Job Search Status
Open to workDesired start date: 2 weeks notice
Open To Work
Valerie M. Sharp
Westminster,MD
Work Preference
Summary
Dedicated healthcare professional specializing in improving patient care quality through comprehensive medical record evaluations. Skilled in team motivation and collaboration, fostering productive work environments. Strong communicator committed to achieving organizational goals and adept at building effective relationships with clients and colleagues.
Overview
39
39
years of professional experience
2
2
Certification
Work History
Appeals Nurse Analysis
Johns Hopkins Health Plan
Hanover, MD
11.2009 - Current
- Reviewed medical records across emergency room, medical, surgical, neurological, pediatric, and psychiatric specialties to ensure compliance with care standards.
- Able to apply this knowledge to criteria of McKesson InterQual and United States Family Health Plan Policy (USFHP), Medicaid (Code of Maryland Regulation\COMAR) and Medicare (CMS criteria).
- Review of pharmacy appeals and determination if medication and clinical scenario meets expedited or standard care.
- Communicated determinations to members and providers verbally and in writing, facilitating understanding of appeals outcomes.
- Communicate closely with the medical directors to facilitate and assure documentation meets medical necessity of each patient, reflecting complexity and acuity.
- Acted as a certified professional coder, providing guidance on coding and claims appeals to optimize resolution processes.
Utilization Nurse
Frederick Memorial Hospital
Frederick, MD
01.2015 - 01.2017
- Freelance Position:
- Reviewed new Medicare and observation admissions as utilization review nurse every other weekend to ensure compliance with guidelines.
- Analysis of patient‘s medical necessity and determination if patient’s admission is appropriate for observation or inpatient status.
- Secured medical authorizations for inpatient transfers to lower-level care facilities, facilitating seamless patient transitions to skilled nursing homes and rehabilitation centers.
- Communicated effectively with external and internal customers, making rapid and accurate decisions while managing multiple tasks.
Utilization Nurse
Advanta Government Services, LLC
Annapolis Junction, MD
01.2012 - 01.2013
- Freelance Position
- Utilization Review Nurse
- Conducted clinical electronic medical record reviews in the specialties of rehabilitation, emergency department, and short surgical hospitalizations. Analyzed clinical reviews and applied criteria set forth by the contractor.
Registered Nurse
Hanover Hospital
Hanover, PA
01.2009 - 01.2012
- Nursing Care specific to the general rehabilitative patient.
- Per diem position.
- Administered medications and monitored patient responses regularly.
- Collaborated with interdisciplinary teams to develop patient care plans.
- Educated patients and families on health management and treatment options.
Lead Utilization Review Nurse Specialist
Johns Hopkins Hospital
Baltimore, MD
06.2007 - 11.2009
- One of the two Lead Utilization Review Nurse Specialists for a 500-bed facility.
- Coordinated utilization review for multiple hospital units, ensuring effective distribution of work assignments and conducting staff education and evaluations.
- Developed methods for concise, accurate, and timely clinical documentation analysis using McKesson InterQual.
- Assessed staff assignments to facilitate timely clinical health outcomes.
- Educated and evaluated staff performance regarding the impending Recovery Audit Contractors (RAC) audit requirements.
Performance Improvement Coordinator
Johns Hopkins Community Physicians
Baltimore, MD
05.2006 - 06.2007
- Enhanced quality across 15 Johns Hopkins Community offices by implementing targeted performance improvement initiatives.
- Created 'Golden Rod' method for systematic investigation of patient concerns and complaints, streamlining resolution processes.
- Evaluated complaints and researched issues, delivering findings to medical director to facilitate informed decision-making.
- Working knowledge of unit operation, performance improvement/regulatory and professional standard evidence-based practice for patient safety/risk management and outcomes management.
Supervisor Utilization Management
Springfield Hospital Center
Sykesville, MD
04.2005 - 05.2006
- Evaluated staff assignments for quality, assessing performance metrics and addressing identified quality issues to enhance service delivery.
- Presented quality issues to quality committee, facilitating discussion and resolution to drive improvements in patient care.
- Implemented Joint Commission on Accreditation of Healthcare Organizations (JCAHO) Standards and National Patient Safety Goals by creating various reports and analyses of indicators related to patient population.
