Jennifer Robbins

Assessed patients to determine physical and psychological health, providing critical care for acute and chronic conditions. Facilitated communication between patients and healthcare providers, enhancing understanding and compliance.

Conducted timely clinical decision reviews for medical services requiring prior authorization across various clinical areas. Reviewed prior authorizations using clinical expertise and established criteria, including InterQual Medical Necessity Guidelines.

Performed utilization management using clinical tools and judgment, triaging phone calls for patients within the program. Participated in daily multidisciplinary rounds to plan and implement safe discharge plans, preventing hospital readmissions.

Determined level of care (Inpatient/Observation) for out-of-state members using InterQual and managed appeals and denials. Handled approvals and denials for patients seeking transplants according to medical necessity guidelines.

Determined level of care (Inpatient/Observation) using clinical tools and knowledge. Managed appeals and denials for commercial insurers, Medicare, and Medicaid, working with physician advisors.

Educated providers, patients, and caregivers regarding healthcare vendors and community resources. Responsible for utilization management using clinical tools and judgment, identifying high-risk patients and barriers to discharge.

Coordinated with multidisciplinary teams to review medically complex patients and create safe discharge plans to prevent hospital readmission. Determined level of care (Inpatient/Observation) using InterQual and clinical knowledge.

Aided providers with patient referrals to various community agencies for additional home care. Closely monitored patient status and communicated with providers to prevent hospital readmissions, triaging patient calls.

Administered medications and treatments as directed, collaborating with providers in interdisciplinary rounds to ensure first-rate patient care. Initiated patient teaching utilizing the 'teach-back' method to prepare patients for discharge.

Performed assessment skills to identify and monitor patient needs, consulting with providers regarding timely and effective treatments. Worked with a committee to create a streamlined process for reconciling patient home medications at admission.

Implemented nursing processes to delegate, provide, and coordinate patient treatment according to the plan of care. Educated patients using the 'teach-back' method to prepare them for discharge, performing direct patient care.

Graduated with a Bachelor of Arts in Psychology. This program provided a foundational understanding of human behavior and mental processes.

Completed an Associate Degree in Nursing. This program equipped me with essential nursing skills and knowledge for patient care.

Earned a Bachelor of Science in Nursing. This advanced my nursing expertise and prepared me for diverse healthcare settings.