Vicki Eversole Email & Phone Number

Cumberland, Maryland, United States

▪ Utilizing clinical judgement on adjudicated professional and institutional medical claims to ensure medical appropriateness and payment integrity.▪ Perform clinical review and investigation of medical claims for rendered services by analyzing medical records and invoices.▪ Position includes interpretation and application of medical policies, provider member/ contracts, Federal/State regulations and mandates.▪ Application and interpretation of clinical/medical policies, corporate policies, federal regulation, and mandates. ▪ Research the evidence –based clinical practice guidelines for treatments/services provided to ensure rendering the best healthcare decisions▪ Accountable for tracking, trending and benchmarking of cost for procedures and services rendered to ensure claim billing accuracy.

Cumberland, Maryland, United States

▪ Responsible for delivery of assigned patient care utilizing the nursing process: assessment, nursing diagnosis, outcomes identification, discharge planning, implementation and evaluation.▪ Supervision and coordination of the health program for all participants, administration of medications, continuity of care and/or emergency treatments. ▪ Responsible for delivery of all required medical services within the scope of practice and implementation of health policies, in accordance with program policies.▪ Consults with professionals in the disciplines to develop and ensure coordination of therapeutic services for participants as appropriate. ▪ Effectively communicate with health care team members while maintaining standards of professional nursing to ensure continuity of care for patients.

Petersburg, West Virginia, United States

▪ Assigned clients across multiple municipalities with primary focus on implementation of individualized plan of care.▪ Assist with engaging in activities to improve social skills and promote individual living.▪ Served as client advocate and liaison for community based services.▪ Managed and assisted with activities of daily living , medication and treatment plan compliance▪ Trained and advised on health and safety to ensure continuation of independent living