Ursula Cresci
Kingston,Pennsylvania
Summary
Dedicated and knowledgeable Registered Nurse with 28 years of inpatient Behavioral Health Utilization Review experience and 6 years of adult and adolescent psychiatric nursing experience. Strong interpersonal skills reflected through ability to collaborate with all disciplines. Knowledge of all aspects of inpatient psychiatric care as well as HIPAA and legal implications of practice. The ability to work independently and organize and prioritize a multifaceted workload.
Overview
34
34
years of professional experience
Work History
Utilization Review Supervisor
First Hospital, Community Health Systems
Kingston, PA
10.2020 - Current
- Organized , monitored and participated in the utilization review activities within the hospital.
- Facilitated the monthly Utilization Management Committee Meeting.
- Participated in Quality Improvement Committee activities.
- Completed chart abstraction for Quality Measure audits.
- Obtained initial, concurrent and retrospective authorizations from multiple insurance carriers.
- Supported or performed clinical appeals.
- Established team priorities, maintained schedules and monitored performance.
- Evaluated employee performance and conveyed constructive feedback to improve skills.
Assessment and Referral Coordinator
First Hospital
09.1998 - 01.2002
- Provided call management services, client assessment, referral and crisis intervention of all incoming contacts.
- Conducted precertification reviews with insurance carriers when needed.
- Communicated assessment findings to the psychiatrist and nursing staff during the admission process.
Utilization Review Nurse
First Hospital
Kingston, PA
02.1994 - 10.2020
- Reviewed each admission to assure criteria for admission had been met and documented.
- Contacted physicians for clarification when needed.
- Prepared and sent appeal letters on denied cases.
- Contacted insurance companies to conduct initial, concurrent and discharge reviews that included reasons for admission, treatment goals and aftercare plans.
- Collaborated with the Treatment Team, reviewed client records and utilized medical necessity guidelines.
- Obtained authorizations from multiple insurance carriers for various levels of care.
Behavioral Health Registered Nurse
First Hospital
Wilkes Barre, PA
06.1988 - 02.1994
- Facilitated therapeutic communication, problem solving and crisis intervention to assist clients to develop and improve coping abilities and gain insight.
- Maintained a structured, safe and therapeutic environment specific to client population.
- Educated clients and families about their medication, diagnosis and treatment.
- Administered medication and medical care.
- Performed the duties of the Nurse Manager in her absence.
- Assessed and evaluated mental health needs, working with multidisciplinary team to initiate, manage and modify individualized care plans.
Education
Associates of Applied Science Degree - Nursing
Luzerne County Community College
Skills
- Utilization Management
- Determine Medical Necessity
- Obtaining Authorizations
- Medical record abstraction and auditing
- Collaboration with Treatment Team
Timeline
Utilization Review Supervisor
First Hospital, Community Health Systems
10.2020 - Current
Assessment and Referral Coordinator
First Hospital
09.1998 - 01.2002
Utilization Review Nurse
First Hospital
02.1994 - 10.2020
Behavioral Health Registered Nurse
First Hospital
06.1988 - 02.1994
Associates of Applied Science Degree - Nursing
Luzerne County Community College
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