Joanna Marie Dolot

• Evaluated existing resources and developed new strategies to maximize effectiveness in addressing identified gaps.
• Streamlined processes to increase efficiency, enabling teams to complete tasks on time
• Working with company’s leadership to define project objectives, processes, policies, procedures and rules
• Collaborating with Team Leads, Training and Quality Team to discuss common errors and make an action plan
• Validating misdirects and two- touch cases
• Assisting Nurse Reviewers regarding process workflow inquiries
• Conducting huddles with the Team to discuss Workflow Errors and give Tips and reminders on how to prevent recurrence of the errors
• Addressing Medical Directors, Auth loaders and Processors inquiries on nurse’s workflow process

• Facilitated accurate decision-making in complex cases (Inpatient/Outpatient services) by consulting with medical specialists when needed.
• Conduct UM retrospective reviews of In-network facilities and determine appropriateness of treatment.
• Review service requests to ensure compliance with applicable criteria, medical policy and member's eligibility and contracts.
• Utilize client specific criteria sets (e.g Milliman/MCG guidelines), applicable client specific medical policy and client clinical guidelines for decision-making to either approve or summarize and route to client’s Medical Directors for review.
• Accurately routes cases to client medical staff for further review when a service or admission does not meet medical necessity, place of service or benefit criteria.
• Responsible for conducting medical management review which require the review of clinical information against client specific but excludes denial determinations
• Ensure member access to medically necessary, quality healthcare in a cost-effective setting according to contract consult with clinical reviewer and/or U.S licensed medical directors to ensure medically appropriate, high quality, cost-effective care throughout the medical management process.

• Doing outbound calls to Diagnostic Facilities to offer assistance with their certification for their Diagnostic Imaging services
• Creating and processing tickets for facility type update, provider assistance, facility record updates/merging, and corrective action manual review for the submitted documents
• Assisting Providers/Office Managers/Credentialing Specialist in completing their registration and assessment for their Diagnostic imaging certification
• Assisting Providers/Office Managers/Credentialing Specialist, on how to pass their failed assessment
• Encouraging diagnostic facilities to participate on our program and be certified for claims reimbursement
• Updating facility records according to their facility type and update
• Reaching out to clients who are leaving online comments or e-mails with their inquiries
• Document appropriate facility information in every reach out to and from the clients

• Setting up Employees claims in accordance of client’s directives
• Determines and analyses eligibility of employees for leave of absence
• Responsible for denial and approval of claims for disability and leave of absence
• Monitoring complete Medical Certification/Verbal Certification on clients/claimants’ system
• Responsible for confirmation of Employees Return to work date
• Documents appropriate information into the clients’ system

• Doing Inbound/Outbound calls for patients/doctors office regarding diabetic and other medical supplies
• Follow up Prescription from Doctor’s offices for our Diabetic and other medical supplies
• Assisting patient’s inquiries regarding status of their medical supplies
• Assuring for a complete Prescriptions from the Doctor’s office

• 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.
• 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.
• Assess patient's needs upon admission (from outpatient/ICU/OR)
• Monitor and record Vital signs and pain level on regular interval or as needed
• Carrying out Doctors orders
• Bedside care, Tubes and drain care, post-OP care and wound care
• Doing blood extractions to be sent to laboratory for testing
• Assist Doctors in bedside wound care or dressing
• Provide health teaching to patients and families
• Proper documentation patients’ care plan and procedures

June 16, 2011 to May 15, 2013

Position: Intensive Care Unit Staff Nurse

• Assess patients’ individual care needs and prepare a care plan in order to meet those needs
• Attach patient to Cardiac monitor and record patients’ physical status such as vitals, Glasgow coma scale and cardiac activity
• Respond immediately to life saving situations
• Collect specimen for laboratory results and report immediately for critical results
• Provide Healthcare needs of critically ill patient's
• Medication administration
• Carry out Doctor's orders for medication, testing or procedures
• Act as a patient advocate and provide appropriate support for the family members

March 16, 2010- June 15, 2011

Position: Medical-Surgical Staff Nurse

• Identify patients’ actual and potential problems by conducting proper and complete assessment
• Interact with patient to determine their physical and psychological needs
• Medication administration
• Maintain safety and standard precautions
• Document all patient’s records and procedures
• Provide health education to both patient and relatives

March 2009- February 2010

Position: Volunteer Nurse

• Assist doctors and other nurses in taking patient’s vital signs and other basic bedside care
• Collaborate with other Staff Nurses in efficient delivery of patient care and maintaining calm environment in caring for the patients.
• Transport patient and equipment and assisting nurses in diaper changing for bedridden patients.