Responsible for utilization review for local hospitals, chart reviews, interaction with hospital staff regarding hospitalization lengths of stay and nursing facility admissions.

Responsible for total patient care for case load of up to sixteen hospice patients including medications, wound care, counseling, and overall coordination of hospice services.

Responsible for medical bill auditing, negotiations with insurance providers for final bill payment, ensuring coding compliance, assistance with chargemaster maintenance.

Responsible for reviews of patient charts to ensure appropriateness and timeliness of care, in accordance with Interqual guidelines. Communication/negotiation with health insurance personnel to obtain authorization for inpatient admission and continued stay certifications. Interaction with attending physicians and social workers regarding discharge plans

Responsible for pre-certification of beneficiaries inpatient admissions and outpatient treatments within the framework of a managed care organization. Initial quality assurance of planned or already-delivered care. Extensive use of InterQual and M & R guidelines. Was first in facility to utilize a completely paperless authorization process using PC. Assisted in initiation of telecommute project.

Responsible for patient care delivery in an intensive care setting, including but not limited to ventilators, intra-aortic balloon pumping and hemodynamic monitoring. Obtained in-house chemotherapy certification during

Monitoring data from national remote research sites; verifying accuracy and adherence to medical treatment protocols, assisting the Clinical Trials Director and Scientific Director as needed; frequent communication with distant clinics for data troubleshooting as well as database problems and questions.

Reconciliation of hospital bills with patient charts follow by negotiation with insurance carrier agents to determine final amount due client hospital by carriers. Was hired as part of the start up program for new site.

Worked as a registered nurse in different hospitals in Tennessee, Oklahoma and Illinois. Started Intensive Care nursing in May of 1982 and continued to practice until accepting auditor position.