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Monifa
monifaramsayjames@gmail.com
954-940-2386
4249 NW 61st Ct
Coconut Creek, FL 33073
Appeals Clinical Nurse, RN
15 years experience W2
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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
Edit Skills
Non-cloudteam Skill
Education
Bachelor's in Nursing/Registered Nurse
Chamberlain University, 2019 - 2020
Associate's in Nursing
Jersey College of Nursing, 2016 - 2019
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