Utilization Review Nurse Resume Example
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UTILIZATION REVIEW NURSE
Professional Summary
Dependable Utilization Review Nurse promoting over ten years of expertise in healthcare industry. Knowledgeable in admissions and stay reviews. Considered to be a critical thinker and a problem-solver due to dynamic patient care planning and understanding of Medicare guidelines. Known for having great rapport with providers and insurance carriers.
Licenses
Alaska RN License - # 33727
Work History
Johns Hopkins Bayview Medical Center - Utilization Review NurseBaltimore , MD11/2018 - Current
- Submitted cases to Keppro for criteria failures and helped facilitate resolutions and approvals.
- Supervised and maintained all utilization review documentation through EPIC and Interqual.
- Obtained authorizations from multiple insurance carriers for various levels of care.
- Facilitated workgroup meetings with Micosoft Teamss to find effective solutions to issues.
- Performed admission reviews based for medical necessity based upon INTERQUAL specification.
- Served as subject matter resource, providing information related to Admission, Inpatient, Observation, Outpatient situations.
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Supported or performed clinical appeals through Peer to Peer facilitation and Follow up with providers and submissions to billing team.
- Performed triage on all incoming patients and determined severity of injuries and illnesses.
- Delivered high level of quality care to diverse populations while overseeing patient admission and triaging based on acuity and appropriate department admission.
Kootenai Medical Center - RN Case ManagerClarkston , WA04/2017 - 11/2018
- Educated family members and caregivers on patient care instructions.
- Maintained highest levels of patient satisfaction, generating referrals to maintain productivity levels for Inpatient rehabilitation unit.
- Managed care from admission to discharge, including patient assessments, care planning, health educations and discharging support to provide comprehensive care to over twenty patients daily.
- Addressed disruptions in patient care, including delays in discharge, postponed procedures and discharge equipment unavailability.
- Communicated with healthcare team members to plan, implement and enhance treatment strategies.
- Partnered with physicians, social workers, activity therapists, nutritionists and case managers to develop and implement individualized care plans and documented all patient interactions and interventions in electronic charting systems.
- Applied nursing expertise to meet needs of Adult patients in challenging Alaskan environment.
Christiana Care Health System - Critical Care Registered NurseMilford , DE08/2014 - 04/2017
- Operated critical care equipment to keep patients stable and promote recovery.
- Delivered outstanding patient care in Adult critical care units.
- Assisted patients initially and every 15 minutes to 1 hour over a 12 hour shift to maintain current understanding of conditions and presentations.
- Counseled patients and families on treatments and care options, including discharge and home care instructions.
- Delivered top-notch care exceeding department, hospital and Joint Commission standards.
- Responded rapidly to critical codes to coordinate stabilization treatments and restore vital functions.
- Documented work in EPIC and updated patients' charts with orders and observations.
- Completed diagnostic tests and patient assessments to evaluate treatment progress.
- Administered medications to treat patients' symptoms and address underlying disease progression.
- Protected critically ill patients from unnecessary risks by limiting visitors, using proper PPE and using strong infection control procedures.
- Managed needs of chronically ill and acute patients with well-coordinated treatment strategies.
- Worked with intubated and ventilated patients, monitoring and reporting on conditions to maintain stats within optimal levels.
- Personalized bedside care and interactions based on cultural backgrounds of different patients.
- Facilitated therapeutic communication, conflict resolution and crisis intervention by redirecting negative behaviors and helping patients regain or improve coping abilities to prevent further disability.
- Triaged patients and delegated treatment needs to qualified staff and specialized departments.
- Assessed and managed various patient treatments for numerous patient diagnoses from sepsis to acute respiratory distress.
- Conducted ongoing monitoring and evaluations of behaviors and conditions, and updated clinical supervisors with current information.
- Quickly responded to situations impacting safety and security to unit, actualizing crisis prevention interventions to control and de-escalate situations.
- Implemented interventions, including medication and IV administration, catheter insertion and airway management.
- Trained new nurses in proper techniques, care standards, operational procedures and safety protocols to optimize performance and safety.
- Trained and coached new employees on protocols and best practices to promote ideal patient outcomes.
- Delivered high level of quality care to diverse populations while overseeing patient admission and triaging based on acuity and appropriate department admission.
Medstar Health - RN, Critical CareNorthwest Washington , DC03/2009 - 11/2013
- Evaluated healthcare needs, goals for treatment and available resources of each patient and connected to optimal providers and care.
- Delivered outstanding care to patients with various diagnoses and managed care from treatment initiation through to completion.
- Administered medications and treatment to patients and monitored responses while working with healthcare teams to adjust care plans.
- Trained new nurses in proper techniques, care standards, operational procedures and safety protocols to optimize performance and safety.
- Delivered medications via oral, IV and intramuscular injections, monitoring responses to address new concerns.
- Worked with interdisciplinary healthcare team to develop, implement and manage care plans, ensuring inclusion of patients' individual needs.
- Documented all patient interactions and interventions in EPIC EMR, including physical and psychological assessments, care plans, treatment and observations.
- Educated family members and caregivers on patient care instructions.
- Provided skilled, timely and level-headed emergency response to critically-ill patients.
- Performed triage on all incoming patients and determined severity of injuries and illnesses.
Skills
- Physician consultations
- Documentation and reporting
- Interpersonal and written communication
- Discharge planning coordination
- Patient and family advocacy
- EMR / EHR
- Case Management
- Strong clinical judgment
Education
05/2007North Arkansas CollegeCity, StateAssociate of Science: Nursing
06/2017Western Governors UniversityCity, StateBachelor of Science: Nursing
06/2020Western Governors UniversityCity, StateMaster of Science: Nursing
- Member of Sigma Theta Tau International
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Resume Overview
School Attended
- North Arkansas College
- Western Governors University
Job Titles Held:
- Utilization Review Nurse
- RN Case Manager
- Critical Care Registered Nurse
- RN, Critical Care
Degrees
- Associate of Science : Nursing
Bachelor of Science : Nursing
Master of Science : Nursing
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