Christine West

Managed case files for injured workers, ensuring medical necessity approval for all medical requests. Performed Quality Assurance checks for diagnoses and prior authorizations, and reviewed all requests including procedures, medications, and therapies.

Performed Quality Review of Worker's Compensation Requests for Authorization (RFA) at the third-party level. Reviewed physician's decision rationale for guideline, grammar, spelling, and clarification accuracy. Generated detailed reports for submission to the Work Comp requestor.

Provided hands-on patient care under the supervision of an RN team lead. Administered medications, monitored patient's clinical status, vital signs, and changes in condition. Documented clinical status via medical reports and wound care.

Performed electronic medical record review (EMR) for multiple hospital entities for retrospective review and approval of inpatient admissions. Formulated admission synopses utilizing InterQual criterion and submitted completed reviews to the FL Medicaid payor for reimbursement. Developed and submitted appeal/reconsideration letters for denied inpatient services.

Interviewed new patient admissions for clinical therapy review, obtaining clinical medical and substance abuse history. Developed an intake admission tool and data entered assessments utilizing ASAM and InterQual criteria. Contacted insurance carriers for pre-authorization and provided clinical data for continued stay reviews.

Completed vocational training at Sea Isle Vocational School, which is now known as Tennessee College of Applied Technology. Acquired an LVN Degree in 1980.

Grade: 3.5

Completed two years of coursework, including prerequisites, in pursuit of an RN degree at Volunteer General Community College. Achieved a GPA of 3.5.