Priscilla Eusebio

Experience

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  Department of Veterans Affairs, VA Southern Nevada Healthcare System

  Apr 1982 - Jul 2009

  Retired RN - VA Southern Nevada Health Care System

  PAST EXPERIENCE:* Exchange Visitor Nurse-Moss Rehabilitation/Albert Einstein Medical Center, Philadelphia, PA* Worked as a Staff Nurse, St. Joseph Hospital, Philadelphia, PA and Philadelphia VA Hospital, Philadelphia, PA from 1970 to 1978* Rehabilitation Specialist, General Rehabilitation Services, Philadelphia, PA from 1978 to 1979* Medial Review Specialist, Professional Standard Review Organization Philadelphia , Conducted Continued Inpatient Stay and Retrospective Reviews of Medicare recipient patients using the Interqual Criteria of Intensity of Service, Severity of Illness and Discharge Screening Criteria. from 1979 to 1981* Medical Review Specialist, Blue Cross of Philadelphia. Developed Philadelphia Blue Cross Continued Inpatient Stay Program for Appropriateness of Inpatient Stay and Level Of Care.from 1981 to 1985* Quality Healthcare Improvement Consultant. Provided consulting services for companies like Kemper Insurance Subsidiaries and Physicians' Case Management Services. Mentored clients on Medicare, Medicaid and Worker's Compensation Programs' Regulations, Medical Bill Audit on 'Unbundled, Upcoded and Fragmented Bills' from 1986 to 1990* Health Science Specialist, Miami Department of Veterans Affairs. Conducted Collaborative Case Management with the Non-Service Connected Veteran's Insurance Companies. Outcome: Medical Care Cost Recovery of veteran's VA Health Care Services from 1990 to 1994* Utilization/Case Management Program Manager. Developed the Utilization and Cost Containment Programs of Southern Nevada Healthcare System to include, Medical Bill Audits of Contracted Physician's Bills to justify ICD9-CM & CPT codes. Conducted 5 to 50% Audit of questionable unbundled & upcoded bills from 1994 to 2009Utilization & Case Management of Veterans' Outsourced Community Services. Medical Bill Audit of Fragmented/Up-coded & Unbundled Medical Bills.Contracted Specialty Community Services for Veterans' care. Show less

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  RETIRED

  Jul 2009 - now

  MY OWN BOSS