Ray Matherly Email & Phone Number

New York, New York, Us

• Conduct prior authorization and concurrent utilization reviews of medical services in accordance with approved departmental guidelines.• Coordinate discharge planning and identify alternate treatment programs for chronic or catastrophic cases.• Review clinical information for medical necessity and cost effectiveness of services within the scope of the individual's benefit plan.• Consult with Medical Directors to determine medical necessity of services.

• Provided appeals utilization review services in accordance with approved departmental guidelines.• Reviewed clinical information for medical necessity and cost effectiveness of services within the scope of the individual's benefit plan.• Collaborated with Medical Directors to determine medical necessity of services.

Chicago, Il, Us

• Provided prior authorization and concurrent utilization review services in accordance with approved departmental guidelines.• Coordinated discharge planning and identify alternate treatment programs for chronic or catastrophic cases.• Reviewed clinical information for medical necessity and cost effectiveness of services within the scope of the individual's benefit plan.• Applied nursing case management principles in coordinating resources necessary to implement treatment options and meet the individual's health needs.• Collaborated with Medical Directors to determine medical necessity of services. • Utilized HEDIS measures to identify and close gaps in care for members. • Managed interdisciplinary research and development projects to improve member services, such as telemedicine, behavioral health and provider search services.• Co-Led Health Ambassador group which educates and promotes healthful behavior for all department staff.

San Antonio, Tx, Us

• Performed quality audits on ICD-10 coding and educated the department staff on errors and coding guidelines. • Educated and trained Primary Care Providers on Risk Adjustment coding.• Developed and implemented market business plans to motivate providers to engage in improving Risk Adjustment metrics.• Served as Subject Matter Expert (SME) for all Risk Adjustment related activities • Assisted in development of training and analytical materials for Risk Adjustment.• Conducted scheduled Business Review meetings related to Risk Adjustment activities.• Developed solution-based, user friendly initiatives to support practice success.• Worked with Senior Leadership on identified special projects.

Chicago, Il, Us

• Performed utilization review and case management activities in accordance with approved departmental guidelines.• Provided professional patient navigation/education services for members.• Coordinated discharge planning and identified alternate treatment programs for chronic or catastrophic cases.•Provided medically necessary cost effective services within the scope of the individual's benefit plan.• Applied nursing case management principles in coordinating resources necessary to implement treatment options and meet the individual's health needs.• Utilized HEDIS measures to identify and close gaps in care for members. • Managed interdisciplinary research and development projects to improve member services, such as telemedicine, behavioral health and provider search services.• Co-Led Health Ambassador group which educates and promotes healthful behavior for all department staff.

Delivered professional nursing care, telephonic triage and case management services in outpatient Radiation Oncology, Medical Oncology and GI Surgery clinics as an agency nurse.

Dallas, Texas, Us

• Provided professional nursing care throughout UT Southwestern hospitals and clinics to include general medical, surgical, telemetry, transplant, radiation oncology, and medical oncology in several inpatient and outpatient units.• Delivered a complete range of RN services and expertise, to include peritoneal dialysis, venous access and management of access devices, wound care, cardiac monitoring and assisting physicians with medical procedures.• Served as charge nurse and other leadership roles as needed.• Utilized prior knowledge of Epic Systems to assist and mentor fellow staff in transition from paper charting to exclusive Epic usage. • Preceptor for new hires, graduates and agency nurses in both nursing duties and Electronic Medical Record orientation and usage.• Member of Rapid Response team while working in freestanding clinics, and administered emergency treatment when needed. • Provided organized assessment and planning for individualized patient care.• Communicated with physicians about changes in patient's clinical condition.• Educated patients and family on health promotion, disease management, medications, pre/post-op instructions, testing and procedures. • Provided case management and patient navigation support to clients and families among various healthcare services.• Accurately obtained and documented patient history and medication lists, assessed individual conditions and needs, and provided care to departmental referrals for acute and chronically ill patients.• Collaborated with oncology research team in assessing and preparing volunteers for clinical trials by obtaining blood specimens, accessing venous implants, administering medications and managing questionnaires and consents.

Provided inpatient nursing care as a contract RN on a general surgical unit at Baylor University Medical Center.

Cincinnati, Ohio, Us

Provided professional nursing care in a variety of medical-surgical and telemetry units as an agency nurse.

Dallas, Tx, Us

Provided professional nursing care in a variety of medical-surgical and telemetry units as a travel nurse.

Arlington, Virginia, Us

Served in a variety of deployable field units and general hospitals. Managed team members as troop housing supervisor, assistant ward manager and Equal Opportunity Program representative.

Bachelor Of Science In Nursing

Bachelor'S Degree, Liberal Studies. Emphasis On Technical/Professional Writing And Editing.

English/Psychology.