Dependable Utilization Review Registered Nurse, bringing over 10 years expertise in healthcare industry. A seasoned nursing professional offering proven clinical knowledge, strong interpersonal skill and extensive knowledge. Specializing in Case Management, medical-surgical, rehabilitation and home health care. Considered hardworking and driven. with excellent reputation for working with multidisciplinary teams to create care plans focused on patient's needs and goals.
Skills
Discharge planning coordination
Interpersonal and written communication
EMR / EHR
EPIC
MCG guidelines
Microsoft office
Work History
Utilization Review Registered Nurse, 01/2018 to Current Capital Health – Levittown, PA,
Perform concurrent review, discharge planning and care coordination in accordance with approved departmental guidelines.
Perform admission reviews based on medical necessity utilizing Milliman Care Guidelines MCG and medical policies.
Facilitated workgroup meetings with interdisciplinary team such as physicians, pharmacist, social worker and other case managers to find effective solutions to members' issues.
Perform ongoing assessments to evaluate member's needs, working with multidisciplinary team to develop, initiate, manage and modify individualized plans of care.
Evaluate medical guidelines and benefit coverage to determine appropriateness of services within scope of plan. And make referrals for appropriate services
Utilize critical thinking skills and work in fast paced environment with minimal supervision.
Maintain accurate records of all members, adhere to company policy in safeguarding HIPPA and release of Patient health information PHI.
As team lead, assist other staff with UM process questions and help management in coordinating day to day activities.
Train new staff and act as mentor, providing resources and communicate company goals. In addition, inspire and motivate staff.
Registered Nurse, Medical-Surgical Unit, 06/2012 to 02/2019 Gritman Medical Center – Moscow, ID,
Utilized EPIC to document data related to patient care such as medications, interventions and patient responses.
Managed patients recovering from medical or surgical procedures, including facilitating wound care, ostomy care, pressure ulcer prevention and pain management.
Managed care from admission to discharge, including patient assessments, care planning, health educations and discharging support to provide comprehensive care to over 5 patients daily.
Educated patients, families and caregivers on diagnosis and prognosis, treatment options, disease process and management and lifestyle options.
Supervised clinician and non clinicians as charge nurse by delegating tasks to maintain continuum of care.
Precepted nurses, providing guidance on unit functions and individual roles, hospital policies and procedures and nursing best practices.
Provided direct patient care, stabilized patients and determined next course of action.
Administered medications and treatment to patients and monitored responses while working with healthcare teams to adjust care plans.
Performed ongoing assessments to evaluate medical needs, working with multidisciplinary team to develop, initiate, manage and modify individualized plans of care.
Used first-hand knowledge and clinical expertise to advocate for patients under care and enacted prescribed treatment strategies.
Facilitated therapeutic communication, conflict resolution and crisis intervention by redirecting negative behaviors and helping patients regain or improve coping abilities to prevent further disability.
Educated family members and caregivers on patient care instructions.
Administered different therapies and medications in line with physician orders and treatment plan.
Home Care Registered Nurse, 12/2010 to 06/2012 Trinity Health Corporation – Queensbury, NY,
Coordinated and collaborated with various multidisciplinary teams to coordinate care and promote patient safety and health.
Educated and supervised patients and family members regarding prevention strategies, self-care techniques and nursing care needs.
Administered medications and treatment to one patient per day and monitored responses while working with healthcare teams to adjust care plans.
Provided skilled, timely and level-headed emergency response to pediatric patients on ventilator
Education
Bachelor of Science: Nursing, Expected in The University Of Texas At Arlington - Arlington, TX GPA:
Associate of Science: Nursing, Expected in Paris Junior College - Paris, TX GPA:
Diploma, Vocational Nursing: Nursing, Expected in Tyler Junior College - Tyler, TX, GPA:
Certifications
Certified Case Manager CCM 2020 to 2025
Milliman Care Guidelines Certification MCG 2018 to 2021
Certified Rehabilitation Registered Nurse - [2015 to 2020
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