Yelena Matoussevitch MSN RN
Staten Island,NY
Summary
Management, coordination, and integration of covered services with non-covered services, as well as the involvement of community organizations, which are important to health and well-being members. Assessed the medical necessity of hospital and doctors’ referrals and arranged preadmission assessments as necessary to verify eligibility. Maintained clinical knowledge and skills to ensure effective clients and staff development. Promoted self and company services and defined scope of services to patients and caregivers. Supervised nurses and nursing assistant staff. Preparing office weekly and monthly reports. Preparing department internal audits. Maintained own professional growth and development.
Overview
16
16
years of professional experience
3
3
Languages
Work History
RN Senior Manager/ Clinical reviewer/ Certified Medical Coder/ DRG Validation
Fidelis Care/ Centene
NY, NY
01.2017 - Current
- The ICD-10 coding changes and its effect on inpatient claims payment
- Chart review will include DRG pre-payment review, hospital readmission review and outlier payment review
- Analyze moderately complex health care information; reviews medical records; integrate medical coding and reimbursement rules; provide pricing guidance
- Ensure medical coding rules and regulations including compliance requirements are adhered to for the appropriate handling of medical necessity, claims denials, and bundling issues
- Provide regular reports on project status and progress; report project results to identify coding improvement opportunities
- Collaborate with other business units (Claims, QHCM, UMC and Analyst) to identify and implement process efficiency and quality improvement practices
- Work with IT resources to implement system efficiencies and configuration enhancements to improve claims processing operations
- Apply Coding Guidelines as described in the ICD-10 Coding Manual
- Maintained accurate documentation of patient records in accordance with HIPAA regulations.
- Managed complex cases involving multiple diagnoses or treatments.
MLTC Senior RN Manager/Clinical Care Manager
Fidelis Care/ Centene
NY, NY
01.2012 - 01.2017
- Responsible for Supervision of RN’s in the Field
- Coordinated with licensed home care services agencies when aide services are provided
- Implemented the plan of care and evaluated whether the plan of care continues to meet each member’s need via clinical reassessment, member interview, and primary care physician and/or medical director review
- Management, coordination, and integration of covered services with non-covered services, as well as the involvement of community organizations which are important to health and well-being members
- Monitored the progress of each member to evaluate whether covered service provided are appropriate, an in accordance with the plan of care
- This was accomplished at each member visit at minimum every six months, or earlier if requested by a member, and through review of service orders with the member primary care provider
- Provided initial assessment of each member upon enrollment, using comprehensive assessment tools, e.g., UAS
- Reassessed each member at least once every six months, using comprehensive assessment tools, e.g
- UAS
- Service authorizations have been completed every two months
- Knowledge of ICD-10 coding
- Assessed patient health and developed individualized care plans accordingly.
- Educated patients on health maintenance, disease prevention, and treatment options.
- Performed physical examinations and assessments of patients' medical histories.
- Collaborated with physicians in developing patient-specific treatment plans.
- Responded quickly to life-threatening situations by providing appropriate interventions.
- Maintained accurate documentation of patient records in accordance with HIPAA regulations.
- Advised family members on the best course of action for their loved ones' healthcare needs.
- Counseled patients on lifestyle changes that could improve their overall health outcomes.
- Managed complex cases involving multiple diagnoses or treatments.
- Provided emotional support to families facing difficult decisions about a loved one's care.
- Worked closely with other healthcare professionals to coordinate patient care.
- Carried out physician orders regarding tests or medication administration accurately and safely.
- Identified potential safety hazards in the environment or among patients' behaviors.
- Attended continuing education courses to stay up-to-date on current trends in nursing practice.
- Maintained thorough, accurate and confidential documentation in electronic medical records.
- Evaluated patients, recognized and addressed complications and coordinated treatment with other members of critical care team.
- Acted as patient advocate and implemented total patient care through team nursing process.
- Updated charts throughout shifts with current, accurate information to maintain strict recordkeeping standards.
- Created, implemented and evaluated patient care plans with medical team.
- Collaborated with doctors to plan post-treatment home care and prevent return hospitalization.
- Counseled patients and caregivers, providing emotional, psychological and spiritual support.
