Health Advocate RN

Posted on: 2006-12-29

KAREN NAIDS, R.N., B.S.N CERTIFIED MEDICAL LEGAL NURSE CONSULTANT CERTIFIED CASE MANAGER 10 Ashwood Lane Plymouth Meeting, Pa. 19462 610-731-1125 KEY ATTRIBUTES 1 Practicing Registered Nurse for over 23 years 2 Significant clinical experience in many therapeutic areas 3 Excellent interpersonal skills 4 Long history of successful interactions with medical and legal professionals as well as patients and their families. 5 Certified Medical Legal Nurse Consultant 6 Certified Case Manager 7 Dependable 8 Quality focused PERSONAL HEALTH ADVOCATE 2005-PRESENT HEALTH ADVOCATE INC. I have been working as an advocate for patients/subscribers and their families with insurance challenges that range from appeals to assisting with pre-certifications and prescription problems. I have assisted people in working through the appeals process for a test or procedure, assisted them in obtaining information about their benefits and have been helping them navigate the complicated health insurance industry. I have written many letters to advocate in member\'s behalf, and have given out information and opinions concerning disease processes. I have also assisted members in making sure that they got their problems resolved in a timely fashion, and I helped direct them to the proper coverages and health care choices. I find and provide them with contact information for the healthcare providers that will provide them with the appropriate treatment. I also answered and helped to solve many benefit issues, including helping people understand their rights and the appeal process. I also triage calls from people with medical issues and help them decide what is the best way to proceed in their care. LEGAL NURSE CONSULTANT 2003 - Present I have been helping attorneys with their medical cases for the past five years. My duties as a Legal Nurse Consultant include helping attorneys to organize, and interpret medical records in order to help decide if there are deviations in the standard of care. I have been assisting attorneys to understand the medical terminology, and help them determine if their cases have merit. I also helped them to identify cases of medical record tampering and fraud. I have done a lot of research on topics specific to their cases to help them justify their positions. I have helped them provide the best case for their clients. I have worked on negligence cases, product liability, personal injury, and workmen compensation cases. I have provided detailed reports, and or time-lines, to help attorneys understand the flow of events of an incident in the hospital or office setting. I have reviewed many records, and offered my opinion of the incident, based on the information. I have interviewed clients and prepared them for deposition, and I have written interrogatories for depositions. I have helped to identify the appropriate expert for a case, and have also assisted to find that expert. A sample of my work product is available upon request, along with a letter of recommendation from two client-attorneys. CASE MANAGER July 2004 - June 2005 I was a Case Manager for Lawrence Memorial Hospital (New London, CT). I handled cases in all areas of the hospital, including the Emergency Room and I was the on-call case manager on the weekends. I managed many insurance issues and complex discharge planning for patients. Conversely, I’ve done many insurance audits for the hospital to help assure that patients are meeting insurance company criteria for hospital stays, and to ensure that the hospital will be paid. I have also handled a lot of quality management issues for the hospital. CAMP NURSE June-August 2005 I worked in a day camp that had 500 kids, and I was the camp nurse. I did a lot of first aid for the campers, which ranged in small cuts and bruises to broken legs and arms. We had to give out medications to the kids that needed them, and respond to any emergency, which happened frequently. We had to call parents if the incident warranted them to pick up their child. The children ranged in age from pre-school to teenagers. VISITING NURSE June 1992 – June 2005 My duties as a Visiting Nurse include patient assessment and monitoring, procedure education and training, and personal treatment of and caring for those individuals recently released from the hospital or rehabilitation center or referred by a physician. I instruct patients and family members on their prescription regimes, and I help them to manage their medical condition in the home environment. I teach patients about their specific condition and I assist them in disease management, diet, and safety. I perform numerous procedures that are ordered by the physician including monitoring vital signs, wound care, enemas, and tracheostomy care. I communicate and coordinate with other service to fit the patient’s needs, while following Medicare, Medicaid or private insurance guidelines. 6/2000 – 6/2005 V.N.A. of Southeastern Connecticut (Waterford, CT) 6/1999 – 6/2005 Utopia Home Care (New London, CT) 12/1997 – 12/1998 North Penn Visiting Nurse Association (Lansdale, PA) 6/1996 – 12/1998 Doylestown Hospital Home Care (Doylestown, PA) 3/1994 – 6/1995 Nursing Unlimited Inc. (Rockledge, PA) 12/1992 – 12/1994 Jeane’s Hospital Home Care (Philadelphia, PA) 6/1992 – 6/1997 Roxborough Memorial Hospital (Philadelphia, PA) HOME CARE COORDINATOR OF SKILLED NURSING UNIT 12/94 – 4/96 Roxborough Memorial Hospital, Philadelphia, PA As Home Care Coordinator for the 27-bed Skilled Nursing Unit, my primary responsibility was to coordinate all aspects of home health care upon the patient’s discharge. Some of these duties included arranging for skilled-nursing visits, physical therapy, or home health aid assistance. I also arranged for the delivery of hospital supplies and equipment as needed by the patient or ordered by the physician. I worked with family members to determine if there were any special needs and I made sure that patient safety was the top priority. I worked closely with insurance companies regarding payment or medical reimbursement. OSTEOPATHIC MEDICAL CENTER OF PHILADELPHIA, Philadelphia, PA 5/1989 – 6/1992 - Pool Nurse 6/1986 – 5/1989 - Staff Nurse, Surgical Short Procedure Unit 6/1984 – 6/1986 - Assistant Head Nurse, Oncology Unit 6/1983 – 6/1984 - Staff Nurse, Medical/Surgical Floor 12/1982- 1983- Rewrote the Diabetic Care Manual for the Hospital. EDUCATION Bachelor of Science in Nursing (1983) Pennsylvania State University, University Park, PA CERTIFICATIONS Fellow of Case Management Association Canyon College (2004) Certified Legal Nurse Consultant (Vicki Milazzo Institute, 2004) Member of Connecticut Bar Association Member of American Association of Legal Nurse Consultants, and Philadelphia Chapter of Legal Nurse Consultants Venipuncture Certified Advanced Physical Assessment Course (1998) Enrolling on a online MSN program LICENSES Registered Nurse State of Pennsylvania (1983-present) Registered Nurse State of Connecticut (1999-present) References available upon request