Tiffany Teachout
Registered Nurse
Vero Beach,FL
Summary
Detail-oriented Registered Nurse with more than 29 years of comprehensive experience in a variety of healthcare settings with a strong focus on collaboration, adaptability, and results. Proven ability with detailed medical record evaluations, ensuring accurate documentation and compliance with insurance regulations. Recognized for taking proactive approach to identifying and addressing issues, with focus on optimizing processes and supporting team objectives. Able to handle multiple tasks effectively and efficiently in fast-paced environments. Equipped with strong problem-solving abilities and a willingness to learn. Poised to contribute to team success and achieve positive results. Ready to tackle new challenges and advance organizational objectives with dedication and enthusiasm.
Overview
30
30
years of professional experience
Work History
Clinical Content Director - ICOG
EviCore by Evernorth
11.2019 - Current
- Monitor CMS site weekly for policy updates to at least 156 (total) program applicable LCDs/NCDs and LCAs/NCAs, expeditiously communicating the updates to the relevant internal stakeholders to ensure compliance.
- Monitor commercial and Medicaid LOB sites for policy updates and expeditiously communicate the updates to the relevant internal stakeholders to ensure compliance.
- Analyze existing EviCore guidelines and identify areas for improvement to enhance efficiency and compliance.
- Conduct comprehensive research (evidence review, evidence grading, and preparation of evidence tables) on clinical topics to inform the development and revision of 43 EviCore guidelines, presenting findings and proposed guideline changes to relevant stakeholders in a timely manner.
- Ensure EviCore guidelines are reviewed least annually by the Medical Advisory Committee (MAC) to promote compliance with applicable state, federal, and accreditation requirements.
- Create detailed gap analyses with EviCore guidelines and other organization policies (Commercial, Medicare, and Medicaid), used by various stakeholders (Clinical Integration, Implementations, ICOG)
- Collaborate with the MSK Clinical Integrations team to align denial rationales with guidelines (EviCore, Commercial, Medicare, and Medicaid).
- Review AMA code updates with relevant stakeholders, write member friendly CPT descriptions, and perform CPT list comparisons as needed.
- Research and respond to health plan inquires sent over from client engagement mangers (CEMs).
- Participate in initiatives to integrate emerging technologies into content development processes.
Nursing Subject Matter Expert (SME)
EviCore by Evernorth
11.2013 - 11.2019
- Provided resolutions for escalated case reviews.
- Served as a resource for internal stakeholders with operational process questions.
- Ensured timely review of urgent and expedited cases through evaluation of reports, assignment to appropriate departments, and follow-up to resolution.
UM Review Nurse
EviCore by Evernorth
11.2012 - 11.2013
- Evaluate medical records and apply clinical knowledge to to assess the appropriateness and medical necessity of healthcare services with established guidelines and insurance criteria.
- Accurately document review findings and recommendations in accordance with organizational policies and regulatory standards.
Registered Nurse
Noor Merchant, MD & Associates
09.1999 - 11.2012
- Utilize organizational skills to provide substantial contributions that aide in achieving the financial goals of the practice with attention to billing of chemotherapy, biotherapy, and supportive medications
- Investigation of insurance benefits and obtaining prior authorization for chemotherapy & biotherapy and supportive medications
- Successful writing of letters of medical necessity and appeals for Medicare and private insurances
- Successful authorship of Administrative Law Judge (ALJ) Medicare appeal and successful sole-representation for testimony on my provider's behalf with ALJ Hearings
- Provide supportive care for patients and their caregivers through education and role of liaison with the doctor
- Preparation and administration of chemotherapy, biotherapy, and supportive agents to 20-25 patients daily
Registered Nurse Per Diem
Indian River Memorial Hospital
12.2003 - 12.2008
- Management of 12 patients per shift on Oncology floor
Registered Nurse
Weiss & Newberry Medical Associates
04.1997 - 09.1999
- Implemented an OSHA program for busy Neurology Office
- Performed chart reviews
- Authored medical necessity letters for various insurances
- Communicated with insurance companies to obtain prior authorizations
- Performed phlebotomy and administered injections
- Obtained detailed patient histories
- Responsible for home care referrals and hospital admissions
Registered Nurse
Mariner Home Health
08.1995 - 09.1999
- Collaborated with multidisciplinary teams to develop comprehensive care plans tailored to individual patient needs.
Monitored vital signs and documented changes in patient conditions, facilitating timely interventions and adjustments in care strategies.
Administered medications and treatments according to established protocols, ensuring patient safety and comfort. - Case Managed a team of 50 patients (08/1995-04/1997)
- Involved in chart reviews for Risk Management (08/1995-04/1997)
- Oversaw Wellness Program for the local agency (08/1995-04/1997)
- Served as Preceptor for new home health nurses (02/1996-04/1997)
- Served as Per Diem RN (04/1997-09/1999)
Registered Nurse Per Diem
Health Force Home Care
10.1998 - 01.1999
- Performed private duty nursing care to patient requiring tracheotomy care, respiratory treatments, wound care, and IV therapy.
Education
BA - Social Science & Criminal Justice
Ashford University
Clinton, IA01.2010
Diploma - Legal Nurse Consultant
Kaplan College for Professional Studies
Boca Raton, FL01.2002
ASN - Nursing
Eastern Florida State College
Cocoa, FL01.1995
AA - General Education
Eastern Florida State College
Cocoa, FL01.1991
Skills
- Strong clinical judgment
- Organizational skills
- Attention to detail
- Problem-solving
- Multitasking
- Adaptability
- Content development and management
- Online research
- Microsoft office (Word, Excel, PowerPoint)
- SmartSheet, Adobe, and Heretto
- SharePoint
- Billing and coding experience
Licenses
Registered Nurse, FL - June 1995 - current
Affiliations
- American Association of Legal Nurse Consultants (AALNC) 2009-2010
- Oncology Nursing Society (ONS) 2001-2011
- Treasurer for Treasure Coast Oncology Group (TCOG) 2009-2011
- Alpha Sigma Lambda (ASL) National Honor Society 2010
Languages
Spanish
Professional Working
Timeline
Clinical Content Director - ICOG
EviCore by Evernorth
11.2019 - Current
Nursing Subject Matter Expert (SME)
EviCore by Evernorth
11.2013 - 11.2019
UM Review Nurse
EviCore by Evernorth
11.2012 - 11.2013
Registered Nurse Per Diem
Indian River Memorial Hospital
12.2003 - 12.2008
Registered Nurse
Noor Merchant, MD & Associates
09.1999 - 11.2012
Registered Nurse Per Diem
Health Force Home Care
10.1998 - 01.1999
Registered Nurse
Weiss & Newberry Medical Associates
04.1997 - 09.1999
Registered Nurse
Mariner Home Health
08.1995 - 09.1999
Diploma - Legal Nurse Consultant
Kaplan College for Professional Studies
ASN - Nursing
Eastern Florida State College
AA - General Education
Eastern Florida State College
BA - Social Science & Criminal Justice
Ashford University
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