Summary
Overview
Work History
Education
Skills
References
Additional Information
Timeline
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Terri Benjamin

Connersville,IN

Summary

Masters-level nurse with compact state license with 14 years nursing experience. Experience with utilization management, DRG and ICD , inpatient code review/audits, planned discharge and concurrent reviews with thorough knowledge of hospital and behavioral health administration and management criteria through Interqual, Milliman (MCG) Care, and ICD Medicare guidelines. Experience with hospice/palliative care with Telephone Triage/ Administration/ Management/ Case Management/Education, in outpatient and inpatient settings. High-performing Manager with 32 years of business management experience that supports an advanced practice degree in nursing administration. Apt at coordinating, implementing, and facilitating direct patient care as well as developing curriculum for training with a patient centered approach. Well versed in after hours telephone triage, education techniques, content design, project management and resource coordination. Excels at comprehensive assessment, development and implementation of care plans. Responsible registered nurse with excellent communication skills demonstrated by 13 years of experience in healthcare. Authorized to work in the US for any employer

Overview

14
14
years of professional experience

Work History

Utilization Management Nurse

Humana
Louisville, KY
05.2024 - Current
  • Completes medical record reviews applying clinical criteria and guidelines such as MCG, InterQual, and Milliman
  • Assesses discharge plans
  • Reviews and extract information from claims
  • Completes documentation for Quality Reviews for Peer Reviews
  • Discuss cases with Medical Directors
  • Works in partnership with other members of the Humana Interdisciplinary team
  • Complies with performance and reporting standards as defined by Humana

Triage Nurse Cardiology

Reid Health
05.2022 - Current
  • Answers calls and interviews patient (if possible) and/or family to obtain medical information and to make an accurate assessment of needs
  • Assigns a triage priority based on observations and available information
  • Initiates scheduling of appointments and procedures, and medication refills
  • Provides patients with education, lab and testing results along with recommendations from cardiologists
  • Communicates and acts as liaison with patients, family, and the cardiology team in a manner that respects confidentiality and dignity
  • Coordinates the needs of the patient with supporting departments
  • Charts concisely, descriptively, and legibly

Clinical Documentation Integrity Specialist

Reid Hospital & Health Care Services
07.2019 - 03.2022
  • Performs prospective and retrospective medical record coding reviews through evaluation of previous visits, lab results, images, physician/consult notes
  • Applies coding and clinical knowledge to identify potential HCC/Risk Adjustment conditions for provider pre-planning purposes
  • Prepares written communication and queries to providers
  • Applies Official Guidelines for Coding and Reporting consistently and appropriately.

Hospice Triage Nurse

Intellatriage
Brentwood, TN
01.2021 - 12.2021
  • Triages high volume patient and family calls for multiple Clients in 5 states after hours
  • Assigns nurses and other staff to tend to patient needs throughout the state
  • Effectively speaks with patients and their loved ones, staff, and referral sources to coordinate patient care after hours
  • Prioritizes calls to the needs of patients and direct staff on where to go and when
  • Assigns visits and processes all after hours workflow through EMR's and Homecare Homebase technology
  • Processes new patient referrals and get them entered into system timely for timely admissions
  • Directs all patient referral and intake processes after hours
  • Ensures compliance with all state, federal, and CHAP requirements
  • Ensures patients are admitted in accordance with policy and appropriate criteria
  • Establishes and maintain positive working relationships with current and potential referral sources
  • Ensures seamless transition of patient's needs by assigning the appropriate staff
  • Ensures maximum third party reimbursement through direct oversight of insurance verification and authorization processes.