- Contributed to emergency preparedness committee by developing and refining planning and response strategies to ensure organizational readiness.
Nurse Manager
Kernan Hospital
Baltimore, MD
10.1991 - 11.2004
- Supervised 73 employees to maintain operational excellence in patient care.
- Oversaw nursing staff to ensure high-quality patient care delivery.
- Developed and implemented nursing policies and procedures for patient safety.
- Managed departmental budgets and resource allocation effectively.
- Managed a 43-bed spinal cord/multi-trauma complex medical rehabilitation unit.
Nurse Manager
Kernan Hospital
Baltimore, MD
05.1997 - 10.2003
- Supervised 52 employees, ensuring high standards of patient care and staff performance.
- Managed a 32-bed stroke rehabilitation unit.
- Facilitated fall prevention committee meetings to develop strategies that enhance patient safety.
Registered Staff Nurse /Charge Nurse
Kernan Hospital
Baltimore, MD
04.1995 - 01.1997
- Delivered patient-centered care for stroke rehabilitation in 33-bed unit, focusing on individual recovery goals.
Registered Staff Nurse
University of Maryland Hospital
Baltimore, MD
08.1991 - 04.1995
- Delivered comprehensive nursing care from admission through discharge, facilitating patient recovery.
- Provided specialized nursing care for neurology/neurosurgical patients, ensuring tailored interventions.
- Contributed to Nursing Professional Model, implementing best practices that enhanced patient care outcomes.
Student Internship
Food and Drug Adminstration
Rockville, MD
09.1993 - 12.1993
- Student Internship at the Center for Devices and Radiological Health.
- Analyzed and interpreted data on electroconvulsive therapy (ECT) treatment to inform preceptor's decision-making.
- Participated in meetings and coordinated various tasks to support USFDA staff operations.
Registered Staff Nurse
Johns Hopkins Hospital
Baltimore, MD
11.1986 - 06.1991
- Provided specialized nursing care for neurologic, neurosurgical, and transplant patients.
- Delivered comprehensive nursing care across diverse clinical settings.
Education
Master of Science - Health Administration
University of Maryland University college
College Park, MD08.1999
B.A. - Health Science & Policy Administration
University of Maryland at Baltimore County
Baltimore, MD12.1994
A.A.S. - Nursing
Trocaire College
Buffalo, NY06.1986
Skills
- Medical record review
- Clinical documentation
- Code compliance
- Utilization management
- Pharmacy appeals processing
- Care coordination
- Patient assessment
- Problem solving
- Effective communication
- Adaptive thinking
- Critical thinking
Certification
- Registered Nurse, 1986-present, Maryland, Pennsylvania
- Certified Registered Rehabilitation Registered Nurse, 1994-present
- Certified Professional Coder, 2011-present
- Completed Course Study for Certified Professional Medical Coder (CPMA)
Timeline
Utilization Nurse
Frederick Memorial Hospital
01.2015 - 01.2017
Utilization Nurse
Advanta Government Services, LLC
01.2012 - 01.2013
Appeals Nurse Analysis
Johns Hopkins Health Plan
11.2009 - Current
Registered Nurse
Hanover Hospital
01.2009 - 01.2012
Lead Utilization Review Nurse Specialist
Johns Hopkins Hospital
06.2007 - 11.2009
Performance Improvement Coordinator
Johns Hopkins Community Physicians
05.2006 - 06.2007
Supervisor Utilization Management
Springfield Hospital Center
04.2005 - 05.2006
Nurse Manager
Kernan Hospital
05.1997 - 10.2003
Registered Staff Nurse /Charge Nurse
Kernan Hospital
04.1995 - 01.1997
Student Internship
Food and Drug Adminstration
09.1993 - 12.1993
Nurse Manager
Kernan Hospital
10.1991 - 11.2004
Registered Staff Nurse
University of Maryland Hospital
08.1991 - 04.1995
Registered Staff Nurse
Johns Hopkins Hospital
11.1986 - 06.1991
Master of Science - Health Administration
University of Maryland University college
B.A. - Health Science & Policy Administration
University of Maryland at Baltimore County
A.A.S. - Nursing
Trocaire College