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ur concurrent review nurse resume example with 8+ years of experience

Jessica Claire
Montgomery Street, San Francisco, CA 94105 609 Johnson Ave., 49204, Tulsa, OK
Home: (555) 432-1000 - Cell: - resumesample@example.com - : - -
Summary

Registered Nurse with talent for customer service and love of Nursing profession. Strong knowledge of Concurrent Review and Dialysis that requires knowledge in all areas of Nursing spectrum. Communicative and team-oriented with proficiency in Microsoft office and Dialysis equipment that takes incredible amount of skill . Proven history of fostering commitment to productivity and quality of care to meet team, individual and management objectives.

Skills
  • Financial document review
  • Records reviews
  • Relationship review process
  • Financial data reviews
  • Policyholder request reviews
  • Reviewing test results
  • Contract reviewing
  • Reviewing benefits
  • Document review skills
  • Conducting reviews
Experience
06/2019 to 10/2020
UR/Concurrent Review Nurse Aetna Medicaid Administrators LLC City, STATE,
  • Contacted insurance carriers to obtain authorizations for services delivered to patients.
  • Referred cases to secondary review for failure to meet MCG criteria.
  • Reviewed patient admissions to determine medical necessity as directed by MSG criteria.
  • Kept detailed documentation on all utilization reviews by using Microsoft office.
  • Collaborated with Physicians, Social workers, Case Management, Management in group meetings to identify issues and find cost-effective solutions.
  • Determined medical necessity and cost-effectiveness of services through utilization review processes.
  • Remained up-to-date on various benefit plans, medical policies and state-specific clinical guidelines or criteria.
  • Collaborated with providers to obtain required clinical information, supporting prior authorization determinations and individual inquiries.
  • Applied medical criteria and clinical judgement to researched cases to evaluate and establish determinations.
03/2016 to 05/2019
Charge Registered Nurse/Dialysis Registered Nurse American Renal Associates Holdings Inc. City, STATE,
  • Collected and analyzed patient data before, during and after treatments and documented all information in patient medical records.
  • Counseled patients on infusions and possible side effects to promote treatment compliance.
  • Monitored patient status during treatment and reported variances and adverse reactions to care teams.
  • Administered Peritoneal dialysis as well as IV push, oral, subcutaneous, IV infusion and intramuscular medications.
  • Administered medications to 48 -/+ patients per day as directed by individual treatment plans.
  • Initiated and documented ongoing quality assurance activities to improve patient care and safety.
  • Coordinated with healthcare team to establish, enact and evaluate patient care plans.
  • Maintained adequate unit supplies to meet expected patient demands.
  • Trained and mentored new RNs on best practices, hospital policies and standards of care.
  • Treated patients using pharmacological and non-pharmacological treatment modalities to address various disorders, diseases and injuries.
  • Addressed unit staff concerns, including staffing ratios, resource management, allocation of responsibilities and optimized workload management.
  • Stocked clinical workstations and procedure rooms with necessary supplies.
  • Observed strict safety measures, including checking medication dosages before administration to patients.
  • Utilized computerized Resource and Patient Management System (RPMS) and Electronic Health Record (EHR) system.
  • Counseled caregivers and families on end-of-life planning and educated on patient care options.
  • Developed and adapted individualized treatment plans according to patient recovery goals.
  • Delivered quality care and comfort to patients with heart failure, pulmonary hypertension, pulmonary embolisms and end-stage renal disease.
08/2014 to 01/2016
RN/Acute Dialysis Registered Nurse VAMC HAMPTON City, STATE,
  • Coordinated care with physicians and other clinical staff to prepare for treatment, carry out interventions and enhance continuum of care to deliver comprehensive services.
  • Administered medications, tracked dosages and documented patient conditions.
  • Monitored and recorded patient condition, vital signs, recovery progress and medication side effects.
  • Performed blood and blood product transfusions and intravenous infusions to address patient symptoms or underlying causes.
  • Delivered direct patient care, including stabilizing patients and identifying treatment options.
  • Boosted clinical accountability and reduced discrepancies by coordinating with other stakeholders to develop and roll out new flow sheet and forms for dialysis treatment.
  • Managed and provided leadership to help staff with direct and indirect patient care and telemetry monitoring.
  • Addressed unit staff concerns, including staffing ratios, resource management, allocation of responsibilities and optimized workload management
  • Assessed patient health needs by reviewing and tracking EKG readings to address telemetry readings and quickly inform teammates on stability or acuity changes.
  • Conducted post-op reviews, tracked patients' vitals and monitored fluids to reach optimal care targets.
  • Collected lab specimens, ordering and interpreting diagnostic tests and lab results.
  • Administered medications and assisted in diagnostic testing for HIV-positive patients.
  • Administered oral, intramuscular and IV medications to patients and monitored responses.
  • Administered scheduled medications and therapies intravenously, rectally, orally, subcutaneously and via intramuscular injections while overseeing pain management plans.
03/2012 to 08/2014
RN Charge Nurse Dialysis American Renal Associates Holdings Inc. City, STATE,
  • Monitored patient status during treatment and reported variances and adverse reactions to care teams.
  • Administered Peritoneal dialysis as well as IV push, oral, subcutaneous, IV infusion and intramuscular medications.
  • Counseled patients on infusions and possible side effects to promote treatment compliance.
  • Administered medications to 48 +/- patients per day as directed by individual treatment plans.
  • Initiated and documented ongoing quality assurance activities to improve patient care and safety.
  • Collected and analyzed patient data before, during and after treatments and documented all information in patient medical records.
  • Delivered quality patient care from admission to discharge through direct supervision of all nursing and ancillary staff.
  • Coordinated with healthcare team to establish, enact and evaluate patient care plans.
  • Monitored and recorded patient condition, vital signs, recovery progress and medication side effects.
  • Maintained strict patient data procedures to comply with HIPAA laws and prevent information breaches.
  • Administered scheduled medications and therapies intravenously, rectally, orally, subcutaneously and via intramuscular injections while overseeing pain management plans.
  • Participated in continuing education programs and workshops to enhance training and nursing knowledge.
Education and Training
Expected in 06/2006 to to
Associate of Applied Science: Registered Nurse
J. Sargeant Reynolds Community College - Richmond, VA,
GPA:
Activities and Honors

Prior to deciding to become a Nurse, I spent several years volunteering for Hospice of Virginia and local Nursing Home facility and a love for the geriatric population.

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Resume Overview

School Attended

  • J. Sargeant Reynolds Community College

Job Titles Held:

  • UR/Concurrent Review Nurse
  • Charge Registered Nurse/Dialysis Registered Nurse
  • RN/Acute Dialysis Registered Nurse
  • RN Charge Nurse Dialysis

Degrees

  • Associate of Applied Science

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