Wendy M. Russo
Kernersville,NC
Summary
Enthusiastic Registered Nurse proudly offering more than 14 years of experience in healthcare environments. Maintains positive relationships with internal and external partners. Remains polished and calm under extreme stress. Experienced professional offering proven clinical knowledge, natural interpersonal strengths, technical abilities and interdisciplinary collaboration with experience in marketing and project management. Quality-focused and efficiency-driven leader. Ready for new opportunity to apply exceptional nursing, marketing and project management skills here at CVS Health.
Overview
18
18
years of professional experience
Work History
Registered Nurse Educator
Aetna, A CVS Health
Work From Home, NC
05.2021 - Current
- Currently serve as department's project manager, managing all department projects in Asana
- Monitor progress of new Post-Acute UMs and provide formal evaluation upon completion of clinical placements while evaluating assessment and survey results
- Contribute educational and clinical expertise to help optimize training courses and boost student learning
- Use focused assessments, 1:1 feedback as well as constructive criticism to implement corrections to case review process to ensure accuracy and correctness
- Empower UMs by educating them to recognize process of utilizing criteria and developing relationships with providers to optimize Member's health outcomes in post-acute levels of care
- Coach underperforming students to help meet clinical objectives
Utilization Review Registered Nurse
Aetna, A CVS Health
Work From Home, NC
01.2017 - 05.2021
- NACMST Commercial UM Dedicated Unit 1/17 - 8/19
- Post Acute Team SE Region 8/19-6/21 Medicare/Commercial
- Performed medical necessity reviews to assess, facilitate and coordinate member's care; Conduct clinical reviews based on medical policies, CMS and MCG guidelines, medical necessity
- Served as unit's Subject Matter Expert/Nurse Educator for commercial case reviews
- Focused reviews on Member's medical needs, appropriateness & availability of in-network providers for Medicare and Commercial Members
- Worked with many other departments within company – SMEs, Network Management, CM, Medical Directors to ensure members healthcare needs
- Worked with both Medicare and Commercial acute, precert and post-acute reviews to maintain proficiency in Medicare and Commercial processes
- Collaborated with leadership on process changes and developing job aids for commercial workflows
Utilization Review Registered Nurse
Blue Medicare
Winston-Salem, NC
12.2014 - 12.2016
- Performed medical necessity reviews to assess, facilitate and coordinate Medicare member's care
- Served as member's advocate to promote and coordinate delivery of quality and cost-effective services
- Assessed for medical needs, appropriateness of level of care and contractual benefits using Medicare guidelines
- Communicated with providers to increase awareness of medical criteria, enhance Member's care
RN Supervisor - Case Manager
Hospice and Palliative Care Center
Winston Salem, NC
05.2014 - 11.2014
- Obtained doctor's orders for plan of care, therapies, medications, DME, report any changes in condition
- Extended marketing efforts to community by volunteering at Hospice sponsored events
- Assessed all admissions assigned through comprehensive assessment, implementation, and overall evaluation of individual patient needs, verify nursing & home health aide visits for Medicare/Medicaid billing
- Supervised team of 17 RNs, LPNs and HHAs working in weekend/on call department
- Supervised on-call center utilized by families of Hospice patients to call and gain access to nurses' advice, care request MD, SW, pastor visits
- Coordinated all scheduling for clinical staff for weekend/on call/triage departments, maintain monthly
- Made weekly/PRN visits to assigned patients to ensure symptom management while following plan of care
Assistant Director of Nursing
Liberty Wood Nursing Center
Thomasville, NC
07.2012 - 05.2014
- Assessed potential admissions/patient referrals at hospitals/homes based on presenting problems/ diagnoses
- Verified payer sources for potential admissions, obtain PASSAR and pre-authorizations
- Supervised LPNs, RNs and CNAs, under direction of Director of Nursing, overseeing scheduling, disciplinary actions and ongoing education
- Provided ongoing support for all admissions through comprehensive assessment, planning, implementation and overall evaluation of individual patient needs
- Coordinated all communication to insurance companies on admissions to facility
- Provided weekly status updates, doctor and nurses notes and progress reports to ensure continued insurance coverage
- Established and monitored infection control programs to provide safe, sanitary environment to prevent transmission of disease and infection
RN - Director of Admissions and Marketing
