and fostering healing both physically and emotionally.

Collaborating with case managers, social workers, physicians, pharmacists and other nurses in caring for patients on a 23 bed acute care adult hematology/oncology unit.

Floating to other adult medical/surgical units to care for patients.