Justine Erving Email & Phone Number

Phoenix, Az, Us

Utilization Review Nurse-Neonatal Intensive Care Unit (NICU)-Peds

Gilbert, Arizona, United States

Owner: Photographer and Videographer.Other services offered are content creating and social media management.

Remote Utilization Review Nurse- Contract-Part timeOscar Health, New York, New York Utilization review management for a managed Healthcare plan completing medical necessity and level of care reviews for requested services using clinical judgment and Oscar Clinical Guidelines, Milliman Care Guidelines, Hayes, UpToDate, etc.Obtained needed information necessary (via telephone and fax) to assess a member's clinical condition and apply the appropriate evidence-based guidelines.Meet required decision-making timeframes, including promptly triggering escalation for cases requiring physician review.Follow documentation guidelines for clear and concise decision-making within the utilization review tracking platform.Appropriately refer members for further care engagement when needed.Participate in special projects related to utilization management when needed.

United States

GHR 09/2022-03/2023Registered Nurse, (Contract) Remote Care Coordinator(CHI) Corporate, San Francisco, CA-RemoteAnalyzed write off data to support initiative being managed by System Director of Quality and Innovation for Acute Care Coordination in Texas Region.Subject matter expert to manage tasks relating to claim write off review, corrected claims, disputes based on accepted medical necessity guidelines, billing and coding rules, plan exclusions, and clinical or payment errors/underpayments noted on write off reports. Managed clinical research and performed medical necessity review as needed to achieve greatest possible cost that could be recuperated to hospital. Make recommendations for updates of PA review, rebilling, or additional appeals.Performed other related responsibilities and special projects as assignedUtilized EPIC, EXEL, Salesforce, Google DOCS and MCG Indicia Meleeo 08/2021-07/2022Registered Nurse Travel Case ManagerDignity Health St. Joseph’s Hospital, Phoenix, ArizonaUtilization Review, Discharge planningNursery ICU, Maternal/Newborn CareUtilized Cerner ACM, InterQual, Navihealth discharge planningAya 06/2021-08/2021Registered Nurse Travel Case Manager-Banner University Medical Center-Tucson, Tucson ArizonaDischarge planningCVICU, MedsurgUtilized Cerner ACM, Navihealth discharge planningBrundage Group 03/2021-06/2021Registered Nurse Travel Case Manager-Long Beach Medical Center, Long Beach CaliforniaNeuro/Trauma ICU, CCU, and Medical ICUDischarge planning, Transfer CoordinatorUtilized Epic, RepisodicProlink Staffing 11/2020-02/2021Registered Nurse Travel Case Manager-Presbyterian Hospital, Albuquerque NMProgressive Care Unit/Covid Disaster Unit Discharge planningCollaborated closely with medical team to facilitate discharge needsParticipated in daily interdisciplinary team roundsUtilized Epic

Houston, Texas Area

Utilization Review and Discharge plann. Perform initial and concurrent reviews in an acute care area on managed care & private insurance patients. Initiates discharge plan & set up any discharge needs that a patient may need for continuation of care. Work with physicians & other health team members to manage resources and decrease patients length of stay. Use McKesson Interqual review to assess medical necessity for federal payors. Discharge Planning, Utilization Review & Utilization Management.

Remote

Performs as a clinical and authorization reviewer for all prospective, concurrent, and retrospective requests within established parameters of a managed care health plan •Performs review for all direct admits to SNF via physician office, ED or HH•Performs all Standard and Expedited prospective reviews, including the patient oral and/or written notifications•Coordinates Medical Director reviews•Coordinators peer to peer reviews with naviCross trained as appeals coordinator

United States

Utilizes: Interqual, MCG, Epic, Allscripts, Eclipsys, Midas, Curaspan(Navi health) , Cerner, Canopy, Paragon, Meditech, etc 02/18-01/19: RN Care Coordinator Dignity Health-St. Rose Domincan Hospital, Las Vegas, Nevada 12/17-01/18: RN Care Manager BaylorScottWhite-Garland, Garland, TX 05/17-08/17:ED Case ManagerFrederick Memorial Hospital, Frederick MD09/16-04/17: ED Case Manager/Inpatient Case Manager, Carroll Hospital Center, Westminister MD06/16-09/16: RN Case ManagerUNC Healthcare System, Chapel Hill, NC03/16-05/16: Interim Director of Case managementKershaw Health, Camden, SC

Houston, Texas Area

Progressive Care Staff nurse taking care of acute care patients who are to complex to go to regular floors but stable enough to leave ICU settings. Patients have complex issues including vent dependency, respiratory failure, CHF, GI bleeds,etc. Used Mckesson HED for electronic documentation. Served on safety committee and served as one of the units preceptors.

Houston Area, Texas

Performs comprehensive health assessments of clients with diagnosis of mental retardation. Supervised licensed and unlicensed staff of twenty to twenty five staff members at a given time. Determine health topics, goals, and interventions as identified through the nursing process. Arrange, incorporate, and modify the resources necessary to accomplish established goals. Perform monthly, quarterly, and yearly chart reviews. Compile and maintain records from assessment data, doctor's visits, face to face visits and triage calls. Train and educate new staff members.

Tomball,Tx

Staff nurse on Telemetry floor working with cardiac & stroke patients. Interpreted EKG rhythms. NIH certified for Stroke patients. Served as preceptor.

Memphis, Tennessee

Bachelors Of Science In Nursing (Bsn), Nursing

Pre-Nursing Studies

Pre-Nursing Studies