Angie Jacob
Dawsonville
Summary
At Northeast Georgia Medical Center, I spearheaded initiatives that enhanced departmental productivity by over 30%, leveraging my expertise in utilization review and HIPAA compliance. My adeptness in fostering teamwork and employing critical thinking significantly improved patient care quality and streamlined operational efficiency. Utilization review professional with strong background in healthcare management and patient care coordination. Skilled in assessing treatment plans, ensuring compliance with regulations, and optimizing resource use. Highly collaborative team player focused on achieving results and adapting to changing needs. Reliable and flexible, with strong analytical and communication skills. Experienced with medical record analysis and review processes, ensuring compliance with healthcare standards. Utilizes robust problem-solving skills to support effective patient care coordination. Track record of maintaining detailed documentation and fostering team collaboration to achieve optimal outcomes. Knowledgeable administrative professional with expertise in medical records management, coding and data entry. Proven ability to review and document clinical data, ensuring accuracy and compliance. Well-versed in ICD-10, CPT and HCPCS coding systems.
Overview
7
7
years of professional experience
Work History
Rehab Utilization Review
Northeast Georgia Medical Center
01.2022 - Current
- Enhanced overall departmental productivity by assisting in training new staff members on utilization review processes, policies, and procedures.
- Promoted organizational goals for cost containment by assisting in identifying opportunities to reduce unnecessary expenditures while maintaining high-quality patient care standards.
- Maintained up-to-date knowledge of industry trends, best practices, and regulatory requirements to ensure accurate and relevant guidance during utilization review activities.
- Boosted accuracy in clinical decision-making by providing detailed analysis of medical records for physicians and nursing staff involved in utilization review processes.
- Contributed to positive patient outcomes by identifying and addressing potential gaps in care through ongoing monitoring of the medical records.
- Supported timely discharge planning by collaborating with case management teams to identify appropriate post-acute care options for patients.
- Ensured compliance with regulatory guidelines by conducting thorough audits of medical records and utilization review reports.
- Contributed to efficient department operations by maintaining organized files and record-keeping systems for easy access and retrieval.
- Reduced instances of denied claims due to insufficient documentation by meticulously verifying the accuracy of all submitted materials during the utilization review process.
- Streamlined data entry processes, ensuring timely submission of all required documentation for utilization review activities.
- Improved patient care quality by efficiently reviewing and analyzing medical records for utilization review purposes.
- Strengthened relationships with external partners like insurance companies through proactive communication about authorizations, denials, appeals, or other related issues.
- Assisted in reducing hospital readmissions through diligent monitoring of patient progress and outcomes.
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Facilitated workgroup meetings with medical personnel to find effective solutions to issues.
- Devise or identify solutions for irregular requests and issues.
- Upheld HIPAA regulations and standards for protecting patient information.
- Performed regular quality and validation assessments on patient data to verify accuracy.
- Performed software updates, upgrades and data backups.
- Conducted quality improvement and customer satisfaction surveys to evaluate patient care.
PPS Coordinator
Northeast Georgia Medical Center
01.2018 - 01.2022
- Maintained accreditation status by adhering to established guidelines set forth by regulatory agencies such as CMS and The Joint Commission.
- Strengthened interdepartmental relationships through active participation in interdisciplinary meetings, promoting communication and collaboration among healthcare professionals.
- Optimized resource allocation, prioritizing high-risk patients for comprehensive intervention services.
- Promoted a positive work environment through fostering teamwork and providing ongoing guidance to PPS coordinators and support staff.
- Increased overall efficiency by creating standardized documentation templates that simplified record-keeping procedures for nursing staff.
- Established a culture of accountability within the department, regularly reviewing individual performance metrics and addressing areas requiring improvement promptly.
- Managed department operations efficiently, ensuring all required deadlines were met while maintaining a high degree of accuracy in documentation and reporting.
- Streamlined workflow processes by developing efficient tools and resources for staff utilization, ultimately increasing productivity.
- Achieved cost savings without compromising quality of care through careful monitoring of budgetary constraints and resource allocation decisions.
- Ensured timely completion of MDS assessments, leading to accurate reimbursement claims for the facility.
- Developed comprehensive training programs for new employees, resulting in decreased onboarding timeframes and increased competency levels among new hires.
- Collaborated closely with clinical teams during treatment planning sessions; facilitated open lines of communication between various healthcare disciplines, resulting in more cohesive and patient-centric care plans.
- Created performance benchmarks that drove continuous improvement efforts throughout the organization, leading to enhanced service delivery outcomes across all departments involved in patient care management process.
- Enhanced patient care by coordinating and evaluating interdisciplinary plans of care for patients.
- Improved care quality by conducting regular audits to ensure adherence to regulatory requirements and standards.
- Continuously sought opportunities for professional development by attending industry conferences, workshops, and seminars; applied new knowledge to enhance the effectiveness of the PPS Coordinator role within the organization.
- Communicated with healthcare team members to plan, implement and enhance treatment strategies.
- Led teams in driving successful patient outcomes by prioritizing standard of care and best practices.
Rehab Registered Nurse
Northeast Georgia Medical Center
01.2018 - 01.2018
- Utilized critical thinking skills to prioritize nursing interventions based on patients'' acuity levels and individual needs.
- Conducted thorough patient assessments to identify changes in condition, promptly notifying physicians and initiating appropriate interventions when necessary.
- Administered medications safely according to established guidelines while closely monitoring for side effects or adverse reactions requiring intervention.
