Nicole Peattie
Campbell
Summary
Accomplished RN Case Manager and Clinical Utilization Review and Appeal Coordinator at El Camino Hospital, adept in multitasking and organization, and known for exceptional decision-making skills. Reduced hospital readmission rates significantly, ensuring optimal patient outcomes through effective case management and appeals. Excelled in team collaboration and problem-solving, enhancing patient satisfaction and financial health.
Overview
19
19
years of professional experience
1
1
Certification
Work History
Clinical Utilization Review and Appeal Coordinator
El Camino Hospital
11.2023 - Current
- combined clinical, business and regulatory knowledge and skill to reduce financial risk and exposure caused by concurrent and retrospective denial of payment for services provided.
- Reviewed and validatee admission status of surgical admissions, verifies procedure against the Inpatient Only List and Inter-Qual Criteria.
- Educated Physicians and facilitated obtaining the correct admission status, ensured that the appropriate notification letters are issued, reviewed concurrent denials and provided insurance reviews,
- Pursued, analyzed and remained up to date on data regarding all medical necessity denials.
- Collaborated with physicians, case managers, Hospital Billing Office staff and payers to appeal denials.
- Insured a functional denial appeals process, including measuring denial and appeal activity, monitoring for patterns and trends, and reporting the outcomes of these activities as requested.
RN Case Manager
El Camino Hospital
12.2005 - Current
- Provided emotional support to patients coping with chronic illness or end-of-life decisions, fostering resilience during difficult times.
- Managed complex cases involving multiple comorbidities, requiring close monitoring and coordination of various healthcare services.
- Collaborated closely with physicians to develop individualized treatment plans, supporting optimal patient outcomes.
- Educated patients and families on available community resources, facilitating access to necessary support services.
- Enhanced patient care by developing comprehensive care plans and coordinating with interdisciplinary healthcare teams.
- Reduced hospital readmission rates through effective case management and patient education on self-care techniques.
- Served as a key liaison between patients, families, and healthcare providers, fostering open communication and trust among all parties involved in the care process.
- Coordinated care conferences with interdisciplinary team members, ensuring all perspectives were considered in the development of comprehensive treatment plans.
- Managed support services and fostered communication among social workers, therapists, hospital staff, and patients.
- Advocated for patients'' rights and preferences, working diligently to align care with individual values and goals.
- Conducted thorough assessments of patients'' needs, enabling more accurate diagnoses and targeted interventions.
- Streamlined discharge planning processes, ensuring a smoother transition for patients back to their homes or other facilities.
- Educated patients and caregivers on healthcare protocols and processes.
- Improved patient satisfaction scores by providing timely follow-ups and addressing concerns promptly.
Education
Bachelor of Science - Nursing
San Jose State University
San Jose, CA12-1997
Skills
- Multitasking and organization
- Customer service
- Data entry
- Decision-making
- Work Planning and Prioritization
- Problem-solving
- Time management
- Clear communication
- Team collaboration
- Task prioritization
Certification
Case Management Certification from CCMC
(expires 5/31/2028)
Timeline
Clinical Utilization Review and Appeal Coordinator
El Camino Hospital
11.2023 - Current
RN Case Manager
El Camino Hospital
12.2005 - Current
Case Management Certification from CCMC
(expires 5/31/2028)
Bachelor of Science - Nursing
San Jose State University
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