On Call

RN Covid, Hotline, Reid Health
08.2021 - 11.2021
  • Rn Lead for COVID 19 Respiratory Clinic/ Hotline Conducts virtual screenings for COVID 19 Provides clinical education on CDC COVID 19 recommendations for prevention and control of COVID 19 Assess callers symptoms and assigns risk score for COVID 19 Initiates Call Backs for COVID 19 Respiratory Clinic Patients via phone for follow-up symptom monitoring
  • Provides information on Vaccines, self isolation, remote monitoring, and symptoms of COVID 19 Initiates referrals to for further evaluation
  • Administrator

Premier Hospice and Palliative Care
Carmel, IN
12.2018 - 11.2019
  • Acts as administrator after hours
  • Triages high volume patient and family calls for the state after hours
  • Assigns nurses and other staff to tend to patient needs throughout the state
  • Effectively speaks with patients and their loved ones, staff, and referral sources to coordinate patient care after hours
  • Prioritizes calls to the needs of patients and direct staff on where to go and when
  • Assigns visits and processes all after hours workflow through Homecare Homebase technology
  • Processes new patient referrals and get them entered into system timely for timely admissions
  • Directs all patient referral and intake processes after hours
  • Ensures compliance with all state, federal, and CHAP requirements
  • Ensures patients are admitted in accordance with policy and appropriate criteria
  • Establishes and maintain positive working relationships with current and potential referral sources
  • Ensures seamless transition of patient's needs by assigning the appropriate staff
  • Ensures maximum third party reimbursement through direct oversight of insurance verification and authorization processes.

RN Case Manager/ Utilization Review

Fayette Regional Health System
Connersville, IN
07.2017 - 07.2019
  • Supports all utilization and case management activities, behavioral and medical, as per clinical policies throughout the Hospital, Emergency Dept, and North Star Detox
  • Determines medical necessity of requested treatment and level of care criteria
  • Performs utilization and concurrent review of in-patient and medical observation cases using Milliman (MCG) and McKesson Interqual criteria
  • Conducts clinical chart assessments through advanced assessment skills and was able to decrease denial rates for services
  • Conducts Insurance pre-authorization requests
  • Reviews denials for pre-authorization requests and responsible for managing client medical denials by conducting a comprehensive analytic review of clinical documentation to file an appeal
  • Prepares sound, compelling factual arguments for the appeal team to review and determine if original denial should be reversed
  • Conducts Peer Review preparation, facilitates peer review meetings, and assesses data collection of review findings
  • Discusses cases with treating physicians and disciplinary team members to understand plan of care
  • Participates in rounds with physicians and leadership team to discuss cases as needed and insure treatment is provides in accordance with established guidelines
  • Identifies and evaluate delays in care and discharges
  • Monitors re-admission rates and conducts assessments on cause for utilization review committee
  • Initiates discharge planning
  • Assesses high risk patients and performs psychosocial assessments in the ER to determine and arrange long term and short-term treatment and placement in a psych facility
  • Arranges care services and placement for short acute rehab, skilled nursing facility, home health, and respiratory services
  • Builds solid and trusting relationships with interdisciplinary, patients, and families
  • Refers patients to community resources to meet post-hospital needs
  • Maintains appropriate documentation of actions and services
  • Prepares reports for utilization review committee
  • Closely collaborates with management team to make necessary improvements and meet department needs
  • Acts as mentor to other department and staff including new hires
  • Assists in training new employees

Operational Manager

Veteran Health Administration Mobile
Dayton, OH
09.2014 - 05.2017
  • Functioned for the Office of Rural Health (ORH) as an educator, consultant, facilitator, researcher, leader, change agent, and resource person for the Veterans Integrated Service Network (VISN) 10 mobile simulation grant project
  • Managed and supported the operations of the mobile simulation program across 38 facilities
  • Responsible for day to day management and supervision of staff
  • Responsible for day to operations for the mobile classroom
  • Participated in management of the budget for the funding supported by the grant
  • Strategically coordinated, planned, and managed the logistics for the mobile simulation program, including scheduling the field simulation sessions
  • Functioned as a liaison between site simulation educators and program managers
  • Functioned as a Subject Matter Expert for simulation training
  • Collaborated with VISN 10 Simulation Lead to develop and implement curriculum related to simulation technology that includes human patient simulators, online software, standardized patients, serious medical game technology, immersive virtual environments, and task trainers
  • Coordinated preparation of simulators and other equipment /props for conducting simulation
  • Facilitated simulation scenario and staff participation with debriefing sessions
  • Trained simulation users in simulation activities, operation of patient simulators, audio-visual equipment, and their maintenance
  • Assisted in formulation of program philosophy, objectives, and policy
  • Oversees all simulation encounters to include after action reports
  • Worked directly with Simulation Operators and Coordinators to develop and implement training modules for the mobile simulation program
  • Developed and maintained Qualtrics surveys and spreadsheets for data collection and analysis
  • Educated Nurses on ACLS
  • Worked with Simulation Based Virtual Software to develop training modules
  • Responsible for all Annual and Quarterly Reporting for the grant.

