Identified care needs of individual patients and coordinated responses based on physician advice, insurance limitations, and procedural costs. Addressed disruptions in patient care, including delays in discharge, postponed procedures, and discharge equipment unavailability.Advocated for patients by communicating care preferences to practitioners, verifying interventions met treatment goals, and identifying insurance coverage limitations.Prospective and concurrent medical necessity reviews using Interqual for elective spinal and orthopedic surgeries using Cerner EMR.

Identified care needs of individual patients and coordinated responses based on physician advice, insurance limitations, and procedural costs. Addressed disruptions in patient care, including delays in discharge, postponed procedures, and discharge equipment unavailability.Advocated for patients by communicating care preferences to practitioners, verifying interventions met treatment goals, and identifying insurance coverage limitations.

Identified care needs of individual patients and coordinated responses based on physician advice, insurance limitations, and procedural costs. Addressed disruptions in patient care, including delays in discharge, [postponed procedures, and discharge equipment unavailability,Advocated for patients by communicating care preferences to practitioners, verifying interventions met treatment goals, and identifying insurance coverage limitations. Concurrent Interqual reviews to meet medical necessity.EMR: EPIC. UM: Interqual

Identified care needs of individual patients and coordinated responses based on physician advice, insurance limitations, and procedural costs.

Collected and reviewed medical records for HEDIS (Healthcare Effectiveness Data and Information Set). Abstracted 6 charts per hour.

Work with Care Management teams on workflow, process improvement. Medical record review supervisor for Healthcare Effectiveness Data and Information Set (HEDIS). Assist with NCQA accreditation.

Quality Improvement, Lean, Project management, Joint Commission, DNV, CMS, Root Cause Analysis, Failure Modes Effects Analysis.

Coordinated patient flow into the hospital, allocate resource pool staff and redistributed nursing staff, act on behalf of administration in their absence, internal and external disaster response.

Medical Intensive Care, charge nurse, preceptor. Working with extremely ill patients, IABP, CVVHD, Code team.