This document is a resume for Ellen Torre, an RN with over 30 years of experience in various nursing roles such as clinical reviewer, orthopedic/neurological nurse, research medical analyst, and more. She is seeking a clinical review or pharmacy account manager role where she can apply her diverse background. She has extensive knowledge of medical issues, treatments, policies and quality assurance. Her resume outlines her areas of strength such as clinical review, medical terminology, and relationship management as well as her professional experience in roles like clinical reviewer and quality review nurse.

1. ELLEN TORRE, RN
8434 SW 8th
Place, Gainesville, FL 32607 • (352) 332-9341(H) (352 215-9577(C) • ellen.torre@cox.net
RN Clinical Reviewer
Results-driven, dedicated healthcare professional with more than 30 years of diverse nursing experiences, including
positions as a clinical reviewer, orthopedic/neurological nurse, research medical analyst, hospice case manager, and
medical rehabilitation consultant. Possess extensive knowledge of medical illnesses and treatments, hospital policies and
procedures, and standards of care that is applied to providing high-quality clinical assessments and reviews of claims.
Adept at conducting utilization audits. Client-focused leader with proven ability to interact with all levels of personnel.
Seeking to apply my diverse background to a clinical review or pharmacy account manager role with an organization that
values efficiency and client satisfaction./
A R E A S O F S T R E N G T H
 Registered Nurse in FL  Clinical Review  Medical Terminology
 Health Provider Coverage  Utilization Audits  Relationship Management
 Training & Development  Medical Billing/Coding  Quality Assurance
K E Y S K I L L S A S S E S S M E N T
CRITICAL THINKING - Monitors, evaluates, reviews, and processes claim appeals for clinical appropriateness.
QUALITY ASSURANCE - Assesses the effectiveness and quality of services provided as related to clinical, functional, and
financial impact and outcomes.
P R O F E S S I O N A L E X P E R I E N C E
AvMed Healthplan, Gainesville, FL 2006 – Present
Retrospective Clinical Reviewer
Research and process live claims and conduct retrospective reviews of previously denied claims/claims appeals for clinical
appropriateness. Review physician notes and other medical records for medical necessity and benefit coverage issues.
Perform utilization audits and internal reviews of specific membership to capture clinical conditions warranting additional
payments. Review appeals with medical coding issues for documentation to meet reimbursement and benefits for coverage
issues.
Vista Healthplan, Sunrise, FL 2004 – 2006
Quality Review Nurse/Clinical Outcomes Manager
Conducted investigations and applied nursing and clinical expertise to review and evaluate providers and practitioners,
using established standards of care as it related to Potential Quality Issues (PQI). Prepared PQI cases and presented
supporting documentation for consideration by Peer Review Committee. Assisted in quality improvement and credentialing
activities. Helped train and develop new employees.
NeighborCare Pharmacy, Deerfield Beach, FL 2002 – 2004
Account Manager
Served as primary liaison for accounts. Handled customer service-related issues. Provided educational in-services. Prepared
facilities for state survey. Coordinated and implemented programs and activities, including tradeshows, marketing
presentations, medical record reviews, and new account creation. Conducted medication room inspections.
Whitehall, Boca Raton, FL 2001 – 2003
Nursing Supervisor
Managed a 155-bed skilled nursing and assisted living facility, leading staff in handling daily care and medical
emergencies. Hired, trained, and developed new staff members. Addressed patient and family issues and concerns.
Conducted MAR/chart reviews for quality assurance.
Accomplishment:
• Received 2003 Account Manager of the Year Award for the Southern Region for outstanding contributions.
Prudential Health Care Service, Plantation, FL 1997 – 1999
Pre-Certification Nurse

2. Provided telephone authorization of medical procedures. Utilized Interqual, Milliman and Robertson's guidelines.
Performed medical records review. Monitored and maintained data entered in customized database.
Ellen Torre Resume, Page 2
P R O F E S S I O N A L E X P E R I E N C E C O N T I N U E D
Connecticut Home Care Services, Inc., Greenwich, CT 1996 – 1997
Temporary Administrator/Nurse Consultant
Helped develop policies and procedures to meet state and federal Regulations for obtaining a license as a homemaker/home
Health aide agency. Created and maintained all necessary operational guidelines for the agency. Managed daily office
activities and team members.
Patient Care, Inc., Greenwich, CT 1996 – 1997
Field Nurse Supervisor/Director of Patient Services/Branch Manager
Managed registered nurses, home health aides, and administrative staff. Adhered to the rules and regulations governing
JCAHO and the state, including chart reviews for survey preparation. Handled daily operational activities, including
budgets, GM reports, marketing, and office administration.
Accomplishment:
• Instrumental in increasing revenue by $10K/week.
E D U C A T I O N & T R A I N I N G
Associate of Science, Nursing, Valencia Community College, Orlando, FL