rn prior authorization coordinator resume example with 11+ years of experience
JessicaClaire
, , 609 Johnson Ave., 49204, Tulsa, OK100 Montgomery St. 10th Floor
H: (555) 432-1000
C:
resumesample@example.com
Date of Birth:
India:
:
single:
:
Summary
Organized Registered Nurse with ten years of experience in a clinical/office setting. Excellent typist, collaborator and office coordinator with proven history of patient care in multiple settings. Dedicated to efficiency and maintaining workflow.
Contacted insurance carriers to obtain authorizations, notifications and pre-certifications for patients.
Created master spreadsheet to record procedures, denials and approvals.
Scheduled patient appointments, diagnostic specialty appointments, tests and procedures.
Maintained files for referral and insurance information, entering referrals into system.
Updated reference materials with Medicare, Medicaid and third-party payer requirements, guidelines, policies and list of accepted insurance plans.
Coordinated resolutions for issues and appealed denied authorizations.
Applied knowledge of Medicare, Medicaid and third-party payer requirements utilizing on-line eligibility systems to verify patient coverage and policy limitations.
Clarified patient inquiries and questions to update patient account information in computer system.
Performed detailed medical reviews of prior authorization request, following established criteria and protocols.
Answered 20-30 average daily phone calls to schedule appointments and address patient inquiries.
Contacted other medical facilities to confirm medical histories and prevent inaccurate diagnoses.
Answered phone calls to provide assistance, information and medical personnel access to maximize office efficiency.
Managed physician calendar, including scheduling patient appointments and procedures.
Scheduled and confirmed patient appointments for diagnostic, surgical and consultation services.
Created and maintained accurate and confidential patient files according to regulatory mandates.
Oversaw delivery of high-quality, cost-effective care with focus on patient safety, comfort and dignity.
Monitored delivery of patient care for entire unit, including implementation of care plans.
Answered patient questions and provided take-home materials for further information.
Maintained comprehensive patient care plans and monitored staffs' implementation of physician's orders.
Administered oral, intramuscular and IV medications to patients and monitored responses.
Collaborated with physicians and nursing staff to deliver quality care.
Monitored and recorded patient condition, vital signs, recovery progress and medication side effects.
Treated patients by administering various types of medications and therapies.
Immunized patients against influenza and pneumonia to protect vulnerable populations from serious illnesses.
Built and maintained excellent rapport with patients and loved ones.
Administered injections, medications and wound care according to needs.
Imparted medical, operational and patient care knowledge to junior nurses to maximize performance and quality of team operations.
Coordinated care with physicians and other clinical staff to prepare for treatment, carry out interventions and enhance continuum of care to deliver comprehensive services.
Conducted patient assessments and diagnostic tests to provide physician with important patient health information.
Used facility EMR system to update patient records, transmit prescriptions and transfer files.
Trained and mentored new RNs on best practices, hospital policies and standards of care.
Educated patients, caregivers, and families on diagnoses, treatment and disease prevention.
Monitored patient status and treatment progress, reporting observations to physicians.
Administered prescribed medications and started intravenous fluids to address patient symptoms and underlying etiologies.
Precepted and mentored new staff, graduate RNs and ancillary staff.
Presented information regarding diagnoses, conditions, illnesses, treatments and outcomes to patients and families in clear, easy-to-understand terminology.
Assessed and assisted patients with diverse range and comorbid chronic diagnoses, including chronic obstructive pulmonary disease (COPD), asthma, congestive heart failure (CHF), cerebrovascular accidents (CVA), diabetes, and sepsis.
Coordinated and performed patient admissions, transfers and discharges.
Supported physicians and consultants with tests and procedures.
Led patient care team and served as Nurse in Charge of health center.
Built and maintained strong working relationships between nursing department and other discipline.
Documented and evaluated effectiveness of care plans and interventions.
Performed IV infusions, intramuscular injections, peritoneal dialysis, IV pushes and oral subcutaneous.
RN Unit Manager, 02/2010 - 06/2015 Windsor Care Center – City, STATE,
Counseled patients and caregivers, providing emotional, psychological and spiritual support.
Offered clinical leadership and oversight to 45-bed long term care unit, including daily scheduling, tasking and administration.
Guided therapeutic communication, conflict resolutions and interventions by deflecting undesirable behaviors to assist patients with developing and amplifying coping skills.
Trained new RN hires and ancillary staff members to meet patient service goals, champion standards of care and improve patient overall satisfaction.
Consistently assessed and evaluated patients' health needs by coordinating across medical disciplines to create, implement and modify personalized care plans.
Completed and maintained personal Performance-Based Development System (PBDS) standards to show consistent clinical competency and sound judgment.
Used facility EMR system to update patient records, transmit prescriptions and transfer files.
Oversaw patient admission and discharge processes to coordinate efficient movements and related paperwork.
Worked with management to identify and implement initiatives to increase nursing staff retention, morale and satisfaction.
Coordinated with clinical staff to keep patients updated and informed on care issues, including discharge delays, equipment inaccessibility and procedure postponements.
Supervised ancillary staff of on-call nurses, including scheduling shifts, delegating assignments and monitoring quality of care.
Met training objectives by instructing new and prospective nursing staff in clinical skills and organizational procedures.
Completed daily chart audits and assessed clinical records to verify accuracy, evaluate performance against goals and check for appropriate education of patients and families.
Improved patient outcomes and quality of care by determining and suggesting changes to processes.
Instructed patients, caregivers and families on diagnoses, treatment options and self-management to maintain continuity of care.
Facilitated patient flow during emergency situations, directing evacuations, admissions and transfers.
Addressed unit staff concerns, including staffing ratios, resource management, allocation of responsibilities and optimized workload management.
Education and Training
Associate of Science: , Expected in 12/2009 - Eastern Kentucky University - Richmond, KY, GPA: Status -
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