Veronica Mccall Email & Phone Number

As a telehealth appeals nurse, my responsibilities include determining eligibility and benefits for each patient. I review provider and member appeals cases for individuals with Medicaid insurance (community and state). I collaborate with medical directors and other disciplines to complete clinical reviews for various inpatient and outpatient cases. I make determinations based on medical necessity, policy, and procedures. This position includes researching in-network and out-of-network providers and services to complete reviews. I review the medical records and utilize multiple systems to obtain adequate information to compile a quality review for determination and closure. I am a team player who assists and covers for my coworkers.

Us

I floated in several areas within the psychiatry department as a registered nurse I & II serving a diverse population of children and adolescents with mental illness, substance abuse/addictions, and physical and sexual abuse. I exercised supervisory skills as a charge nurse, and led rounds for a multidisciplinary team consisting of doctors, nurses, social worker, and case manager. Led and participated in therapeutic group therapy and 1:1 counseling sessions. I collaborated as a team player, assessed patients, and identified goals and outcomes for a diverse group of patients. I served as a leader and “super user” to train staff on the Epic system. I administered medications, performed nursing skills, and demonstrated critical thinking skills by making appropriate nursing decisions.

Us

Reviewed and managed outcome data for a pediatric trach unit. I created graphs, interviewed prospective applicants, created a unit website, collected data, and developed and presented presentations for the staff as well as for various managers, directors, and upper management. I provided training for staff, participated in several improvement initiative projects, and initiated outcome strategies.

As a nurse, I assessed, monitored, educated, and treated pregnant, antepartum, and postpartum women and children in the home setting. I Managed a caseload of at least twenty-eight cases. I worked with first-time mothers, newborn and premature infants, and pediatric cases within the city limits. I completed grief home visits for SIDS cases and other causes of infant or fetal demise. I followed up on public outbreaks cases. I Coordinated and managed care within various disciplines. I coordinated and implemented health promotion meetings and activities for clients and their families. I reviewed clinical information, assessed patients, and reported abnormal findings to the physician. I provided community resources, initiated and followed up on referrals made to specific programs, conducted chart audits, and coordinated visits for Mentally Retarded Developmentally Delayed (MRDD) patients and their families. I trained and mentored new staff members, residents, and nursing students. I obtained and ordered literature on various topics for the staff members for their clients/families.

Us

I held a registered nurse position on a medical, neuro, and respiratory unit. I served as a charge nurse for a 3 unit pediatric medical unit. I assigned incoming patients to a specific unit, room, and nurse. I performed all aspects of nursing care, resolved conflict, trained and mentored staff members, and completed staffing assignments for oncoming shifts. I worked in collaboration with various interdisciplinary teams and provided education and community resources as needed.

Postgraduate Degree, Psychiatric/Mental Health Nurse/Nursing

Master'S Of Science Degree, Public Health/Community Nurse/Nursing

Bachelor Of Science In Nursing

Associate Degree Of Nursing