Stacie Dixon

• Reviewing cases with both Commercial and Medicare lines of business
• Reviewing both acute and Post-acute case types to determine appropriateness of care
• Reviewing cases on a national level
• Reviewing both initial as well as continued stay review cases with discharge planning
• Monitored treatment progress by reviewing medical records, lab results, physician notes.
• Identified potential areas of fraud or abuse within the organization's operations.
• Reviewed appeals related to denied or reduced reimbursement decisions.
• Communicated regularly with physicians and providers regarding appropriateness of care delivery within established parameters.
• Documented all activities related to utilization management in the electronic medical record system.
• Assessment for medical necessity for each specialized line of business as well as case type, interchangeably, throughout the shift.
• Ensuring compliance to make sure services meet regulatory and accreditation standards through MCG and CMS criteria
• Thorough documentation of findings
• Professionally communication and submission of cases to medical directors for review
• Issuing approvals, denials, NOMNC’s with DENC creation and submission, as well submission of specialized letter reviews to Quality Control

• Facilitates movement of all patients checked in (Average of 80 patients per shift).
• Direct and assist all emergency room nurses with their patient assignment.
• Monitor, manage, and distribute patient load evenly and appropriately for each nurses assignment.
• Oversee Emergency Severity Index (ESI) assigned for each patient during triage and allocate to appropriate nursing staff.
• Provide direct correlation and communication with all physicians and providers for all patients including: each incoming EMS patients, review of admission criteria for appropriateness for pending admissions, all patient transfers, discharge planning, and follow-up appointments.
• Receive all incoming emergency medical service (EMS) / Air Care calls.
• Provide routine treatments, medication administrations, emergency care and interventions for life threatening situations.
• Medical record audits for compliance of required standards of practice as well as policy and procedure adherence.
• Record review for appropriate documentation in accordance to admission criteria, core measure parameters, and discharge planning.
• Use of Microsoft Word, Excel, Outlook, and Power Point for various chart audits, compliance documentation, patient transfers, and medical record reviews for adherence of set department documentation standards.
• Monthly inventory of supplies, including documentation in Excel and team meeting of cost saving measures for improvement.

• Perform administrative duties and oversee staff of: emergency room, inpatient unit, orthopedic post surgical unit, intermediate care unit (ICU), and psychiatric rooms.
• Be a resource for each departments nursing staff (approximately 30 nurses each shift)
• Ensure and eforce quality patient care measures and metrics.
• Supervise and organize nursing personnel to provide adequate staffing amongst various departments.
• Manage on-call staff and resources, or, personally cover for call-ins.
• Maintain accurate documentation regarding employee attendance records, time off requests, and scheduling changes.
• Liaison between patients, patients families, and providers to provide quality care.
• Assisted in the development of training programs for new employees related to safety protocols, infection control processes, and core measure metrics.
• Developed and implemented nursing policies and procedures to ensure compliance with local, state, and federal regulations.
• Record review of Involuntary Commitment cases for behavioral health patients and psychiatric holds. This includes: communicating with law enforcement and magistrates for appropriate documentation/notarization.
• Chart review for admission criteria, treatment standards, and appropriateness for admission.
• Collaboration with medical staff, including physicians and case management for each admission.
• Participated in multidisciplinary meetings with other healthcare professionals such as physicians and therapists.
• Performed daily rounds to evaluate patient condition, provide feedback on performance, and address any issues or concerns.
• Evaluated nursing practices regularly against best practice guidelines set forth by various governing bodies.
• Conducted regular performance evaluations for all staff members in order to identify areas of improvement.
• Facilitated a safe working environment by addressing potential hazards promptly before they became an issue.
• Initiated incident reports when a deviation from standard protocol occurred involving patients or staff members.
• Identified opportunities for process improvements within the department in order to streamline operations.
• Responded quickly during emergency situations while maintaining composure under pressure.
• Actively participated in educational activities designed to increase knowledge base related to nursing practice.
• Completed daily rounds of nursing department to verify nursing service personnel performance alignment acceptable nursing standards.
• Investigated and reported accidents, leveraging new knowledge to improve protections for patients and staff.
• Answered questions and addressed concerns from employees promptly through email, phone and in person.
• Coordinated and led in-services to facilitate nursing leadership development and career growth.
• Created and integrated new nursing protocols designed to improve patient outcomes while minimizing medical errors.
• Maintained comprehensive base of unit supplies to meet expected patient demands, public health emergencies and mass casualty incidences.
• Recruited, interviewed, hired and coached employees and promoted high level of care quality to patients.
• Responded to emergency situations with speed, expertise and level-headed approaches to provide optimal care, support and life-saving interventions.
• Maintained strict patient data procedures to comply with HIPAA laws and prevent information breaches.
• Utilized computerized Resource and Patient Management System (RPMS) and Electronic Health Record (EHR) /Electronic Medical Record (EMR) system.
• Referred patients to specialized health resources or community agencies to furnish additional assistance.
• Achieved departmental goals and objectives by instituting new processes and standards for in-patient care.

