Jeffery O.

I worked in the Government Business Division of Amerigroup, a WellPoint/Anthem company. Amerigroup, a Medicare/Medicaid Managed Care Organization, manages public funded health programs. Anthem/Amerigroup serves over 4.5 million beneficiaries of state sponsored health plans. Key Responsibilities: * Durable Medical Equipment (DME) utilization review nurse * Manage daily department workflow, triaging/delegating task to ensure timely execution * Serve as liaison to medical equipment vendors, physicians, and health plan Medical Directors for claim/complaint resolution * Train new associates, developed training materials used to train associates * Determine medical necessity of medical equipment working directly with health plan Medical Directors, when necessary, to establish medical necessity * Ensure compliance with regulatory guidelines/state regulatory bodies and adherence to contractual obligations in regards to review and management of benefit utilization * Maintain strict adherence to federal confidentiality/privacy regulations

I was the Medical Captain of the local volunteer fire department.

Helping Hands Nursing Agency is responsible for ensuring the adequate staffing year-round for a variety of clients ranging from long term care facilities to large inpatient acute care hospitals and home health agencies. Duties include actively participating in the development and implementation of individualized treatment plans for patients with a broad range of health problems as well as being responsible for ensuring that doctors' orders are addressed in a timely manner, including diagnostic testing, medical procedures, and consultations.

I was employed as a Nursing Intake Specialist. CareCentrix is a centralized home health intake for managed care patients. I authorized and coordinated home care services and durable medical equipment for members of participating health plans. This position required above-average computer literacy and demanded the ability to multi-task and to utilize excellent time management skills. Key Responsibilities: * Identify payor sources for home health care services * Negotiate home health pricing directly with administrative staff of national home health care agencies * Work directly with clients, physicians, home health providers, social workers, and discharge planners to coordinate home health referrals and home Durable Medical Equipment (DME) * Acquire authorizations from client health plans, issue authorizations directly to home care providers and DME providers after negotiating pricing * Excellent customer service skills working directly with callers (typically discharge planners & physicians) to quickly resolve any concerns, report any concerns real-time to administrative staff via e-mail

Much of my experience with Texas Medical Professional Staffing agency was with private duty ventilator dependent patients. I provided one-on-one care to chronically ill children in their homes managing in-home emergencies such as emergency trach changes and manually ventilating patients with an Ambu bag as needed. Providing skilled nurse visits to homebound adult Medicare patients familiarized me with Medicare guidelines expanding my knowledge-base beyond the clinical spectrum and made me aware of billing and reimbursement processes. Other assignments frequently included staffing a local emergency department providing direct patient care to trauma/medical patients. Key Responsibilities: * Home Health Field Nurse: Perform skilled nursing visits for acute and chronic home care clients providing 1:1 intensive private duty care in patient's home * Report client progress directly to Registered Nurse (team leader) and administrative nursing staff and act as a home health team member working directly with physicians, clients, and therapist to track client * progress and assist clients to reach set goals * Emergency Department: Stabilize cardiac/trauma patients in a busy emergency department requiring quick critical thinking and analysis to ensure delivery of appropriate and effective patient care.

Beginning my professional nursing career in CHRISTUS Jasper Memorial Hospital's busy medical/surgical unit afforded me the opportunity to vastly expand my knowledge-base beyond my clinical training in nursing school. I was recruited from the medical/surgical unit to become one of only two LVNs to participate in a trial program to reintroduce LVNs to this hospital's Emergency Department. This program proved successful utilizing LVNs for skills/interventions by allowing the primary nurse time to focus on the comprehensive plan of care.