Long-term temporary assignment (November 2008-June 2009) at Nautilus Healthcare Management Group, providing services to Greater Newport Physicians and Edinger Medical Group. Conducted Prospective, Concurrent and Retrospective reviews of authorization requests, utilized HMO benefit structure and benefit interpretation guidelines, Medi-Care criteria and other recognized and evidenced-base criteria to assist in the decision making process.

Responsible for authorizing medical treatment and associated diagnostic testing on Workmanís Compensation claims not assigned to a medical case manager.

Responsible for performing pre-admission reviews, concurrent reviews, and procedural certifications for contracted client, Pacific Life and Annuity.

Responsible for reviewing and assessing cases on admission using IS/SI criteria.
Collaborated with health care team, patient, family, and payor re: discharge planning and facilitation of care.

Responsible for pre-admission authorization and continued stay review for medical and surgical cases. Evaluated medical necessity and intensity of service for acute inpatients and continued stay resulting in shortened bed days and cost savings. Performed procedure reviews. Developed comprehensive rehab assessment form for use in review of rehabilitation cases, resulting in time-savings in the review process. Responsible for Workalert (Short Term Disability) Program (1997-1999). Responsible for other special programs in office as needed.

Assessed potential blood donors by taking medical histories and evaluating current physical status. Performed phlebotomies, observed donors during process and post-donation, monitored for reactions and treated such, on occurrence. Charge Nurse responsibilities included directing and providing clinical supervision of all blood collection operations in specific blood center or bloodmobile on an operational level. Personally certified all staff in CPR.

Assessed potential blood donors by taking medical histories and evaluating current physical status. Performed phlebotomies, observed donors during process and post-donation, monitored for reactions and treated such, on occurrence. Charge Nurse responsibilities included directing and providing clinical supervision of all blood collection operations in specific blood center or bloodmobile on an operational level. Personally certified all staff in CPR.

Responsible for all aspects of school health services. Provided immunizations, conducted state mandated screenings, assessed health and development of all students referred for special education. Worked with Head Start/State Pre-School Program, elementary, and junior high students.

Nursing