Paula Fletcher Email & Phone Number

Palm Beach County, Fl

Utilization review for Medicaid/Medicare insurance company in acute and skilled nursing facilitiesLiaison between members, Doctors, nurses, case managers, and insurance company to assure quality of care.Coordination of benefits for optimum healthcare in an inpatient/outpatient settingDocumentation of hospital care of member using McKesson

Palm Beach Gardens, Fl

QA/UR for a workman comp insurance company.Submission of claims for paymentCase reviews with plan's Medical Director

Insurance reviews in acute care setting * Daily report to Medical Directors* Referrals to disease management programs* Discharge planning

Performed preadmission screenings* Admission of patients to SNF * Conducted Insurance Reviews* Procured new referral sources

Preadmission screenings * Care Planning/UR* Discharge planning/Disease management, community service referrals * Follow up calls to ascertain completion of services ordered to maintain continuity of care in the home

Responsible for admissions, continued stay reviews using Interqual criteria* Insurance reviews to obtain authorizations for admit, continued stay * Liaison between Doctors, nursing staff, insurance companies, patients and families to insure continuity of care* Discharge planning, community and disease management referrals and procurement of needed items, services or SNF's post discharge

Conducted insurance reviews in acute setting using Interqual criteria* Liaison between Doctors, hospital case managers, patients, families and insurance company to assure quality of care.* Discharge planning and referrals to disease management programs, community resources as needed for health maintenance

Preadmission screenings, placement assessments, referral follow-ups.* Liaison between hospitals, Doctors, insurance companies, patients and families.* Case management/discharge planning for all admitted short term residents Marketer for a SNF, ALF and Rehab Center in the Palm Beaches.

Weekly in-house consultation in 4 LTC facilities in South. FL. * Implementation of wound care program, treatment modalities, and state required documentation * Coordination and procurement of DME supplies* Involved in UR and QA meetings in each facility * Development of marketing strategies for new comprehensive wound management program, as well as implementation and training program, targeting outcomes and cost management. * Conduction of clinical case studied for innovative new products, as well as collection of data for a national incidence and prevalence census.

Development of in-house wound clinic in LTC facility * Introduction of hyperbaric therapy and use of laser doppler assessment to local physician's group as an adjunctive treatment modality resulting in the increase of wound healing by 11%* Implementation of training course for new nursing staff and physical therapist-speeding assessments and establishing a consistent cohesive documentation system exceeding present required standards

Development of a comprehensive data collection system for DME * Coordination of clinical data and medical supplies for 14 SNF's in 4 states.* Monthly in-house wound consultation in 13 facilities* Development of training and educational programs * QA/UR in nursing departments for all facilities

Case Management

Lpn, Nursing

Nursing Education