• Perform medical necessity and policy review for Medicare and Medicaid claims, this includes hospital systems and commercial payers • Reviews include medical necessity, appropriateness of setting, LOC, quality of care, experiment treatment/procedures, and coding • Responsible for audits of federal and state contracts• Competent in InterQual criteria • IRO appeals and audits for multiple large healthcare organizations across multiple states• UPIC review • Competent with Medicaid regulations • Competent with ICD-9 codes and HCAHPS

• Teach the assigned curriculum of the program per the state regulations• Teach basic nursing care and supervise clinical rotations• Administer testing as assigned by the program• Grade work completed by students• Teach assessment skills and critical thinking• Evaluates student’s clinical and lab performance using the designated tools for the course

• Responsible for Medicare and Medicaid Reimbursement• Documents all activities in the appropriate system(s) on a timely basis.• Monitors and facilitates appropriate utilization of resources using evidenced-based clinical criteria• Audits and improves the overall quality and completeness of clinical documentation.• Interacts with nursing staff, case management and coding staff to facilitate modifications to clinical documentation that ensures accurate depiction of the level of clinical services and patient severity.• Conducts education for all members of the patient care team.• Reviews the quality of the medical record documentation in selected diagnostic categories.• Supervise staff according to company policy • Ensure that patients are seen and physician orders are carried out in accordance with state and company policy• Comply with the State Department of Health regulations • Responsible for training/ orienting new employees that perform Clinical chart audits for other VNA office location• Created the training manual for Performing chart audit reviews that have been given to all new hires

• Responsible for assessing and caring for the critically ill patient• Proficient in EKG interpretation• Assist physician with procedures• Preceptor to new hire RNs• Perform dialysis with a CRRT machine• Ventilator Care• Oversee RN, LPN, and CNA personnel• Code team and Rapid Assessment Team leader• Responsible for mixing IV drips when the pharmacy is off-site• Responsible for educating staff on policies and procedures• Developed and implement nursing care plans• Charge Nurse on all shifts with staffing and assignment duties• Effective organizational skills and interpersonal skills• Able to make critical decisions regarding patient care when in high-stress situations• Created educational training for staff on Neuromuscular blocking agents• Organized Critical Care Seminar for over 100 medical personnel including physicians and nurses to obtain continuing education credits.• Educated patients on disease processes and medications.

• Ensure that all clinical employees are current on BLS certification • Ensure that all appropriate clinical employees are current on CPI certification• Educate the community on basic First Aid and CPR skills • Responsible for making sure all data is accurately transcribed to appropriate• excel spreadsheets• Ensure that employees have met the educational requirements to maintain current positions within the facility

• Responsible for organizing surgical dates for patients• Maintained an organized clinic schedule• Applied and removed casts• Obtained prior authorization for all testing and procedures• Educated patients on cast care and brace care• Obtained accurate history prior to the exam

• Duties included daily patient reports and daily physician interaction with knowledge of labs, vital signs, and general updated patient information.• Demonstrated the ability to interact with patients, staff, and physicians on a daily basis in a professional setting. • Obtained medications, documented cardiac rhythms, assessed patients, performed wound care, started IVs, educated patients, reviewed charts, and performed patient admissions and discharges. • Commended for multitasking abilities and being prompt at all times.• Assumed Charge Nurse on a majority of working shifts