Dedicated and compassionate Licensed Practical Nurse with 6 years of experience providing high-quality patient care in fast-paced healthcare environments. Skilled in administering medications, assisting with patient assessments, and collaborating with interdisciplinary teams to enhance patient outcomes. Proven ability to manage multiple tasks while maintaining a focus on patient safety and comfort.
• Conducts direct outreach to new Medicare members to provide personal assistance with their new MAPD, DSNP, and MMP plans. Serves as an advocate to ensure members are well informed about plan benefits, provider options and how to use their new plan benefits.
• Conducts pre-certification, inpatient retrospective, out of network and appropriateness of treatment setting reviews within scope of licensure by utilizing appropriate medical policies and clinical guidelines in compliance with department guidelines and consistent with the members eligibility, benefits and contract.
• Applies clinical knowledge to work with facilities and providers for care-coordination.