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Velisiwe Nkomo, RN, BSN

18959 Dallas Pkwy #2614, Dallas TX 75287

Mobile Phone: 2142232425
To acquire a position in nurse case management working with the Medicare and/or
Medicaid programs that will allow me to fully utilize my education and skills.
Pediatric Homecare Nurse
Jun 2009 - Current
Epic Med staff | Dallas, TX
Provide acute care to pediatric ventilator dependent patients in their home per
M.D orders
Administer medications per M.D orders
Coordinate patient's plan of care with doctors and other service providers.
Case Manager
Feb 2008 - May 2009
United Healthcare | Dallas, TX
Provided case management and utilization review for a caseload of 500 Medicaid m
Coordinated various services for members based on qualification criteria and med
ical necessity.
Reviewed and authorized requests for medical supplies or services per TMHP guide
Conducted telephonic assessments of members every 3 months and updated plan of c
are accordingly.
Medical Reviewer
Feb 2007 - Feb 2008
TrailBlazer Healthcare Enterprises | Dallas, TX
Reviewed clinical documentation of appealed denied Medicare claims based on medi
cal necessity.
Provided decision for claims in appeals and re-determinations using DRG's and IC
D-9 codes
Communicated with clients via e-mail, phone and mail pertaining to appeals.
Health Information Manager
Nov 2005 - Jan 2007
LifeCare Center of Plano | Plano, TX
Reviewed clinical medical records for accuracy of services related to clinical s
tandards of practice and care
Performed monthly chart audits as scheduled by the compliance leadership team
Ensured confidentiality of medical information as related to the HIPAA regulatio

Staff Nurse
Jan 2005 - Nov 2005
LifeCare Center of Plano | Plano, TX
Provided care to patients in acute care unit.
Received and transcribed orders from M.D's
Assigned tasks to nursing assistants and ensured provision of holistic nursing c
Bachelor of Science in Nursing Degree (BSN)
University of Oklahoma | Oklahoma City, OK
Graduated with a nursing GPA of 3.80
Vocational Nursing Certificate (LVN)
NCTC | Gainesville, TX
Graduated with a nursing GPA of 3.75
Member of the Phi Theta Kappa