Candy Frey
Hudson,IN
Summary
Experienced Utilization Review Nurse with a track record of delivering high-quality care and ensuring cost-effectiveness for patients and healthcare facilities. Skilled in assessing medical necessity and collaborating with physicians to determine appropriate classifications for optimal patient outcomes. Proficient in submitting clinical information to payers and specializing in denial review. Expertise in setting up Peer-to-Peer (P2P) discussions for physician advisors with payors. Holds a Bachelor of Science in Nursing, providing a solid foundation for a career in the healthcare industry.
Overview
24
24
years of professional experience
Work History
Utilization Review Specialist
Parkview Regional Medical Center
02.2022 - Current
- Perform admission reviews based for medical necessity based upon IQ specification
- Communicating with attending to ensure appropriate level of care.
- Submitting clinical to payor with-in payor gridline.
- Submitting cases for criteria failures and helped facilitate resolutions and approvals.
- Sending reconsideration's to payor and setting up P2P for attending, Physician Advisors internal and external.
- Manage high volume of cases efficiently by prioritizing tasks and maintaining strict deadlines for completion of reviews.
Case Manager Sepcialist
Parkview Regional Medical Center
01.2021 - 02.2022
- Managed support services and fostered communication among social workers, therapists, hospital staff and patients.
- Consulted with clinicians to devise and manage ongoing discharge plans for up to 20 new patients.
- Collaborated with external agencies to meet needs of patient's post-discharge.
- Access and document delays in discharge.
- Educated patients and loved ones about different therapy/rehab options returning home.
- Continually assessing needs of patient to implement safe discharge plans.
- Developed and implemented performance improvement strategies and plans to promote continuous improvement.
House Supervisor
Parkview Dekalb Hospital
03.2015 - 01.2021
- Provides for general administration of hospitals after hours. Including but not limited to following:
- Supervision of staff and public relations.
- Patient and staff satisfaction.
- Physician satisfaction and protection of hospital assets.
- Establishes adequate staffing and patient flow after hours.
- Reviewed clinical documentation to assess standards and quality of care
- Direct day-to-day administrative and operational functions for: 8 ICU; 20 MS and 15 bed ED facility, providing guidance and leadership to over 15 employees across more than 4 departments
Emergency Room Registered Nurse
Dekalb Hospital
12.2015 - 04.2016
- Delivered medications via oral, IV and intramuscular injections, monitoring responses to address new concerns.
- Assisted patients dealing with traumatic injuries or illnesses, including stroke patients, accident victims and cardiac patients.
- Educated family members and caregivers on patient care instructions.
- Administered different therapies and medications in line with physician orders and treatment plan.
- Cared for patients in 15-bed unit, supporting fellow nurses in delivering outstanding treatment to patients
- Performed triage on incoming patients and determined severity of injuries and illnesses
Cardiac RN
Parkview Heart Institute 4th Floor
11.2011 - 12.2015
- Epic experience.
- Administered nursing care to cardiac patients undergoing diagnostic, therapeutic or emergency services.
- Conducted initial assessments, documented findings in patient records and notified physicians of abnormal findings.
- Assisted in diagnosis and treatment of conditions such as unstable angina, cardiomyopathy, coronary artery disease, and cardiac dysrhythmia.
- Administered medications to 5 patients and monitored response to medications
- Cared for patients in 30-bed unit, supporting fellow nurses in delivering outstanding treatment to patients
ICU Staff Nurse
DeKalb Hospital
04.2013 - 03.2015
- Delivered age-appropriate medical care for adult, adolescent and geriatric ICU patients.
- Monitored patients' respiratory status and ventilator operation and made adjustments to promote stabilization.
- Recorded patients' medical status and treatment details in electronic charts to accurately document medical care in 8 bed ICU.
- Guided and educated patients and caregivers on diagnoses, disease management, preventive measures, medication use and self-care to foster consistency in care administration.
- Oversaw various aspects of telemetry by administering vasoactive drugs, titration, thrombolytic therapy, dysrhythmia interpretation and chest tubes.
Pharmacy Technician
Kroger Pharmacy
03.2001 - 11.2011
- Calling doctors' offices, hospitals, and insurance companies to insure script accuracy, patient safety, and billing issues.
- Consulted with insurance company representatives to complete claims processing, resolve concerns, and reconcile payments.
- Monitored ordering of pharmacy medication stock to maintain streamlined inventory and low overhead.
- Filled prescriptions and prepared prescription labels with absolute accuracy.
- Coordinated verification and filling of more than 100 daily prescriptions in high-volume pharmacy environment
Education
Bachelor of Science - BSN
Indiana Wesleyan University Fort Wayne Education And Conference Center
Fort Wayne, IN03.2019
Associate of Science - Nursing
Indiana University Purdue University At Fort Wayne
Fort Wayne, IN2010
Certificate - Pharmacy Tech
Kroger
Fort Wayne, IN2001
Skills
- Public relations
- Safety prevention
- Patient and staff satisfaction
- Case Management
- Medical Records Management
- Staff Management
- Needs Assessment
- Direct Patient Care
- Interdisciplinary Collaboration
- Emergency Response
References
References: Deanna Dekoninck RN., House Supervisor PDH. (260) 920-8728; Nora Hively UR RN: 260-248-9760; Inesa Makevit NP., (260) 431-4945; Jennifer Gillingham RPH, Kroger Pharmacy (260) 492-2054.
Timeline
Utilization Review Specialist
Parkview Regional Medical Center
02.2022 - Current
Case Manager Sepcialist
Parkview Regional Medical Center
01.2021 - 02.2022
Emergency Room Registered Nurse
Dekalb Hospital
12.2015 - 04.2016
House Supervisor
Parkview Dekalb Hospital
03.2015 - 01.2021
ICU Staff Nurse
DeKalb Hospital
04.2013 - 03.2015
Cardiac RN
Parkview Heart Institute 4th Floor
11.2011 - 12.2015
Pharmacy Technician
Kroger Pharmacy
03.2001 - 11.2011
Bachelor of Science - BSN
Indiana Wesleyan University Fort Wayne Education And Conference Center
Associate of Science - Nursing
Indiana University Purdue University At Fort Wayne
Certificate - Pharmacy Tech
Kroger
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