Liberty Wood Nursing Center
Thomasville, NC
03.2009 - 07.2012
- Responsible for increasing census from 78 to 103, exceeding budgeted monthly census
- Assisted in increasing CMI by assessing and admitting appropriate patients for skilled care
- Ensured daily maximum reimbursement rates for Medicaid, Medicare and Managed Care patients
- Assessed potential admissions/patient referrals at hospitals/homes based on presenting problems/ diagnoses
- Verified payer sources for potential admissions, obtain PASSAR and pre-authorizations
- Communicated all admission information to residents and families, completing all paperwork with residents/families/responsible parties
- Scheduled family meetings to discuss discharge planning, assist in setting up home health services for residents upon discharge
- Responsible for all marketing efforts to hospitals/doctor offices
- Responsible for knowledge of daily Medicaid rate as well as reimbursement from Medicare/Managed Care companies
- Reported monthly budgeted goals to administration via projections/reports regarding referrals and admissions to facility
- Extended marketing efforts to community by volunteering at local senior centers
- Designed all printed marketing materials, facility brochures, newsletters and monthly newspaper advertisements
- Coordinated all communication to insurance companies on admissions to facility
- Provided weekly status updates, doctor, nurses & progress notes to ensure continue coverage from insurance companies
Director of Marketing and Advertising
The Palladium, Times
Oswego, NY
01.2001 - 01.2006
- Managed advertising team of 7 sales representatives
- Handled account list of over 150 prospective clients
- Responsible for 40% of revenue accrued by advertising staff
- Responsible for estimating demand for corporation's products and services and discovering new market segments that would be interested in buying from company
- Responsible for creating and meeting yearly budget projections for monthly advertising revenue
- Responsible for setting advertising rates with corporate managers as well as monthly revenue goals for advertising representative
- Boosted brand awareness and generated leads while managing internal and external marketing campaigns and programs
Education
Bachelor of Science - Healthcare Management
Capella University
Minneapolis, MN2022
Associate of Applied Science - Nursing
Cayuga County Community College
Auburn, NY05.2008
Associate of Applied Science - Business Administration Marketing
Cayuga County Community College
Auburn, NY05.2003
Skills
- Microsoft SharePoint
- Nursing Consultation
- Managing Multiple Projects
- Project Development
- Technical Presentations
- Workflow Planning
- Performance Improvement
- Timely Project Completion
- Process Development and Implementation
- Leading Projects
- Continuous Improvement Projects
- Project Deadlines
- Project Goals and Milestones
- Budget Forecasting
- Product Development and Launch
Accomplishments
- Received multiple CVS Values in Action awards for assistance to other UMs throughout the year, including boosts from upper management/leadership
- Involved with Network Management on a UM level to ensure Members/Plan Sponsors needs were met
- Subject Matter Expert for Private Duty Nursing and Network Deficiency reviews for fully insured designated teams within unit
- 7+ years experience in a leadership role with multiple supervisor positions
- Extensive knowledge and training developed and provided to UM Staff, Senior Managers and Associate Managers on commercial products and processes, self-insured and fully insured, involved in commercial job aids and process changes
- Oversaw Enhanced Discharge Pilot Program for SE SRL Team
- Currently serving as Project manager for UM Nurse Education Department. Successful projects with tasks tracked in Asana include:
-Successful role out of curriculum development and training of new National AR/LTAC UM Team
-Managing Medicare OD Dismissal process project to educate entire market UM staff
-Managing The Role of the UM project to educate entire market CM
Timeline
Registered Nurse Educator
Aetna, A CVS Health
05.2021 - Current
Utilization Review Registered Nurse
Aetna, A CVS Health
01.2017 - 05.2021
Utilization Review Registered Nurse
Blue Medicare
12.2014 - 12.2016
RN Supervisor - Case Manager
Hospice and Palliative Care Center
05.2014 - 11.2014
Assistant Director of Nursing
Liberty Wood Nursing Center
07.2012 - 05.2014
RN - Director of Admissions and Marketing
Liberty Wood Nursing Center
03.2009 - 07.2012
Director of Marketing and Advertising
The Palladium, Times
01.2001 - 01.2006
Bachelor of Science - Healthcare Management
Capella University
Associate of Applied Science - Nursing
Cayuga County Community College
Associate of Applied Science - Business Administration Marketing
Cayuga County Community College
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