RN CHN (Field RN’s supervisor)
Caring Professional, Inc.
Brooklyn, NY
01.2012 - 01.2015
- Responsible for training RN’s for MLTC Intakes
- Field visits, skilled nursing, patients’ assessments and teaching
- PCA/HHA supervision and evaluation
- Complete documentation, recertification UAS/OASIS and progress notes
- Provided direct nursing care to patients, including administering medications, wound care, and IV therapy.
- Performed physical examinations and assessments of patients' medical histories.
- Monitored vital signs, such as blood pressure, temperature, respiration rate, pulse rate and weight.
- Educated patients on health maintenance, disease prevention, and treatment options.
- Ensured compliance with infection control policies and procedures.
- Responded quickly to life-threatening situations by providing appropriate interventions.
- Maintained accurate documentation of patient records in accordance with HIPAA regulations.
RN Intake Coordinator/Woodhull Hospital – Discharge Planner
Americare, CSS
Brooklyn, NY
01.2008 - 01.2012
- Obtained physicians and authorized practitioners orders, verified orders in writing, disseminated orders to appropriate health care personnel
- Developed plans of care whenever possible and appropriate that involved physicians, authorized practitioners, patients and caregivers
- Provided information to patients, caregivers, referral sources and other staff members regarding services and associated cost
- Demonstrated knowledge of reimbursement and regulations
- Assessed the medical necessity of hospital and doctors referrals and arranged preadmission assessments as necessary to verify eligibility for Home Care
- Maintained clinical knowledge and skills to ensure effective client and staff development
- Promoted self and company services and defined scope of services to patients and caregivers
- Developed and enhanced relationship with referral sources
- Completed documents and submitted work as per applicable Americare policies and procedures
- Collected daily visits report from RN visiting nurses and prepared office weekly and monthly reports
- Assessed patient health and developed individualized care plans accordingly.
- Educated patients on health maintenance, disease prevention, and treatment options.
- Performed physical examinations and assessments of patients' medical histories.
- Collaborated with physicians in developing patient-specific treatment plans.
- Responded quickly to life-threatening situations by providing appropriate interventions.
- Maintained accurate documentation of patient records in accordance with HIPAA regulations.
- Managed complex cases involving multiple diagnoses or treatments.
Education
MSN -
I.Ya. Horbachevsky Ternopil National Medical University
01.2022
BSN -
I.Ya. Horbachevsky Ternopil National Medical University
01.2015
Certified ICD-10 Coding from Division of national Certification Services, LLC
Skills
- Community health
- Health Promotion
- Quality Improvement
- Geriatric Care
- Discharge Planning
- Healthcare billing
- Medical assessment
- Health care consultation
- Nursing staff leadership
- Case Management
- Electronic Health Records Management
- Patient Management
- Care Planning
- Care Plan Development
- ICD-10 Coding
- UAS assessment
- Home Health Care
- Patient Discharge
- Nursing Plan Development
- Patient Satisfaction and Process Improvement
- Disease management programs
- Medical Screening
- Strong medical ethic
- Evaluations
- Long-Term Care
- Team Coordination
- Intake and discharge
- Bi-lingual in English,Russian and Ukrainian
- Health and wellness expertise
- Follow-up calls
- Medical Records Management
- Strong Clinical Judgment
- Patient Assessment
Rn Licenses
- New York, 597286
- New Jersey, 26NR22171600
- Florida, RN 9543293
Languages
- English
- Russian
- Ukrainian
Timeline
RN Senior Manager/ Clinical reviewer/ Certified Medical Coder/ DRG Validation
Fidelis Care/ Centene
01.2017 - Current
MLTC Senior RN Manager/Clinical Care Manager
Fidelis Care/ Centene
01.2012 - 01.2017
RN CHN (Field RN’s supervisor)
Caring Professional, Inc.
01.2012 - 01.2015
RN Intake Coordinator/Woodhull Hospital – Discharge Planner
Americare, CSS
01.2008 - 01.2012
MSN -
I.Ya. Horbachevsky Ternopil National Medical University
BSN -
I.Ya. Horbachevsky Ternopil National Medical University
Certified ICD-10 Coding from Division of national Certification Services, LLC
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