Neshanta Malone

Collects, analyzes and evaluates clinical documentation received using established criteria to determine appropriateness of clinical decisions. Uses clinical knowledge, communication skills and independent critical thinking skills towards interpreting criteria, policies and procedures to provide the best and most appropriate treatment care or services for members.

Collaborated with patients and their families to implement rehabilitation treatment plans and discharge needs. Consulted with community systems and insurance companies to facilitate crisis management, advocacy, and follow-up. Performed utilization review, financial management, and reimbursement for services.

Identified and treated health disorders among students and provided instruction in health maintenance and disease prevention. Developed policies, procedures, and work standards for the school health program. Prepared health records for supervisors, the board of education, and the health department.

Reviewed medical records to determine medical necessity and performed retrospective reviews to distinguish inpatient from observation services. Utilized review criteria from Milliman, Interqual, and Medicare guidelines for medical appropriateness. Audited medical records and bills for accuracy and medical necessity, identifying underpayments and overpayments.

Provided direct patient care to pediatric and adult patients in acute settings, performing TPE exchanges per protocol. Delivered direct patient and family teaching on central venous access devices, hemodialysis, and considerations for hemodynamically unstable patients. Evaluated patient lab work daily and assisted MDs and NPs in decision-making for hemodialysis patients.

Performed concurrent utilization review on a patient-by-patient basis using Interqual and CMS guidelines for medical necessity. Coordinated multiple aspects of care to ensure patient success, collaborating with social workers and physicians to facilitate patient needs. Provided psychosocial management and addressed individual, familial, and environmental needs for adult and pediatric patients.

Supervised LPNs and hemodialysis technicians within the hemodialysis unit. Participated in interdisciplinary rounds and implemented necessary changes. Provided direct patient and family teaching on the care of central venous access devices.

Supervised LPNs and CNAs for the East wing of the nursing center. Participated in interdisciplinary meetings, supervisor meetings, and implemented necessary changes. Served as an educator and resource for staff, performed specialty admissions, and involved the interdisciplinary team in this process.

Served as a case manager, liaison, educator, and resource for interdisciplinary healthcare team members, patients, and families for TPN/VAD. Case managed specialty patient admissions, transfers, and discharges for both adults and pediatric patients. Assessed Medicare patients going home with TPN to ensure guideline compliance and served as a preceptor for students.

Supervised LPNs and technicians in the hemodialysis unit. Provided patient and family teaching on the care of central venous access devices and special considerations for unstable patients. Evaluated lab work and assisted physicians in direct patient care.

Responsible for providing direct patient care in the Intensive Care Unit and medical surgical unit. Supervised LPNs and student nurses in the intensive care setting.