Download to read offline
Denise Resume
- 1. Denise L. Lakins denise.lakins@yahoo.com 537Herbert Road Akron, OH 44312 (330) 607-3426 CAREER SUMMARY Professional RN experienced with the Medicare and Medicaid population. Excellent communication and interpersonal skills as well as the ability to quickly establish relationships with co-workers to accomplish both team and individual goals. Proficient in Interqual, Milliman, Excel, Amisys and CCMS. PROFESSIONAL EXPERIENCE CGI October 2012 – August 2016 Nurse Auditor • Consultant for OB assessment and diabetic pregnancy assessment for Oklahoma Community Care 360. • Responsible for reviewing medical records to determine the medical necessity of clinical services rendered to beneficiaries of various health plans including Commercial, Medicaid, and Medicare clients. Medical necessity reviews include acute care, physical, speech, and occupational therapy, rehabilitation and outpatient surgeries. Mercy Medical Center December 2010 – October 2012 Utilization Review Nurse • Skillfully completed concurrent and retrospective chart reviews for the insurance, Medicare, and Medicaid population during inpatient hospitalization utilizing Milliman and Interqual criteria. • Prepared appeal letters and assisted in the appeals process in the event a claim is denied. • Collaborated with physician and social worker for discharge needs. • Communicated with staff members and admission specialists for correct status of patient. Buckeye Community Health Plan December 2006 – December 2010 Concurrent Review Nurse January 2010 – December 2010 • Skillfully completed concurrent and retrospective chart reviews for members during inpatient hospitalization utilizing interqual criteria • Identified member cases that required medical director review • Collaborated with facility case manager to assist with discharge planning needs • Maintained high quality rapport with denial coordinator on admission, continued stay and level of care denials • Communicated with inpatient members and reported status to Buckeye case managers and recorded annual HEDIS measurements CM II Start Smart Team December 2006 - December 2009 • As case manager identified, educated, supported and monitored high risk pregnant members via telephonics, mailing, and utilization of community agencies. • Collaborated with the OB physician and office staff to initiate 17P injections (progesterone) for members with a history of pre-term delivery. • Assessed for HEDIS measurements for the high risk pregnancy population. • Educated providers and office staff on proper coding and billing practices, HEDIS and state-mandated quality metrics specifications, provider profiling and pay-for-performance measurement, and medical record review criteria. Solicited identification of barriers the office faces in providing care to members. • Developed care plans. • Reviewed and provided oversight of member assessments collected by three team members CM II for NICU • Created and developed program, organized the responsibility and focus for newly created position. • Established guidelines and interventions for case management from birth to one year of age. • Collected weekly updates of NICU infants and reported to VP of case management. • Communicated and reported program statistics and trends monthly to corporate using Excel Data collected used for benchmarking.
- 2. Summa Hospital January1986 – December 2006 Staff RN • Bedside nurse specializing in Perinatal, NICU, and Mother/Baby Nursing. • Skillfully assisted with resuscitation of the newborn. • Certified in neonatal resuscitation. • Served on recruitment and retention committee for seven years. • Clinical Ladder II nurse for ten years. EDUCATION Idabelle Firestone School of Nursing, Akron, OH – RN Diploma – 1985 University of Akron, Akron, OH – Bachelor Science of Nursing – 1995