Palliative Care Simulation Coordinator/Project Manager

Veterans Health Administration
Dayton, OH
09.2015 - 09.2015
  • Functioned as a Subject Matter Expert for Palliative Care Simulation Training
  • Supported the Veterans Integrated Service Network (VISN) 10 lead in developing scenarios that adapt and align with operational requirements
  • Coordinated Learner Logistics and administrative support needs
  • Developed and Implements virtual training modules for medical training of VA staff
  • Planned and Designed scenarios for training with standardized and virtual patients
  • Designed 4 palliative care Decision seem virtual simulation cases centered on Pain Management with the PACT Team and Delivering "Bad News", which were approved for national implementation into the
  • TMS training system
  • Developed Decision Simulation virtual cases for the VA Virtual Medical Center
  • Educated Nurses on ACLS
  • Worked with Simulation Based Virtual Decision Simulation Software to develop training modules
  • Responsible for all Annual and Quarterly Reporting.

Patient Care Manager

AseraCare Hospice
Richmond, IN
01.2014 - 06.2014
  • Responsible for day to day management of patient care activities and supervision of staff
  • Provided daily, leadership supporting the operations of the agency
  • Delegated tasks appropriately and within licensure requirements
  • Responsible for scheduling out of visits requested by Registered Nurse, Social
  • Worker, and Chaplain at beginning of benefit period
  • Responsible for rescheduling, declined, missed, and reassigned visit requests
  • Ensuring staff are completing visits in a timely manner
  • Managed all components of the calendar-changing of service codes, visit dates, clinicians assigned, scheduling out of PRN visits, etc
  • Prepared for interdisciplinary team meetings and ensuring all of the notes are completed prior to the meeting
  • Served as the scribe and facilitator for interdisciplinary team meetings
  • Gathered necessary information to input a complete referral
  • Scheduled durable medical equipment (DME) delivery and pick up
  • Processed satisfaction surveys
  • Notified appropriate staff at death or discharge (pharmacy, physician, supply company, etc.)
  • Ensured Medicare patients have eligibility
  • Verified commercial insurance
  • Obtained authorization and reauthorization, as needed
  • Proficient at "Home Care, Home Base" electronic record keeping system
  • Ensured patient's benefit period is correct and patient events are input into "Home Care, Home Base" electronic record keeping system
  • Responded to phone referrals/inquiries in a timely, professional, and compassionate manner, entering referral data into systems as soon as received when possible
  • Responses may include triage of medical concerns within scope of practice
  • Participated in on-call schedule and to provide direct skilled bedside nursing care in patient home or IPU
  • Participated in quality improvement program and the evaluation of nursing and other clinical services to decrease denial of claims and ADR's
  • Advocated for patients and families, maintaining existing programs and creating new ones to meet their special needs
  • Weekend Warrior