- Enhanced patient satisfaction by providing compassionate, holistic nursing care that addressed physical, emotional, and spiritual needs.
- Assisted in the training and mentorship of new nursing staff members, contributing to a positive work environment and high-quality patient care.
- Prevented the spread of infections by consistently adhering to strict infection control protocols and educating patients on proper hygiene practices.
- Collaborated with interdisciplinary teams to develop comprehensive treatment plans for complex patients with multiple comorbidities.
- Served as a preceptor for nursing students during their clinical rotations, providing valuable real-world experience and guidance to foster professional growth.
- Skillfully managed challenging patient situations using de-escalation techniques, crisis intervention strategies, and therapeutic communication skills.
- Improved patient outcomes by implementing evidence-based nursing interventions and individualized care plans.
- Participated in ongoing professional development opportunities to stay current on best practices in nursing care and emerging trends in healthcare delivery.
- Promoted a culture of safety within the healthcare facility by participating in quality improvement initiatives, identifying potential hazards, and advocating for best practices in nursing care delivery.
- Provided support for patients'' families during difficult medical decisions or end-of-life care, serving as a liaison between the healthcare team and loved ones.
- Advised patients and caregivers of proper wound management, discharge plan objectives, safe medication use, and disease management.
- Contributed to interdisciplinary team meetings by presenting relevant clinical data about patients'' progress toward reaching established goals of care.
- Facilitated patient transitions between different levels of care, ensuring continuity of services and minimizing disruptions in treatment plans.
- Implemented evidence-based fall prevention strategies, resulting in a significant decrease in patient falls within the unit.
- Demonstrated expertise in wound management techniques resulting in accelerated healing times for patients with complex wounds or pressure injuries.
- Streamlined medication administration processes for increased safety and accuracy during busy shifts.
- Collaborated with interdisciplinary teams to develop comprehensive care plans for complex cases.
- Educated family members and caregivers on patient care instructions.
- Documented treatments delivered, medications and IVs administered, discharge instructions, and follow-up care.
- Communicated with healthcare team members to plan, implement and enhance treatment strategies.
- Managed patients recovering from medical or surgical procedures.
- Evaluated patient histories, complaints, and current symptoms.
- Explained course of care and medication side effects to patients and caregivers in easy-to-understand terms.
- Monitored patient reactions after administering medications and IV therapies.
- Offered exceptional care and support to individuals recovering from acute incidents and dealing with chronic conditions.
- Used first-hand knowledge and clinical expertise to advocate for patients under care and enacted prescribed treatment strategies.
- Observed and documented patient factors such as diets, physical activity levels, and behaviors to understand conditions and effectively modify treatment plans.
- Implemented care plans for patient treatment after assessing physician medical regimens.
- Promoted patient and family comfort during challenging recoveries to enhance healing and eliminate non-compliance problems.
- Quickly responded to situations impacting safety and security to unit, actualizing crisis prevention interventions to control and de-escalate situations.
- Delivered high level of quality care to diverse populations while overseeing patient admission and triaging based on acuity and appropriate department admission.
- Facilitated therapeutic communication, conflict resolution and crisis intervention by redirecting negative behaviors and helping patients regain or improve coping abilities.
- Equipped patients with tools and knowledge needed for speedy and sustained recovery.
- Participated in evidence-based practice project implementation, nursing competency development and nursing simulation activities.
Education
Associate of Science - Nursing
Northland Community And Technical College
East Grand Forks, MN01-2016
Skills
- HIPAA compliance
- Insurance verification
- Healthcare regulations
- Utilization review
- Ethical standards
- Quality improvement
- Records analysis
- Documentation and reporting
- Utilization management
- Compliance procedures
- Teamwork and collaboration
- Problem-solving
- Time management
- Attention to detail
- Problem-solving abilities
- Multitasking
- Reliability
- Excellent communication
- Critical thinking
- Organizational skills
- Adaptability and flexibility
- Decision-making
- Patient confidentiality
- Self motivation
Accomplishments
At NGHS, we were the second company to use the Epic rehab module. I worked with the NGHS IT team and also the Epic builders to ensure the highest quality documenting on an electronic health record. In working directly with the Epic build team, many of our documents became the "foundation" of the rehab portion of Epic
Affiliations
- Association of Rehabilitation Nurses
- Georgia Hospital Association
I won the NGHS all star award for excellence in compliance and regulatory standards twice.
NGHS recognizes staff who go above and beyond to help ensure accuracy and compliance. My work with Epic and CMS helped ensure that we had fewer denials and maximum reimbursement.
Timeline
Rehab Utilization Review
Northeast Georgia Medical Center
01.2022 - Current
PPS Coordinator
Northeast Georgia Medical Center
01.2018 - 01.2022
Rehab Registered Nurse
Northeast Georgia Medical Center
01.2018 - 01.2018
Associate of Science - Nursing
Northland Community And Technical College
Similar Profiles
Tiffanie ShafferTiffanie Shaffer
Registered Nurse at Northeast Georgia Medical CenterRegistered Nurse at Northeast Georgia Medical Center
Susan ChastainSusan Chastain
Travel Registered Nurse/Charge Nurse at Northeast Georgia Medical CenterTravel Registered Nurse/Charge Nurse at Northeast Georgia Medical Center
Janet McDuffieJanet McDuffie
Pre-surgical Testing Registered Nurse at Northeast Georgia Medical CenterPre-surgical Testing Registered Nurse at Northeast Georgia Medical Center