Sign In
Looking for talent?
Check out our hiring section
Login to your account
Remember me?
Login
Forgot password?
Not a user yet?
Click here to register.
LOADING
Select Login
Uploaded File
Monifa
monifaramsayjames@gmail.com
954-940-2386
4249 NW 61st Ct
Coconut Creek, FL 33073
Appeals Clinical Nurse, RN
14 years experience
W2
0
Recommendations
Average rating
97
Profile views
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
Experience
Grievance and Appeals Nurse
Healthcare
Dec 2016 - Apr 2020
Sunrise, FL
Processed appeals and determinations
Performed Clinical Review
Composed resolution letters
Developed new Overturn process for department
Appeals
Nursing
Clinical reviews
Prior Authorization
Clinical Review
Remove Skill
Prior Authorization Nurse
Healthcare
Dec 2012 - Dec 2016
Sunrise, FL
Performed clinical reviews of authorization requests using appropriate criteria
Provided accurate and complete documentation with the rationale used to approve request
Processed over 30 cases a day
Multitasked between computer and multi-line phone requests
Entered and maintained clinical information in multiple health management systems
Nursing
Clinical reviews
Prior Authorization
Clinical Review
Remove Skill
Prior Authorization Nurse
Insurance
Dec 2008 - Dec 2012
Davie, FL
Performed clinical reviews of authorization requests using appropriate criteria
Provided accurate and complete documentation with the rationale used to approve request
Processed over 30 cases a day
Multitasked between computer and multi-line phone requests
Entered and maintained clinical information in multiple health management systems
Nursing
Clinical reviews
Prior Authorization
Clinical Review
Remove Skill
Edit Skills
Non-cloudteam Skill
Education
Bachelor's in Nursing/Registered Nurse
Chamberlain University, 2019 - 2020
Record has not been verified.
Associate's in Nursing
Jersey College of Nursing, 2016 - 2019
Record has not been verified.
Certifications
Interqual Certified
RN Florida license
Skills
Clinical Review
2020
12
Clinical reviews
2020
11
Nursing
2020
11
Prior Authorization
2020
11
Appeals
2020
3
Case Management
0
1
CDI Coding
0
1
Health Services Administration
0
1
Mental Health
0
1
Patient Safety
0
1
Registered Nurse
0
1
Surgical Nursing
0
1
Triage
0
1
Utilization Review
0
1