• Position required a nurse file review for the patient’s medical chart including chronological summary, determining causal relationship to the injury, medical necessity, and if treatment was reasonable. Made recommendations in order for the adjustor to make a decision on the course of action. • Set up IMEs (independent medical examinations) and peer reviews as directed by the adjustor, with follow-up and deadlines met. Upon completion reviewed and summarized the report and in a timely… Show more • Position required a nurse file review for the patient’s medical chart including chronological summary, determining causal relationship to the injury, medical necessity, and if treatment was reasonable. Made recommendations in order for the adjustor to make a decision on the course of action. • Set up IMEs (independent medical examinations) and peer reviews as directed by the adjustor, with follow-up and deadlines met. Upon completion reviewed and summarized the report and in a timely manner.• Communicated and worked well with team players, taking on extra work as necessary to meet all deadlines. Show less

• Responsible for reviewing medical documentation and determining if requested treatment plans are appropriate for certification. • Consult with physician advisors as needed if requested treatment plan appears excessive or unnecessary. • Proficient in bill review to ensure accurate payments are made in accordance with certified treatment plans. • Comprehensive knowledge of New Jersey PIP laws and Carepath Guidelines.• Responsible for training new staff members on company… Show more • Responsible for reviewing medical documentation and determining if requested treatment plans are appropriate for certification. • Consult with physician advisors as needed if requested treatment plan appears excessive or unnecessary. • Proficient in bill review to ensure accurate payments are made in accordance with certified treatment plans. • Comprehensive knowledge of New Jersey PIP laws and Carepath Guidelines.• Responsible for training new staff members on company protocols and technology.• Effective communication skills when telephonically dealing with clients. Show less

• Coordinated patient care from the acute care facility to home. • Responsible for assessing patient needs, obtaining durable medical equipment, organizing a plan of treatment through collaboration with physician and key hospital staff utilizing strong organizational and effective communication skills needed to facilitate a safe transfer to home. • Exceeded expectations of the number of referrals generated.

• Managed patient care by reviewing computerized files. Determined if patient treatments such as physical therapy, pain management, testing and surgery were appropriate and necessary.• Consulted with medical directors to determine course of treatment when necessary.• Researched procedures, medical devices and medications to aid in the determination of approval or denial status of the requested treatment.• Efficient in maintaining cost effectiveness of care provided.

• Assessed the level of patient care needed after trauma or illness. Managed and coordinated health care for the patient from the hospital setting to the rehabilitation facility and to the home.• Provided necessary services in a cost efficient manner through negotiation skills with various vendors.