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1

nurse consultant

  • Provide compliance oversight to business areas.
  • Work with business areas to ensure compliance with all state and federal laws.
  • Maintain regulatory compliance with our Adverse Determination letters.
  • Maintaining State specific Policies 
2

nurse consultant

  • Process medical insurance claim forms with records and predetermation requests, ie medical necessity reveiws, experimental & investigational reivews, possible prexesiting claims includding surgical, medical, intravenous drug, and DME reviews.  Also reveiw of some home health and hospis claims. 
  • Collect information and make judgments through the review of medical records and other documents.
  • Reveiwing and determing use of new ICD, CPT and HPPC codes for contract apllicability, medical necessity policies, experatemental & investagatial pocedures, and automation of the claims.
  • Develop manuals, texts, workbooks, or related materials for use in conjunction with production materials and/ for training. 
  • Reviewed Health Statements for potential clients.
  • Transplant Coordinator, aiding pretermination all solid organ transplants.
  • Handicapped Dependant Child Coordiator, aiding in extending children on parents policy when child age limit of the policy had be reached.
3

nurse consultant

  • Nurse Educator for all staff licensed and non-licensed
  • Provide assistance to persons with disabilities in reaching less accessible areas of municipal facilities.Adhere to local, state and federal laws, regulations and statutes.
  • Dental Coordinator, reveiwing and deterination new ICD and ADA (HPPC) codes for contract apllicability, medical necessity, and system automation.  Claims reveiw.  Working closly with the Dentist and other dental  providers, also working closely with and dental consultants both locally and nationally.
  • Collect information and make judgments through the review of medical records and other documents.
4

nurse consultant

  • Oversight of State implementation of Medicaid’s Early Periodic Screening, Diagnosis and Treatment (EPSDT) benefit. Medicaid subject matter expert on beneficiary Due Process and EPSDT, responsible for development and maintenance of training materials, outreach to stakeholders, beneficiaries, and state contractors.  
  • Medical Review staff member for the Dental Liasiion.
  • to aid in the best outcomes for the insure.
  • Acting Assitant Manager in the absent of the Manager.
5

nurse consultant

  • Market research and analysis for potential developmental areas in need of memory care facilities.
  • Designed a 75 bed Assisted Living and Memory Care Facility based on evidence based research.
  • Actively participated in the logo design for new company.
  • Obtained a certificate of need for memory care facility in Alabama.