Lori Clark Email & Phone Number

North East, MD, US

King Of Prussia, Pennsylvania, United States

King Of Prussia

Remote

Participates in all aspects of the utilization review functionality including record analysis with established criteria (McKesson Interqual and MCG); communicates with hospital physicians and Physician Advisors regarding determinations for appropriate status; performs concurrent reviews and submits appropriate documentation to payors for authorizations.

• Collaborates with patients, their support systems, and their primary care providers to provide a model of care that ensures the delivery of quality, efficient, and cost-effective healthcare services.
• Assesses, plans, implements, coordinates, monitors, and evaluates all options and services with the goal of optimizing the member's health status.
• Works with patient clinical sites to include providers and other team members in identifying targeted populations, and risk stratifies members to prioritize needs and direct interventions.
• Works with Population health management leadership to continuously evaluate process, identify problems, and propose process improvement strategies to enhance the medical home delivery of care model.
• Utilizes appropriate conflict resolution, assertiveness, negotiation, and collaboration skills throughout the health care continuum.

• Performs complete and accurate medical record reviews of charts collected from provider offices and the abstraction of critical data from medical records received via fax, mail, or electronic means
• With exceptional organizational skills, responsible for planning, organizing and coordinating HEDIS data abstraction activities which includes scheduling, coordinating, and conducting onsite medical record reviews
• Conducts medical record review by first identifying the eligible population and then extracting relevant data to serve as indicators for healthcare measures, to include body mass index assessments, cervical cancer.
• Ensure that HEDIS processes and outcomes comply with all applicable accreditation standards and regulatory requirements.

• Managed a queue of UR/Medical Record Abstraction audits to clinically support patient's admission status, following pertinent processes for high-priority cases (i.e.- OBS, NOTA, Re-admits)Participated in special.
• Determine, request, and obtain appropriate supporting documentation from hospital, physicians, and current medical literature. Organizes and prioritizes multiple cases concurrently to ensure departmental workflow and.
• Proficiently utilize multiple computer based systems to complete and document work

West Grove, PA

• Cared for patients with various levels of acuity on a busy OB/GYN floor, performing various functions on the unit independently at times
• Worked closely with MD's, CNM's, CRNA's, and fellow nurses
• Assisted with circumcisions
• Functioned as OB triage nurse, labor nurse, delivery nurse, and postpartum nurse as well as cared for GYN patients and occasional med/surg patients as needed. Was strongly skilled at phlebotomy and IV placement

Newark, DE

Managed a large caseload of patients utilizing superb time management and organizational skills in two zip codes involving the start of care (Oasis documentation), ongoing assessment of the patient's needs regarding an ever-changing plan of care for various acuities and diagnoses, and the determination of resources required to move the client into a more.

• Worked and collaborated closely with physicians during the labor, delivery, and post-partum period and functioned as charge nurse on the unit
• Cared for and utilized autonomy and critical thinking skills with patients through inductions, prenatal assessments, and triage (independently assessed women to rule out prenatal complications or prepare them for.
• Assisted with C-sections as circulating nurse and newborn nurse in the OR
• Participated as member of the breast feeding committee
• Cared for healthy newborn infants as well as those with health complications in the newborn nursery;Cared for overflow medical patients and GYN surgical patients

Msn, Registered Nursing/Registered Nurse, 4.0

Bachelor Of Science (Bs), Registered Nursing/Registered Nurse

Associate Of Science (As), Registered Nursing/Registered Nurse

Education record