Utilization Review Customer Service

Kim Dzieciolowski R.N. BSN

*** ******** ***** *****, ******, Michigan 48130

248-***-****, ad66vt@r.postjobfree.com

Dedicated and compassionate registered nurse and clinical coordinator with 10 years experience in general medical hospital care, ICU hospital and outpatient dialysis clinic settings. Direct experience accurately reviewing clinical measures, performing utilization review, and with Medicare/Medicaid billing. Excited to use my deep understanding of medical necessity and background in utilization review to help guide patients through the continuum care as a Utilization Review RN.

Clinical Coordinator and Clinical Knowledge: Extensive clinical knowledge in acute care, ICU, and outpatient. Skilled at performing patient screenings, chart reviews, adapting medical plans, and documentation of medical necessity.

oSkilled in proper ICD 9 and 10 coding, ABN reports and follow ups, and performing utilization review/case management with interdisciplinary team within ICU and Med/Surgical settings.

Conflict resolution and customer service: Proficient with working with variety of socioeconomic backgrounds and personnel to de-escalate using proactive listening, empathy, calm professionalism and excellent customer service.

Excellent technology skills and fast learner: Proficient in verbal and written communication both online, phone or in person. Skilled with variety of EMRs, Microsoft Suite, and data entry.

CORE COMPETENCIES INCLUDE: Documentation & Editing Quality Assurance Utilization of Services Strategic Planning Healthcare Compliance Time Management Organizational Skills Workflow Management Education & Training Leadership Objective Analysis Oral & Written Communication Continuum of Care Medical Terminology Clinical Guidelines Care Coordination Regulatory Requirements & Standards (ICD10, CMS, Medicare, Medicaid) HIPAA Utilization Review

Professional Experience

Davita Dialysis (Chelsea, Ann Arbor, Jackson, Ypsilanti, Brighton, Riverview) 3/2022-present

Float RN

Registered nurse who demonstrates adaptability and team work, floating to different units and different roles as needed.

Provided and supervised medically complex patients, performing duties including but not limited to taking and monitoring vital signs, initiation and termination of dialysis, documentation, physical assessment of patients and patient treatments, taking and transcription of physician’s orders, drawing and documentation of ordered laboratory work.

Skilled at interpreting medical data and making quick medical adjustments as needed or recommending additional services for patient safety as needed.

Demonstrates leadership, performing personnel management of dialysis technicians and ensuring excellent patient care and customer service.

Davita Dialysis (Garden City, Novi Locations) 2/2016-3/2022

Chronic In center Dialysis Nurse/ Clinical Coordinator

Developed plans of care based upon assessment with specific objectives, goals and interventions tailored to meet patient's needs.

Aiding clinic in coordinator skilled care of dialysis patients, ensuring proper treatments, performing chart auditing, advocating for additional services or sessions, and communicating to medical team.

Demonstrates extensive knowledge of Medicare, Medicaid, Local Coverage Determinations (LCD/LCA), National Coverage Determinations (NCD), Official Guidelines for Coding and Reporting, and ability to accurately apply utilization review criteria (CMS) when necessary.

Henry Ford Hospital Detroit, MI 8/2015-2/2016

Registered Nurse- ICU

Strong understanding of acute care Medicare guidelines and health plans, working closely with interdisciplinary team of physicians, social workers/case managers, and rehabilitation team to develop plan of care and goals towards safe discharge or overcome barriers to discharge.

Aided in patient screening and determining appropriateness and medical necessity of patient referrals and medical care.

Demonstrated exemplary customer service and empathy, able to connect with patients, family members and team members and develop strong working relationships.

Adept at problem solving, navigating with professionalism any staffing concerns or patient issues with staff in calm and helpful manner.

Comfortable working with wide variety of ethnicities and socioeconomic backgrounds.

Huron Valley Sinai Hospital Commerce, MI 3/2013-8/2015

Registered Nurse- Med/Surg

Assessed new patient admissions for identification of status and medical necessity and able to document appropriately in EMR to support the level of care required.

Worked with social workers and case managers to assess continuity of care and advocate for continued hospitalization or discharge to the next appropriate level of care in accordance with regulations.

Provides patient care that reflects a respect for patients' rights, dignity, values, culture preferences, and expressed needs and an attention to providing comfort, relieving pain, and alleviating anxiety.

Conduct daily utilization management assessment to facilitate appropriate use of health care resources and coordination of care.

St. Joseph Mercy Hospital Pontiac, MI 6/2003-3/2013

Registration and Billing Assistant

Demonstrates exemplary Medicare billing knowledge, correcting billing incidents as needed, and performing medical coding using ICD 9, 10, ABN reports and performing follow ups.

Worked with insurance companies, customers and physicians to ensure proper information is documented and performed insurance review for pre authorizations.

Education

Bachelor of Science in Nursing, 2012

Oakland University Rochester, MI

Bachelor of Science in Dietetics, 2003

Madonna University Livonia, MI

Certifications

BLS American Heart Association

Foundation of Utilization Management Certification

Quality Series: Utilization Management

Utilization Management: The Review Process

Utilization Management: Acute Care Roles and Responsibilities

Utilization Management: Legal Concerns

Utilization Management: Medicare Beneficiaries

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