Svetlana Peterson Email & Phone Number

- Review Provider request for relevant and complete supporting documentation (request additional per HP policies),- Utilizing clinical guideline to authorize services or procedures (oncology and cardiology),- Work close with Medical Reviewers/Clincal Specialist to facilitate positive outcomes for requests of services and procedures,- Support clinical initiatives per UM department and Utilization Management Committee,- Verify accuracy of codes and services and apply them accurately with appropriate documentation,- Comply with HIPAA requirements and all company policies and procedures,- Comply with current URAC standards as they are related to the position,- Act as an interdepartmental liaison between all company offices, departments, and committees.

Raleigh, North Carolina, United States

• Resource nurse on Surgical Short Stay Unit and Oncology Unit.• Displayed effective communication skills in initiating and maintaining therapeutic relationships with patients/family.• Worked collaboratively with an interdisciplinary team to provided patient-centered care for successful transition of care hospital to home.• Assisted in wellness coaching of preventative health options to patients and families.• Liaised between patients and physicians and other interdisciplinary teams to ensure patient comprehension of treatment plans.• Supported patients emotionally through communication and care by being a trustworthy advocate. • Educated patients and family members on proper post surgical discharge care and highlighted the individualized care plan.• Closely monitored acute conditions and provided education on pharmacological and non-pharmacological management and treatments of various disorders and diseases, including COVID-19.• Promoted patient independence by implementing patient care goals in collaboration with patient/family.• Provided assistance in audit for DME compliance per requesting supervisor.• Provided excellent customer service and comply with HIPAA confidentiality.

• Conducted clinical chart reviews utilizing multiple EMR systems per client request.• Worked with various insurance types Medicare, Medicaid and commercial plan patients. • Performed Clinical Chart Abstractions, over reading, IRRs per client request.• Locate medical screening results/documentation to ensure quality measures are followed in the closure of gaps. Works with clients to close care gaps.• Maintain confidentiality of business and protected health information. Maintain confidentiality and adhere to HIPAA requirements.

United States

• Conducted clinical chart reviews utilizing multiple EMR systems per client request.• Worked with various insurance types Medicare, Medicaid and commercial plan patients. • Performed Clinical Chart Abstractions, over reading, IRRs per client request.• Locate medical screening results/documentation to ensure quality measures are followed in the closure of gaps. Works with clients to close care gaps.• Maintain confidentiality of business and protected health information. Maintain confidentiality and adhere to HIPAA requirements.

Cary, North Carolina Area

Created and implemented a Success Vocabulary for all nursing staff to increase patient and family engagement and satisfaction. Promoted cultural sensitivity for our community diverse population for family and friends. Encouraged our patient population to be part of the care plan in orders to get well to go back enjoying their life as independent as they wish! I enjoy finding sources that could help patients and families to achieve their optimal independence.In cooperation with the auxiliary teams we improved patient and family care process to maximize greater outcome of patient stay, streamline and/or improve patient discharge education to prevent/minimize patient readmission.• EPIC superuser, Soft ID super user, PD resource, blood transfusion resource.• Liaised between patients and physicians and other interdisciplinary teams to ensure patient comprehension of treatment plans.• High level of personal accountability. Closely monitored acute conditions.• Educated patients and family members on proper individualized care plan and discharge care.• Promoted patient independence by implementing patient care goals in collaboration with patient and family.• Engaged in the Unit Council as a key member from Patient and Family Experience committee. Established monthly Opioid Pain Management Audit with educational keynotes for staff.• Supported patients emotionally through communication and care by being a trustworthy advocate. • Provided excellent customer service and comply with HIPAA confidentiality.

Raleigh-Durham, North Carolina Area

• Successfully completed Medicine Unit New Grad Program.• Promoted pharmacological and non-pharmacological management and treatment of various disorders and diseases.• Assisted patients/family with active and potent counseling in health maintenance and disease management.• Liaised between patients and physicians and other interdisciplinary teams to ensure patient comprehension of treatment plans.• Educated patient/family on proper discharge care and highlighted the individualized care plan. • Participated in a Work Life Committee for the Unit.• Promoted patient independence by implementing patient care goals in collaboration with patient/family.• Provided excellent customer service and comply with HIPAA confidentiality.

Bachelor Of Science In Nursing, Registered Nursing/Registered Nurse

Resuscitation Science

Cardiac Arrest, Hypothermia, and Resuscitation Science. Received a Statement of Accomplishment of an online course. This course is.