Priscila Martins, Rn, Bsn Email & Phone Number

Saint Louis, Mo, Us

Saint Louis, Mo, Us

Hartford, Ct, Us

Us

Oversaw over 300 clinical quality audits for new and established clinical teams; identified quality improvement opportunities, root cause analysis, and implemented corrective actions to streamline workflow. Key Accomplishment:• Effectively evaluated performance metrics to outline and communicate improvement strategies and underlying issues.

Us

Facilitated administrative, technical, and human resource operations within the department, administering training to new and existing staff members to ensure adherence to overarching policies, procedures, and evolving objectives. Maintained up-to-date best practices, fostering on-going process improvement for enhanced regulatory compliance and overall success. Spearheaded a team of 12 utilization review nurses in conducting clinical coverage reviews, leveraging Health Services Review Software; conducted five clinical review audits for each nurse on a monthly basis. Presented audit findings to leadership teams, providing actionable recommendations for growth. Key Accomplishment:• Trained clinical teams and provided performance evaluations annually, establishing clear channels of communication to foster collaboration and expectations of excellence.

Us

Reviewed and responded to authorization requests and maintained adherence to national standards; prepared documentation and conducted audits of patient records to support management needs. Key Accomplishments:• Utilized CareOne to conduct 14+ prior authorization reviews per day, in accordance with Medicare and Medicaid Guidelines; established protocols for medical appropriateness of varying requests. • Ensured appropriate escalation to Medical Director when treatment requests did not align with medical necessity guidelines or to evaluate necessity. • Established comprehensive guidelines for authorization requests from CMS. • Acted as SME for review processes and interpretation of Medicare and Medicaid guidelines; provided training on Milliman, InterQual, and CMS/MAC guidelines. • Created and oversaw SharePoint, maintaining spreadsheets, as well as Live Denial clinical quality audits of over 150 cases in two weeks. • Received Star award for excellence in work performed for CMS Audit.

Provided patient care in accordance with health needs and medical history; administered medications and treatments as prescribed and collaborated with supervising physicians to determine patients’ evolving needs. Cared for 33 Alzheimer and Dementia patients, tending to daily needs. Evaluated unstable patients and administered effective care; utilized IV, g/t, and NG, among other methods in medication administration. Executed wound care, respiratory treatment, catheter and tracheostomy care. Supervised and directed CNA staff as needed. Compiled and presented nursing summaries, Medicare skilled list charting, and acute charting.

Bachelor Of Science, Nursing

Associate Of Science, Nursing