Hemalatha Subash

Registered nurse with 20+ years of experience. Innovative, enthusiastic, and uncompromising in work ethic. Strong interpersonal and teamwork abilities. Excellent training and team management skills. Quick learner with an ability to switch between different processes. Motivated professional with solid background enhancing operational efficiency and team performance. Responsive to changing business demands with adaptable, strategic approaches. Performance-driven and industrious attitude with innovative mentality focused on driving company success. Adaptable assistant general manager with solid knowledge of recruiting and evaluation techniques, customer service principles and financial management concepts. Collaborative team player bringing several years of comprehensive experience completing managerial and administrative tasks to keep company running smoothly. Commended for outstanding staff performance to boost company morale and productivity.

• Registered Nurse, State of Vermont (NCLEX RN-passed)
• State of Colorado (Active USRN license)
• Registered Nurse and Midwife, Indian nursing council

• Review medical records to determine the appropriate level of care through the application of Interqual/Milliman Criteria.
• Documentation of findings in a clear, concise and effective manner.
• Review of appeal information to either uphold or overturn original finding.
• Managing and training a team for home health auditors (Underwent training in USA for home health auditing).
• Prepare monthly reports, track productivity and quality and provide feedback as needed.
• Completes review of pended claims utilizing Client screening tools post service for any of the following: Medical Necessity or Contractual Reviews and submit recommendations to client for determination.
• Reviews medical records and renders a decision based on established criteria exercising independent decision making and judgment using advanced knowledge on a regular basis.
• Review clinical information for concurrent reviews, extending the length of stay for inpatient as appropriate.
• Provide appropriate referral to disease management and case management personnel.
• Performing case review and first level determination approvals for inpatient, outpatient, and ancillary services requests and providing pre-certification for medically necessary procedures and hospitalizations and referring to medical director those that require additional expertise.
• Reviewing for benefit determination, medical appropriateness, and medical necessity using client screening tools.
• Coordinate physician in patient care including assessment and assisting in procedures. Assess Patients to identify appropriate nursing interventions.
• Collaborate with Members of an Interdisciplinary Health Team to Plan, implement, coordinate and evaluate patient care in consultation with patients and their families.
• Facilitate clinical staff for continuing education program, initiate and facilitate classroom discussions, design training material for candidates, prepare and deliver lectures to candidates.
• Conduct classroom-based training, administer assessments to evaluate the candidates and training program, tracking progress of the candidates and provide feedback as required.

• Lathu444@gmail.com
• Lathu666@gmail.com

• Hinduja Global Solutions (Sagility Health), Coimbatore, Tamilnadu, India, Assistant General Manager, Payment Integrity, 08/01/21, Present, Individual contributor/clinical researcher., NCLEX trainer., Facilitating DRG and home health concept building., Creating clinical denials for home health and identifying potential overpayments for clients., Developing audit workflows for various clinical programs., Assisting in development of process related tools.
• SCIO Health Analytics, Chennai, Tamilnadu, India, Clinical Auditor for Short Stay (US Healthcare), Post claims and appeals (Reviewing medical necessity for level of care)., Senior Manager for home health program (US Healthcare-Managing and training a team of 30-40 members)., Clinical reviewer for DRG-CVA (US Healthcare) - pre and post claims (Validating the clinical conditions)., 03/01/13, 07/31/21
• Accenture, Bangalore, Karnataka, India, Subject Matter Expert, Utilization Review Nurse-Clinical US-RN, 03/01/12, 01/31/13
• IELTS Academy, Bangalore, Karnataka, India, NCLEX RN Trainer for Nurses, 01/01/11, 01/31/12
• St. Mary's Institute of Nursing, Bangalore, Karnataka, India, Assistant Lecturer/Clinical Instructor, 08/01/10, 12/31/10
• Focus Educare Pvt Ltd, Bangalore, Karnataka, India, NCLEX-RN Online Content Developer, 05/01/09, 04/30/10
• Sri Shantini College of Nursing, Bangalore, Karnataka, India, Assistant Lecturer/Clinical Instructor, 06/01/08, 12/31/09
• R.K Hospital, Bellary, Karnataka, India, Registered Nurse, Medical Surgical Wards, 04/01/06, 04/30/08
• Ruby Hall Clinic, Pune, Maharashtra, India, Registered Nurse, Medical Surgical Wards, 01/01/05, 01/31/06