Please read my resume and tell me howI can improve it...like the appearance of job hopping, employment gaps(due to auto accident) and length...the whole thing...thank you....jo

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MANAGED HEALTHCARE/DISEASE/CASE MANAGEMENT/UR/QA/UM/INSURANCE/SENIOR NURSE/LPN

OBJECTIVE:
To obtain a position where I can provide
comprehensive healthcare management services,
to facilitate appropriate healthcare
treatment, effectively manage customer
relations and improve healthcare programs and
that will utilize and enhance my 34 years of
vast nursing skills while being upwardly
mobile in my career goals.

EXPERIENCE:
02/2007 - Present
Medical Gatekepers, Inc
Wakefield, MA
2007 HEDIS EXTRACTOR
*Thisassignment encompasses medical chart data collection from provideroffices and includes (entire) medical record collection on a selectnumber of charts for Recredentialing. I am/was responsible forsetting/confirming site visit appointments prior to the appointmentdate by faxing patient lists to provider offices and locate and reviewall assigned medical charts to perform the abstraction in a clear,concise and accurate manner keeping in mind the need to meet strictdeadlines. Copy all chart documentation per 2007 HEDIS specificationskeeping all information collected in a safe, organized and confidentialfashion until they were either delivered or sent by FEDEX the assignedofice. Required extensive travel.

10/05 - Present
MSI Consulting,Inc.
Heart Alert, Inc.
Atlanta, GA
DISEASE CASE MANAGER
*HeartAlert provides clinical tele-medicine management for disease specificprograms to include CHF, COPD, HTN, MI, CAD, END STAGE RENAL DISEASEand their co-morbities such as elevated lipid profiles, edema andobesity as well as rehabilitation support for post cardiac procedures(s/p bypass surgery, etc) including telephonic data collection,analysis, and communication of both objective and subjectiveinformation received from the patient enrolled in the diseasemanagement process in conjunction with many home health agencies. I wasresponsible for implementing the plan of care to our disease specificprograms. I am responsible for performing an initial/admissionassessment on all new enrollees as well as risk screening and a H &P with the patient verifying the accuracy of same and medicationprofile as well as co-morbidities. After the assessment is completed alevel of patients management and an initial encounter score isdetermined at which time pt is entered into the scheduler for 14teaching points based on American Heart Association guidelines. Patientobjective data is reviewed daily and if data is outside establishedparameters and follow standing orders/protocol (titration of diuretics,beta blockers and ace-inhibitors) on incoming data elements that areoutside the established parameters and follow-up on any patients whorequired interventions per standing physician orders in a busy callcenter enviroment maintaining and exceeding required production on aconsistent basis. Case loads 200 patients. All patient encounters aredocumented in the Heart Alert Clinical Information System. (PCM)

05/03 - 11/03
Matria Healthcare
Marietta, GA
NURSE CLINICIAN I/DIABETIC DISEASE CASE MANAGER
*MatriaHealthcare is an integrated disease management services company forpatients, members, physicians, health plans and employers in a busyinbound/outbound HED call center. In my position as a Nurse ClinicianI, it was my job to improve the health outcome of my 300+ patientcaseload through detailed health risk assessments (insulin, non insulindependent diabetics) to include co-morbidities such as COPD, ASTHMA,CHF, CAD, HTN and Obesity by member education based on current AmericanDiabetic Association guidelines, using clinical interventions (HbA1c,Microalbulmin, Lipid Profile), compliance management (Lifestyle andSelf management skills) weight management, smoking cessation andfavorable outcome reporting such as decreased healthcare costs andreduction in sick day usage. I was also responsible forinbound/outbound marketing calls to enroll potential members into theDiabetes Advantage Program. Consistently met or exceeded the companytarget goals. (Production)

07/02 - Present
Kelly Healthcare Services
Atlanta, GA
PRE-CERTIFICATION NURSE
*Variousshort term assignments. Processing pre-certifications on the phone inqueue using M&R and InterQual guidelines based on medicalnecessity. I worked with all products ranging from Managed Care, HMO,PPO, POS, EPO to lndemnity Plans. Proficient in HEDIS, and HIPAAguidelines. Intensive 1-1 Outpatient detox.

10/01 - 07/02
Maxim Healthcare, Traveling Nurses/Per Diem, Nurse Finders, Inc.
Colorado Springs, CO
LPN/CONTRACT/PER DIEM
*Various assignments throughout Denver, Colorado Springs and Pueblo areas to include:
PhysiciansOffices *Internal Medicine, Allergists, Cardiology, Oncology,Orthopedics, OB/GYN (Telephonic Triage/Referrals/AssistedProvider/Private Practices in Colorado, Occupational Medicine,Geriatrics, Endocrinology, Primary Medicine, Gastroenterology and otherSpecialties), front and back office duties to include but not limitedto Vitals, EKG's, PFT's, Pulse Ox, Veni-punctures, Blood Sugars,Immunizations, Charts, Allergy testing and Injections, Suture Removal,Medical Records and assisted as needed *Coordinated my Nurse CallAppointment Visits
*Collected and prepared all lab specimens, entered data into computer system and prepared specimens for pickup by courier.
*Pre-Certification *Pre-Authorization *Concurrent Review *Prior Approval
*RetroApprovals *Referrals *Insurance Verification *Medical Record Audit(HEDIS) *Telephone Triage *Credentialing (Onsite) *Re-Credentialing
*Claims *Claims Review *Billing *Billing Review *EOB's *COBRA
*Light Collections *Process Referrals *Flu Clinics
*Psychiatric (Acute) and LTC facilities (Alzheimer's)
*Hospital Staff Relief (Med-Surg), Started, managed and discontinued IV's,
Medication Administration

10/00 - 11/01
Insurance Overload Systems/Atria Healthcare
Denver, CO
QUALITY ASSURANCE COORDINATOR
*Responsiblefor ensuring the accuracy of paperwork an