Tiffanie A Cloud
Columbia,United States (+1)
Summary
A polished professional manages multiple tasks, utilizes electronic medical systems, and provides excellent customer service to Members and Providers. Adheres to medical records policies and procedures to comply with HIPAA regulations. Track record of effectively troubleshooting issues and maintaining patient confidentiality.
Overview
21
21
years of professional experience
Work History
Clinical Reviewer
CareCentrix
09.2022 - 11.2023
- Managed authorizations for Wellcare patients discharged from acute care hospitals to skilled nursing facilities (SNFs), inpatient rehabilitation facilities and long-term care hospitals.
Registered Nurse
SC Dept Of Juvenile Justice
01.2014 - 12.2022
- Administered and documentation standard and ordered medication administration and treatments.
- Educated juveniles on diagnosis and prognosis, treatment options, disease process, and management and lifestyle options.
- Referrals to Psychiatry, the Medical Doctor and Dental as needed.
Medical Review Nurse
Palmetto GBA
07.2018 - 09.2022
- Reviewed Home Health claims request for the Review Choice Demonstration Program. Made decision to provisionally affirm or non-affirmed. Notified Provider of non affirm decision along with education.
- Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
Managed Care Coordinator
Blue Cross Of South Carolina
09.2002 - 06.2018
- Demonstrated knowledge and skills in areas of utilization management (UM), medical necessity using medical policies and guidelines.
- Performed concurrent and retrospective UM-related reviews and functions and for ensuring that appropriate data is tracked, evaluated, and reported
- Actively participated in process improvement initiatives to include training of incoming Managed Care Nurses.
Education
Associate of Science - Nursing
York Technical College
Rock Hill, SC06.1996
Skills
- Regulatory Compliance
- Time Management
- Attention to Detail
- Decision Making
- Multitasking Abilities
- Analytical Thinking
- Excellent Communication
Timeline
Clinical Reviewer
CareCentrix
09.2022 - 11.2023
Medical Review Nurse
Palmetto GBA
07.2018 - 09.2022
Registered Nurse
SC Dept Of Juvenile Justice
01.2014 - 12.2022
Managed Care Coordinator
Blue Cross Of South Carolina
09.2002 - 06.2018
Associate of Science - Nursing
York Technical College
Similar Profiles
Miss S DesulmeMiss S Desulme
Healthcare Customer Service Representative/Claims Representative at CareCentrixHealthcare Customer Service Representative/Claims Representative at CareCentrix
UNIQUE DemorcyUNIQUE Demorcy
Clinical Review Nurse at CareCentrixClinical Review Nurse at CareCentrix
DALLAN JONESDALLAN JONES
Collector at CareCentrixCollector at CareCentrix