Karen Herbst
Green Lane
Summary
Experienced appeals nurse consultant prepared for this role. Excellent track record in commercial standard and expedited appeals for members and providers. Skilled in review of clinical records, regulatory compliance, and resolution of appeals. Known for reliability, flexibility and team collaboration.
Overview
35
35
years of professional experience
Work History
Appeals Nurse Consultant
Aetna
10.2022 - Current
- Review and resolve clinical standard and expedited appeals
- Apply appropriate clinical criteria, policies and state mandates
- Consult with medical directors and external clinical support as required
- Part of expedited intake team responsible for determining if appeal meets expedited requirements
Case Manager
Aetna
12.2012 - 10.2022
- Telephonic case management for Medicare members
- Developed and implemented comprehensive case management plans to address client needs and goals
- Educated clients on available programs, benefits, and services, empowering them to make informed decisions about their care needs
- Collaborated with multidisciplinary teams to address client needs
Home Care RN
Grand View Hospital
06.2002 - 12.2012
- Reduced hospital readmission rates by closely monitoring patients' health status and promptly addressing concerns or changes in condition
- Provided skilled nursing interventions such as wound care and catheter management for diverse patient populations
Home Care RN
Penn Care At Home
07.2000 - 06.2002
- Provided skilled nursing interventions such as wound care and catheter management for diverse patient populations
Registered Nurse
Lankenau Hospital
06.1990 - 07.2000
- Cardiothoracic ICU nurse (4 years)
- Combined medical and surgical ICU nurse (4 years)
- General medical-surgical nurse (2 years)
Education
Bachelor of Science - Nursing
Bloomsburg University of Pennsylvania
Bloomsburg, PA05-1990
Skills
- Case documentation
- Problem-solving
- Time management
- Attention to detail
- Team collaboration
- Adaptability and flexibility
- Records review
- Reliability
- Critical thinking
- Effective communication
Timeline
Appeals Nurse Consultant
Aetna
10.2022 - Current
Case Manager
Aetna
12.2012 - 10.2022
Home Care RN
Grand View Hospital
06.2002 - 12.2012
Home Care RN
Penn Care At Home
07.2000 - 06.2002
Registered Nurse
Lankenau Hospital
06.1990 - 07.2000
Bachelor of Science - Nursing
Bloomsburg University of Pennsylvania
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