Samantha Ream, Bsn, Rn Email & Phone Number

Philadelphia, Pennsylvania, United States

• The Medical Policy Coordinator is responsible for developing and maintaining medical policies which conform to accepted medical practice standards, researching and developing clinical rationale for annual and quarterly.
• Develops and maintains new and existing medical policies conforming to accepted medical practice standards and in accordance with evidence based principles of medicine, Company benefit structure, state and federal.
• Presents Medical Policy Bulletins to appropriate workgroups and committees and revises documents according to recommendations.
• Researches and develops clinical rationale for annual and quarterly medical code updates.
• Serves as a resource to company associates, and personnel of affiliated companies, by answering clinical inquiries using medical literature, company policy, and other appropriate resources.
• Assists in developing written responses to questions of a clinical nature received by the departmental medical director and other management staff.

Philadelphia, Pennsylvania, United States

• Coordinates all levels of medical, pharmacy, and mental health appeals
• Performs review of medical documentation using Interqual criteria or Medical Policy to determine if the requested service can be approved
• Ensures all assigned appeals are completed within the compliance timeframes
• In accordance with NCQA guidelines, generates appropriate correspondence to inform the applicable parties of the appeal determination
• Completes disclosures of clinical documents as applicable and in accordance with corporate policies
• Maintains knowledge of NCQA standards, Interqual Criteria, as well as applicable state and federal government regulations related to appeals

Warminster, Pennsylvania

• Coordinates case review activities consistent with corporate policy and client-specific procedures
• Determines the types of review, peer clinical reviewer specialties and selects peer clinical reviewers.
• Ensures that the case is forwarded to, and received by, the peer clinical reviewer in a timely manner
• Monitors case due date and takes steps to ensure timely return to the client
• Ensures that the peer clinical reviewer’s determination is complete and oversees transcription
• Notifies the client and other designated parties of the final determination

Horsham, Pennsylvania

• Confers with internal and/or external customers to provide prompt and accurate information about products and/or services by various methods of communication while promoting customer loyalty for the client.
• Ensures customer satisfaction and loyalty by consulting with customers, assisting customers, and resolving a wide variety of customer requests, inquiries, and complaints.
• Resolves customer questions and concerns effectively and efficiently by actively listening, communicating clearly and concisely, and assuring customer understanding.
• Documents customer interactions and transactions, recording details of inquiries, complaints, comments and actions taken, to include Adverse Events.
• Obtains and examines all relevant information to assess validity of complaints and to determine possible causes. Outbound calls made that are related to the product or service, and/or in follow-up to a customer inquiry.
• Ensures that production and quality expectations are achieved and meet or exceed all client contractual requirements.

Fort Washington, PA

• Provide drug and/ or medical device information to patients and caregivers while actively resolving customer questions and concerns
• Identify adverse events and product complaints as outlined by client guidelines
• Accurately collect information required by individual programs and correctly capture in specific program databases while managing and/ or utilizing all telecommunication effectively.
• Develop and deliver training materials to current and new hire associates for designated client including internal, and client utilized applications, product knowledge, medical information, and patient centered.
• Ensure associates exceed the performance standards of both the company and the client requirements, this includes, but is not limited to client certification.

Abington, PA

• Preform as a member of a multi-disciplinary healthcare team to provide patient centered care on an inpatient rehabilitation unit
• Effectively interact with patients to access individualized needs while obtaining and conducting thorough patient assessments
• Accurately document patient information in a computerized charting system and/ or hand written documentation as per hospital policy and procedure.
• Assist patients with activities of daily living and integrated fall risk procedures
• Dispense patient medication while following all safety checks to ensure accuracy and limit medication errors

Bachelor’S Degree, Registered Nursing/Registered Nurse, Gpa: 3.78

Diploma, Registered Nursing/Registered Nurse, Cum Laude

Disploma, Cosmetology/Cosmetologist, General

Licensed Cosmetologist

Psychology, Dean’S List