AseraCare Hospice
01.2011 - 01.2014
  • Provided on-call care at all times of day and night through support for patients and families
  • Ensured efficacy of pain and symptom management through monitoring of treatment regimens
  • Collaborated with Facility Staff, Medical Director and interdisciplinary team to develop effective plan of care
  • Prioritized calls and instructs visit nurses and case managers to see patients as needed
  • Completed on-going telephonic assessment of the impact of the terminal diagnosis on the patient's physical, functional, psychosocial and environmental needs and activities of daily living, including: the risk for pathological grief, cultural and spiritual implications, and verbal and non-verbal communication patterns
  • Communicated actively and effectively through receiving, recording and conveying information to the interdisciplinary personnel in a timely manner
  • Documented patient care
  • Provided initial and ongoing patient/family instruction, education and support regarding the disease process, self-care techniques, end-of-life care, and issues of ethical concerns
  • Answered all incoming calls from internal and external customers providing appropriate telephonic interventions according to HOM guidelines and in collaboration with interdisciplinary team members
  • Triages phone calls through problem assessment and needs identification utilizing critical thinking skills and all available patient records including HOM clinical guidelines
  • Received and processed physician's orders according to established practice guidelines

Education

Master - Nursing Administration

Purdue Global University
12-2011

Bachelor - Nursing

Indiana University East School of Nursing
01.2011

Skills

  • Remarkable experience in hospice after hours care and call center telephone triage (10 years)
  • Apt at coordinating, managing, and implementing hospice care to patients and families (10 years)
  • Well versed in education techniques, content design, project management and resource
  • Coordination (5 years)
  • Diligent Utilization Review/CDI Nurse Specialist ensuring that patients get the appropriate level of
  • Medical care (5 years)
  • Specialize in finding a balance between the fiscal needs of the hospital or medical facility and the
  • Care needs of each patient (10 years)
  • Exceptional knowledge of utilization review, case management, and disease management (2 years)
  • Solid understanding of state and federal regulatory requirements affecting care coordination
  • Services, specifically Medicare, Medicaid and HIPAA (10 years)
  • Proficient in Microsoft Word, Excel and utilization review modules MCG, Interqual in information
  • Systems (5 years)
  • Proficient at simulation technology for advanced training (4 years)
  • Specializes in assessing documention of level of care to reduce denials for services (2 years)
  • Triage
  • Pain Management
  • Utilization Management
  • Epic
  • Medication Administration
  • Nurse Management
  • Meeting Facilitation
  • Critical Care Experience
  • EMR Systems
  • Nursing
  • Hospital experience
  • ICD-10
  • Utilization review
  • Care Coordination
  • Discharge Planning
  • Performing assessments
  • Medical Coding

References

References: Indiana Samuals NP: Phone-317-506-1560 Cynthia Baily: Phone- 765-580-1785 Amanda Sudoff: Phone-765-309-6039

Additional Information

  • Certifications and Licenses , Registered Nurse (RN) June 2009 to Present Indiana Registered Nurse August 2014 to Present Ohio Registered Nurse February 2017 to Present Kentucky Compact State License December 2021 to October 2023 Compact state License # 28185387C Registered Nurse May 2021 to May 2022 California Rgistered Nurse May 2021 to May 2022 Oregon Registered Nurse May 2021 to May 2022 Washington Registered Nurse May 2021 to May 2022 Alaska RN License, Additional Information

Timeline

Utilization Management Nurse

Humana
05.2024 - Current

Triage Nurse Cardiology

Reid Health
05.2022 - Current

On Call

RN Covid, Hotline, Reid Health
08.2021 - 11.2021

Hospice Triage Nurse

Intellatriage
01.2021 - 12.2021

Clinical Documentation Integrity Specialist

Reid Hospital & Health Care Services
07.2019 - 03.2022

Premier Hospice and Palliative Care
12.2018 - 11.2019

RN Case Manager/ Utilization Review

Fayette Regional Health System
07.2017 - 07.2019

Palliative Care Simulation Coordinator/Project Manager

Veterans Health Administration
09.2015 - 09.2015

Operational Manager

Veteran Health Administration Mobile
09.2014 - 05.2017

Patient Care Manager

AseraCare Hospice
01.2014 - 06.2014

AseraCare Hospice
01.2011 - 01.2014

Master - Nursing Administration

Purdue Global University

Bachelor - Nursing

Indiana University East School of Nursing

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