Janice Lewis-webb
Mansfield,TX
Summary
To seek and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills.
Patient-oriented Nurse with 40 years of diverse experience in direct patient care, staff supervision and department operations. Skilled at multitasking and prioritizing patient needs and daily assignments. Offering expertise with Utilization Management specialty. Seasoned nursing professional offering proven clinical knowledge, natural interpersonal strengths and technical abilities. Knowledgeable about EMR charting, medication administration and interdisciplinary collaboration focused on optimizing patient care and support. Quality-focused and efficiency-driven leader. .
Overview
47
47
years of professional experience
Work History
First Level Nurse Reviewer
AIG
03.2018 - 12.2022
- Participated in quality assurance activities to identify areas requiring improvement within the organization''s policies, procedures, or workflows related to medical review processes.
- Maintained strict adherence to HIPAA regulations while handling sensitive patient information during the course of case evaluations.
- Facilitated accurate decision-making in complex cases by consulting with medical specialists when needed.
- Increased efficiency in case processing times by utilizing advanced software systems for case management and documentation purposes.
- Promoted a collaborative work environment by fostering strong relationships with colleagues, support staff, and healthcare providers to ensure optimal patient care.
- Improved patient outcomes by conducting thorough case reviews and offering clinical recommendations.
- Ensured compliance with regulatory requirements through meticulous documentation of cases, findings, and recommendations.
- Upheld professional nursing standards by participating in continuing education opportunities, maintaining licensure requirements, and adhering to the organization''s code of ethics.
- Reviewed and documented relevant information into data system applications.
- Determined and authorized services for patients in accordance with guidelines and regulations.
- Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
- Expedited claims resolution process through comprehensive analysis of medical records and determination of medical necessity for services rendered.
Utilization Precertification Nurse
Aetna Inc.
01.1991 - 01.2017
- Clinical review for approvals for high dollar intravenous therapy and medical equipment
- Utilization management of home health and outpatient therapy services
- Clinical review and predetermination for medical necessity and elective surgical procedures
- Knowledge and experience in managed care, Medicare and HMO insurance
- Clinical liaison with medical services and provider credentialing.
Medical personnel pool
03.1985 - 12.1991
- Contract staff relief medical surgical floor nursing
Intravenous therapy float post partum nurse
Tri City hospital
11.1988 - 12.1989
- Administered medications via oral, IV, and intramuscular injections and monitored responses.
- Performed accurate documentation of patient assessments, interventions, and outcomes in compliance with regulatory standards.
- Educated patients on disease management, self-care techniques, and wellness strategies to improve long-term health outcomes.
- Implemented infection control measures that significantly reduced hospital-acquired infections.
- Updated patient charts with data such as medications to keep records current and support accurate treatments.
- Monitored patient reactions after administering medications and IV therapies.
- Documented treatments delivered, medications and IVs administered, discharge instructions, and follow-up care.
Home health field nurse
Concepts of care
08.1981 - 08.1984
- Facilitated smooth transitions between healthcare settings by effectively coordinating with other healthcare professionals, including physicians, therapists, and social workers.
- Demonstrated strong clinical judgment in prioritizing patient needs during high-pressure situations.
- Served as a knowledgeable resource for family members seeking guidance on caregiving tasks, equipment usage, or community resources available to support them during challenging times.
- Promoted a safe home environment for patients by identifying potential hazards and recommending appropriate modifications.
- Educated patients and their families on proper medication administration, disease management, and self-care techniques.
- Reduced hospital readmissions by closely monitoring patients'' vital signs and promptly addressing any health concerns.
- Educated patients and families on disease processes, medications and treatments.
Medox
05.1978 - 10.1981
- Contract staff relief floor nursing and private duty home nursing
Emergency room nurse
Charlton Methodist Hospital
01.1976 - 05.1978
Education
No Degree - Insurance Adjuster
Innovative Adjusting Academy
Dallas, TX03.2022
No Degree - Associate Degree Nursing
El Centro College
Dallas, TX01.1990
Licensed Vocational Nursing -
Dallas Vocational Nursing
01.1976
Biology -
Bishop college
01.1970
Skills
- Utilization management
- Nursing Documentation
- Medical record review
- Vital signs monitoring
- HIPAA Compliance
- Patient Safety
- Clinical judgment
- Patient confidentiality
- Clinical assessment
- Healthcare regulations
- Utilization review
- HIPAA knowledge
- Policy compliance
Socialnetworks
https://indeed, https://Not interested, https://www.linkedin.com/in/deborah-phelps-a070bb212
Timeline
First Level Nurse Reviewer
AIG
03.2018 - 12.2022
Utilization Precertification Nurse
Aetna Inc.
01.1991 - 01.2017
Intravenous therapy float post partum nurse
Tri City hospital
11.1988 - 12.1989
Medical personnel pool
03.1985 - 12.1991
Home health field nurse
Concepts of care
08.1981 - 08.1984
Medox
05.1978 - 10.1981
Emergency room nurse
Charlton Methodist Hospital
01.1976 - 05.1978
No Degree - Insurance Adjuster
Innovative Adjusting Academy
No Degree - Associate Degree Nursing
El Centro College
Licensed Vocational Nursing -
Dallas Vocational Nursing
Biology -
Bishop college