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Monifa
Appeals Clinical Nurse, RN
11 years experience W2 Coconut Creek, FL
Actively seeking
Monifa
Appeals Clinical Nurse, RN
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Clinical reviews Nursing Prior Authorization Appeals Case Management CDI Coding Health Services Administration Mental Health Patient Safety Registered Nurse
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Recent Experience
Grievance and Appeals Nurse 12/16 - 04/20
Appeals Nursing Clinical reviews Prior Authorization
Prior Authorization Nurse 12/12 - 12/16
Nursing Clinical reviews Prior Authorization
Prior Authorization Nurse 12/08 - 12/12
Nursing Clinical reviews Prior Authorization
Summary

  • Over 20 years of nursing experience in case management, utilization management, mental health, managed care, and medical-surgical fields
  • 5 years of direct appeals experience
  • Experienced in CMS reviews for appeals
  • Worked with Jiva, Seibel, and Diamond and reviewed in Pre-service, Concurrent, and Post Service
  • Currently pursuing a bachelor's in Nursing at Chamberlain University

PROFESSIONAL SKILLS

  • Interqual Certified
  • Utilization management
  • Case management
  • Advanced verbal, written communication, and organization skills
  • Proficient in Microsoft Office

Top 5 Skills
SkillsProficiencyLast Used
Clinical reviews
2020
Nursing
2020
Prior Authorization
2020
Appeals
2020
Case Management
0
Education and Certifications
Bachelor's in Nursing/Registered Nurse
Chamberlain University, 2019 - 2020
Associate's in Nursing
Jersey College of Nursing, 2016 - 2019
Interqual Certified,
RN Florida license,
Preferences
Availability:Immediately
Willing to relocate?:No
Prepared to Travel:No travel (0%)
Employment Type:Any
Security Clearance:No clearance
Citizenship:U.S. Citizen