• Prepare surgical suite, gather all supplies, equipment, instruments, suture, and any artificial / bovine heart valves.
• Set up, operate, and troubleshoot all equipment to ensure proper maintenance throughout case, including: defibrillator (internal and external), pacemaker, LVADs, bovie, suction, cell saver, intravenous (IV) pumps, radio frequency identification (RFID) pads / wands, laparoscopic cameras / monitors, headlamps, microscopes, etc.
• For robotic cases: set up / drape robot for sterility, position robotic arms, track and document robotic instrumentation counts, connect to appropriate monitors.
• Assisted surgeons with procedures, such as positioning patients and passing instruments.
• Provided direct patient care in the operating room, including pre-operative, intra-operative, and post-operative assessments.
• Maintained a sterile environment during surgery through use of proper techniques and knowledge of aseptic technique.
• Performed scrub duties to include selection and opening of supplies, preparation of surgical field, and instrumentation during surgical cases.
• Evaluated patient response to anesthesia throughout the procedure, taking appropriate action when indicated.
• Monitored vital signs before, during and after surgery; reported changes or irregularities to anesthesiologist and physician immediately.
• Provide 24 hours a day 7 day a week emergency call.
• Documentation of entire procedure, including: supplies used, staff present, patient positioning, specimens, family notifications, and safety communications used.
• Maintained thorough, accurate and confidential documentation in electronic medical records.
• Demonstrated knowledge of current trends in nursing practices by attending continuing education classes or seminars.
• Ensured compliance with standards of professional practice as well as state and federal regulations related to health care delivery services.
• Maintained a safe environment for all patients by adhering to infection control policies and procedures.
• Utilized critical thinking skills to assess clinical situations quickly and accurately.
• Initiated emergency measures in response to life threatening situations or complications occurring during surgery.
• Documented patient progress notes accurately and efficiently in the electronic medical record system.
• Record review and auditing of cases for clinical review and compliance.
• Provided emotional support and comfort to families during difficult times.

• Receive and register all incoming patients (approximately 200 per shift).
• Record patient demographic information and verify insurance for emergency department, laboratory, radiology, physical therapy, surgical procedures, and direct admissions.
• Register all patients into computer system and ensure correctness of all demographic information, verify insurance on various websites, and collect patient co-payments.
• Update demographics as needed, including: physical and mailing addresses, guarantee information, emergency contact, billing information, Medicare, Medicaid, and private insurance updates.
• Review workers compensation records for appropriate guarantor documentation and providers information.
• Process release of information requests according to HIPAA regulations.
• Manage and secure valuables in locked safe for entire facility.
• Specialize in high degree of compassion when communicating with patients providing information and insurance details.
• Enter confidential personal health information and financial information into system with a high rate of accuracy and confidentiality.
• Monitor all emergency room patients for status, wait time, and pending results.
• Personally inform patients of delays and provide explanations in a professional and compassionate manner.
• Audit and review of records for ordered procedures for completion prior to discharge.
• Faxing of all documentation to insurance companies for prior authorization / precertification and insurance approval.
• Calling Medicaid and Medicare companies for prior authorization / precertification of outpatient procedures.
• Assisted with scheduling outpatient appointments.
• Pull claims in the insurance department to verify payments.
• Pull claims in the insurance department for denials for dispute settlement requests.
• Filing of all miscellaneous charges into medical record.
• Maintain and update excel spreadsheet for insurance department to record and review cost-saving measures.

As CNA:

• Assist the nurses and providers with any tasks within my scope, including: placing foleys, collecting specimens for testing, assisting patients with ambulation/bathroom needs, obtaining and documenting vital signs, perform and document EKG's, patient transportation, room turn-over, etc.