Trisha Lee

Conducted utilization review and managed denial processes to support patient care. Collaborated with medical teams and office staff to assess patient needs for inpatient care. Advocated for patient rights and facilitated access to necessary resources and support systems.

• Independently contracted Registered Nurse traveling within PA, DE, MD to perform health & wellness screenings and/or administer flu vaccinations (PA licensed only). Provide participants with blood pressure checks, BMI assessments, capillary tests for cholesterol & glucose levels and, health coaching.

• Coordinated the integration of Social Services/Case Management functions into the patient care, discharge, and home care planning processes with other hospital departments, external service organizations, agencies, and health care facilities. Conducted concurrent medical record review using specific indicators and criteria. Acted as a patient advocate, investigated, and reported adverse occurrences, performed staff education related to resource utilization, discharge planning and psychosocial aspects of healthcare delivery.

• Provided case management and discharge planning services, including interacting, supporting, and consulting with physicians, social workers, and other disciplines to coordinate care while, also evaluating severity of illness and intensity of service, as well as assessing patients' post-hospital needs.

• Responsible for care management of all patients entering the AEHN system. Monitored and coordinated care delivery with attending or PCP, nursing, PT and other therapies and other care management staff and facilitated discharge planning from the Emergency Unit.

• Coordinated letters on Medicare compliance and/or Utilization management cases that required medical necessity status determinations.

• Proficient in Utilizing Milliman & InterQual criteria. Independently managed large case-load of per-diem & DRG hospitals.

• 3/2004 – 01/2006: Staff Nurse in ICU/Critical Care Unit. Cross-trained for Interventional Radiology with competency in the administration of moderate sedation. 11/2002 – 3/2004: Staff Nurse on Medical/ Surgical floor.

• Administered hemodialysis treatments, IV medications, blood transfusions while utilizing the nursing process.