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