Celebrating the Role of Nurses in Auditing

By March 26, 2019January 5th, 2021Celebrate Caring Community Well-being
Photo of Melissa Little

Independence Blue Cross (Independence) wants to Celebrate Caring by recognizing nurses who carry on the proud tradition of providing compassionate care, comfort, and security to all of us.  Do you know a nurse who delivers exceptional care and compassion every day? We want to hear about it. Submit your story by April 5 and Independence may reward that nurse through our Celebrate Caring campaign. As part of the Celebrate Caring campaign, we’re also highlighting some of our nurses and how they help enhance the health and well-being of our members and communities — beyond the beside — in their roles at Independence.

When you think of where you might find a nurse, do you only think of doctors’ offices and hospitals? You may be surprised to learn that many nurses work at Independence in several departments throughout the organization. From providing support to our members, to helping make clinical decisions, our nurses perform a variety of important work, including auditing!

Melissa Little is one of these nurses. As a delegation oversight specialist, she is responsible for taking a close look at how companies hired by Independence to provide services (known as “delegates” or vendors) are doing their jobs. She examines members’ case files to ensure accuracy and compliance with Independence’s policies and regulatory requirements and identifies any opportunities for improvement.

“After five years as a nurse in a hospital setting, I came to Independence,” she said. “My clinical knowledge is helpful in understanding vendors’ case files, and how they apply established criteria to members’ information to make determinations when there is a request for services.”

Delivering Quality Care to Our Members

Ensuring that our vendors are making appropriate decisions is an important part of delivering quality care to our members. As a nurse, it’s rewarding for Melissa to know that her work is touching the lives of our members.

“You don’t need to work in a hospital to make a difference,” she said. “You can still have a positive impact on someone’s life, even if you’re outside of the clinical setting.”

For Melissa, knowing that she is helping our members is especially important since she doesn’t interact with them directly in her current role.

“I miss interacting with patients, but I feel that by auditing case management files, I can still look out for the members’ best interests,” she said. “I always look for opportunities to improve our processes in order to better serve our members so that they receive the best possible care.”

Celebrating Nursing in Non-Traditional Settings 

As someone that has enjoyed a diverse career path in nursing, Melissa is excited that Independence is recognizing nurses, including those in non-traditional roles, through its Celebrate Caring campaign.

“Most people have no idea that Independence employs as many nurses as they do, or what their roles are,” she said. “I think this campaign will show just how valuable all nurses are, and it shows how much Independence values nurses.”

 

Veronica Serrano

About Veronica Serrano

Mother. Wife. TV junkie. Shopaholic. That’s me in a nutshell – outside of work. As a copywriter at IBX, I enjoy learning about the health and wellness topics that I write about and hope to incorporate more healthy habits into my daily life to give me the energy to keep up with my baby girl.