
Dedicated RN Case Manager with 16 years of experience in case management and patient advocacy. Expertise in discharge planning and utilization review, with a strong focus on regulatory compliance. Track record of driving positive patient outcomes and ensuring continuity of care through effective system navigation.
Classified patient admissions by evaluating documentation and charts for accuracy.
Requested admission orders from physicians to ensure regulatory compliance.
Coordinated interdepartmental collaboration to facilitate timely testing and procedures.
Maintained extensive knowledge of various insurance types, including Medicare's two-midnight rule and Managed Care Medicare.
Administered chemotherapy, immunotherapy, and other cancer treatment modalities.
Managed treatment side effects to enhance patient comfort.
Delivered effective pain management interventions for optimal patient care.
Utilization review and case management
InterQual and MCG guidelines
Insurance compliance and regulations (Medicare,Medicaid, Commercial)
Clinical documentation and necessity reviews
Collaboration with physicians and insurance providers
Electronic health records management( Meditech,Midas,Careport, Nate Tempo
Healthcare resource management
Effective communication skills
Critical analysis abilities
Basic life support certification