Jeremy Williams

Conducted initial, concurrent, and retroactive stay reviews using InterQual, CMS, and hospital policies. Collaborated with physicians and internal teams to ensure appropriate level of care and managed payor notifications and documentation.

Performed clinical tasks on patients on the regular Pediatric floor and the Pediatric Special Care Unit. Served as a staff nurse and an intermittent acting charge nurse.

Practiced direct patient care for patients in their homes. Served on the Ethics Committee and the Corporate Compliance Committee.

Practiced direct patient care in a Level 1 trauma center emergency department. Provided high-acuity care and managed critical patients.

Practiced direct patient care across multiple specialties, including emergency department trauma levels 1-5 and cardiac care. Managed diverse patient acuity levels in various clinical settings.

Practiced direct patient care in a Level 2 trauma center emergency department. Provided critical care and managed diverse patient populations.

Reviewed and investigated Medicare fraud, waste, and abuse through medical record and coding review. Investigated medical professionals regarding billing and coding for Medicare claims and corrected aberrances. Conducted onsite reviews and interviews.

Practiced clinical nursing across a wide range of specialties including emergency departments, chronic pain, cardiac step-down, recovery, endoscopy, ophthalmology, cardiology, rehabilitation, and home health. Gained experience with multiple electronic health record systems and provided extensive patient and caregiver education.

Performed prior authorizations for healthcare services and made coverage determinations on concurrent and retrospective hospitalizations. Conducted utilization review, utilization management, and discharge planning. Performed quality assurance, referral management, and process improvement management.

Performed reviews and made decisions regarding requests for medical services through complex software. Conducted prior authorizations, discharge planning, quality assurance, referral management, and process improvement. Utilized InterQual, coding systems (CPT, ICD-9), and Microsoft Office.

Performed concurrent stay reviews of inpatient hospitalizations and utilization review using complex software. Conducted discharge planning, quality assurance, and referral management. Utilized Milliman, coding systems (CPT, ICD-9), and Microsoft Office.

Performed concurrent stay reviews of inpatient hospitalizations and utilization review using complex software. Conducted discharge planning and quality assurance. Utilized InterQual, coding systems (CPT, ICD-9), and Microsoft Office.

Managed complex medical and psychosocial issues for elderly patients in a PACE program. Served on committees for financial rates and skill development. Utilized complex medical software like EPIC and Microsoft Office.

Authored appeal letters for encounter-specific denials, working closely with adjusters and claims personnel. Collected data and clinical information post hoc from various service providers. Used evidence-based studies and collaborated with third-party entities for assistance in appealing cases.

Remained at home to provide full-time care for infant daughter. Managed daily household operations and child-rearing responsibilities.

Conducted initial and concurrent stay reviews using InterQual, Milliman Care Guidelines, CMS, and hospital policies. Collaborated with physician advisors and providers to ensure appropriate level of care prior to discharge. Facilitated communication between payors and the facility to guide providers and case management teams on throughput.

Managed concurrent and retroactive denials, authored appeal letters for various payors, and facilitated peer-to-peer reviews. Collaborated with third parties for legal escalations and utilized platforms including EPIC, InterQual, and Milliman CareGuidelines.

Completed coursework focused on advanced nursing principles and practices. Gained expertise in evidence-based care and healthcare systems.

Studied fundamental nursing concepts and clinical skills. Prepared for entry-level registered nurse practice.