Goal-oriented Registered Nurse and Medical Chart Reviewer with 24- year background in nursing and healthcare. Core competencies include case management, utilization review, concurrent inpatient review, and post-payment medical chart review as well as extensive experience in Medicare and Medicaid payment and documentation requirements. Performs documentation review with accuracy and efficiency.
Current Registered Nurse licensure in Texas. Proficient in Microsoft Word and Excel. Extensive experience and training in McKesson Interqual and Milliman Care Guidelines with effective utilization in determining medical necessity for inpatient admissions and outpatient services, in pre-payment, concurrent and post-payment methodologies. Comprehensive experience in ICD-9 and CPT coding procedures, as well as recent completion in August 2015 of ICD-10 RN Boot Camp Coding Class. Experience with DRG and clinical validation methods. Plan for testing soon to obtain coding certifications.
Worked as a telephonic case manager, guiding worker's compensation patients through the healing process to ensure a timely progression to optimum health, productivity and return to work for CompChoice clients. Utilized worker's compensation-specific medical management programs, along with interpersonal skills, nursing knowledge and expertise. Left this position to broaden experience in medical review at OFMQ.
Worked as a RN Health Care Finder for HealthNet as part of their contract with the TRICARE Military Health Program. Proudly assisted military members and their families in obtaining quality health care by obtaining appointments and appropriate health care services, utilizing provider contacts, as well as medical and nursing knowledge. Also performed pre-certification review and authorizations for requested services by military and TRICARE certified providers using appropriate InterQual review guidelines. Left after 7 years when TRICARE awarded the contract to Humana and all nursing positions were moved to centralized locations.
Performed duties as a Registered Nurse on the cardiac step-down unit, medical-surgical floor, pediatrics and intensive care units. Using the nursing care process, provided comprehensive care to patients during their hospitalization. Worked closely with all members of the care team, included doctors, medication techs, LVN's, physical, respiratory and occupational therapists, and nursing aides to provide optimal and quality patient care.
Medical Chart Reviewer
Inside Sales Representative
Secretaries and Administrative Assistants
Smiths station ,Alabama
About this resume
This is a resume for a Medical Chart Reviewer in Denison, Texas with experience working for such companies as Recovery Audit Review Consulting Company and TrailBlazer Healthcare. The grade for this resume is 0 and is one of hundreds of Medical Chart Reviewer resumes available on our site for free. Use these resumes as templates to get help creating the best Medical Chart Reviewer resume.