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Jacqueline
jacquelinebellas@aol.com
813-310-8558
Zephyrhills, FL 33543
Onsite Utilization Review Nurse
25 years experience W2
0
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Average rating
8
Profile views
Summary

Skills

  • •MEDICAID (10+ years)
  • •DISCHARGE PLANNING (10+ years)
  • •PATIENT CARE (10+ years)
  • •DOCUMENTATION (4 years)
  • •INTERVIEWING (3 years)
  • •Utilization Review (10+ years)
  • •Interqual (10+ years)
  • •LPN (10+ years)
  • •Utilization Management (10+ years)
  • •Time Management (10+ years)
  • •Case Management (5 years)
  • •Outlook (10+ years)
  • •CPR (10+ years)
  • •Microsoft Excel (10+ years)
  • •Teaching
  • •training (5 years)
  • •Customer Service
  • •Medical Terminology (10+ years)
  • •Phone Etiquette (10+ years)
  • •HEDIS (5 years)
  • •Managed Care (10+ years)
  • •EMR Systems (10+ years)
  • •NCQA Standards (10+ years)
  • •Triage (5 years)
  • •Medical Management
  • •Documentation Review (10+ years)
  • •ICD-10 (10+ years)
  • •Cerner
  • •Nursing
  • •Typing
  • •Microsoft Office
  • •ICD-9
  • •Epic (5 years)
  • •Medical Records (10+ years)
  • •Nurse Management
  • •CPT Coding (10+ years)
  • •Crisis Intervention (5 years)
  • •Insurance Verification
  • •Medication Administration (5 years)
  • •Critical Care Experience (Less than 1 year)
  • •Auditing (5 years)
  • •Employee Orientation (5 years)
  • •Anatomy Knowledge
  • •Hospital Experience

Experience
Onsite Utilization Review Nurse
Medical Devices
Apr 2014 - present

Onsite concurrent review with use of Interqual guidelines to determine medical necessity for hospital stay. Care coordination & discharge planning on admission for Medicaid members regions 5 & 6. Referrals to appropriate programs & community resources. Cost containment. Reduced length of stay by early discharge planning & care coordination. Implemented workflow processes that improved efficiency & outcomes. Documentation audits for Quality Assurance.

Medicaid Nursing Utilization Review
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Regional Nurse
Medical Devices
Apr 2014 - Apr 2014
/ Utilization Review Nurse/ Nurse Case Manager
Nursing Utilization Review Project Management
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Disease Management Nurse
Medical Devices
Aug 2007 - Aug 2010
Proactive outreach to members to provide health education & assist/ support in self - management of chronic conditions. Health assessments, triage, referrals, Motivational Interviewing for compliance & participation. Maintained caseload of 80-120 members. Preceptor for new staff, subject matter expert for healthcare computer programs. Participated in pilot programs & focus groups to improve workflow processes.
Compliance Nursing Triage Health Assessments
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Nurse Care Coordinator/ Case Manager
Medical Devices
Jun 2003 - Aug 2007
Nursing Project Management
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Clinical Staff Nurse
Medical Devices
Sep 2000 - Jun 2003
Nursing
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Clinical Field Nurse
Medical Devices
Jul 1999 - Sep 2000
Nursing
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LPN/Charge Nurse
Medical Devices
May 1996 - Jun 1998
LPN Nursing
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Edit Skills
Non-cloudteam Skill
Education
Excelsior Univerisity
Northshore Technical Community College 2016
Minor: LPN
LPN to RN Nursing Program
not provided
Certifications
LPN years
CPR years
PN
Skills
Nursing
2021
20
Medicaid
2021
7
Utilization Review
2021
7
Project Management
2014
4
Compliance
2010
3
Health Assessments
2010
3
Triage
2010
3
LPN
1998
2
HEDIS
0
1
ICD-10
0
1
ICD-9
0
1
MS Excel
0
1