Abdel Jawhar, RN
Margate,FL
Summary
Utilization Management Registered Nurse offering excellent communication and good judgement. Known for having great rapport with providers, social workers, clinical reviewers, and care coordinators. Experience includes nearly 2 years of utilization review (DME, surgery, medication authorizations) as well as over 2 years of nursing school clinical experience in offering comprehensive patient care in medical/surgical, intensive care, emergency, pediatric, and psychiatric environments. Work well with diverse patient population and foster trusting relationships to improve patient outcomes. Efficiently coordinates with healthcare professionals to advance patient care.
Overview
5
5
years of professional experience
1
1
Certification
Work History
Utilization Review Nurse
Aetna
Virginia, IL
03.2022 - Current
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Performed prior authorization review of services requiring notification.
- Submitted cases to medical directors for criteria failures and helped facilitate resolutions and approvals.
- Advocated for and strived to protect health, safety and rights of patient.
Utilization Management Nurse
Centers Plan For Healthy Living
Margate, Florida
05.2021 - 03.2022
- Authorized medically necessary services in coordination with the care management department.
- Reviewed care management documentation and outcomes evaluation to ensure members received services and support required to meet psychosocial, educational and health care needs.
- Ensured that the services required for the plan of care is met in partnership with the person centric process which may include his/her significant other, primary caregiver, the primary and attending physicians, and various other providers and support involved in the member’s care.
- Provided utilization review for pre-authorization, concurrent and discharge reviews and post service review.
- Applied medical necessity guidelines based on appropriate criteria
- Utilized knowledge of community resources and the member’s benefit structure.
- Interacted with providers and facilities in a professional, respectful manner.
- Recognized quality of care issues and escalated the issues appropriately.
- Assisted Physicians, Nurses, Social Workers, and Patients with the Appeals and Grievances process following denial determinations.
- Assisted members with the coordination of services from various settings as appropriate.
- Participated in other meetings as requested.
- Supervised and maintained all utilization review documentation through CaseTrakker.
- Submitted cases to Medical Directors for criteria failures and helped facilitate resolutions and approvals.
Pharmacy Technician
CVS Health
Livonia, MI
09.2015 - 09.2016
- Processed over 150 prescriptions per day in busy pharmacy achieving decreased customer wait times and maintaining excellent customer satisfaction.
- Performed various pharmacy operational activities with strong commitment to accuracy, efficiency and service quality.
- Solved customer problems in-person or over telephone by providing assistance with placing orders, navigating systems and locating items.
- Assisted patients in minimizing medical expenses by recommending generic alternative prescription medications.
- Calculated dosage, filled prescriptions and prepared prescription labels with absolute accuracy.
- Communicated instructions to patients or caregivers.
- Communicated with prescribers to verify medication dosages, refill authorizations and patient information.
- Helped pharmacist clear problematic prescriptions and address customer questions to keep pharmacy efficient.
Pharmacy Technician
Walgreens
Canton, MI
08.2014 - 06.2015
- Trained new-hires into the various departments within the pharmacy such as order processing, doctor calls, and decoding prescription codes.
- Transcribed prescriptions and patient information from referral documentation into SCRIPTPRO pharmacy software system.
- Obtained refill prescriptions for continued treatment.
- Managed calls to and from internal and external customers for clarification of prescriptions, requesting further information or to inform of delay in services due to lack of needed information.
- Transferred Prescription Call Backs to Pharmacist in order to complete intake/referral of patient for services.
Pharmacy Technician
CVScaremark
Canton, MI
03.2012 - 12.2013
- Scheduled pharmacy staff and managed specific allotted hours per staff member.
- Assisted pharmacists at Flu Clinics.
- Managed drug inventory, including controlled (C-II) medications, pseudoephedrine products, diabetic supplies and OTC products.
- Processed insurance claims, including large national insurance brands such as BlueCross BlueShield, Kaiser, Aetna, Cigna and United.
- Maintained patient records and medication records for yearly audits.
Education
Associate Degree in Nursing - Nursing
Schoolcraft College
Livonia, MI05.2020
Nursing Assistant Training Program - Nursing Assistance
Schoolcraft College
Livonia, MI2017
Skills
- Interpersonal and written communication
- Documentation and reporting
- Physician consultations
- EMR / EHR
- Patient consultation
- Oxygen saturation standards
- Family planning services education
- Strong clinical judgment
- Patient and family advocacy
- Chronic disease management
Clinical Rotations
- Completed 7 clinical rotations at Providence Park Hospital in Novi, Regency at Canton Nursing Home, Huron Valley Sinai Grace of Commerce, Beaumont Trenton, Beaumont Dearborn, Harper Hospital, and Children's Hospital of Michigan.
- Maintained comfort and safety of each patient through careful monitoring and knowledge application.
- Worked alongside experienced nursing professionals to learn new procedures.
- Observed patient care outcomes including patient feedback to facilitate ongoing quality care.
- Administered and monitored medications, noted side effects, and reported issues to senior staff.
- Updated patient charts using Citrix with data such as medications to keep records current, and support accurate treatments.
Certification
- Registered Nurse License (Michigan): 4704365072 Exp: 11/19/2022 (processing renewal)
- Registered Nurse License (Multistate-Compact): RN9559681 Exp: 07/31/2024
- Registered Nurse License (New York) 821465 Exp: 06/30/2024
- Certification in Basic Life Support (BLS) Exp: 02/2023
Timeline
Utilization Review Nurse
Aetna
03.2022 - Current
Utilization Management Nurse
Centers Plan For Healthy Living
05.2021 - 03.2022
Pharmacy Technician
CVS Health
09.2015 - 09.2016
Pharmacy Technician
Walgreens
08.2014 - 06.2015
Pharmacy Technician
CVScaremark
03.2012 - 12.2013
Associate Degree in Nursing - Nursing
Schoolcraft College
Nursing Assistant Training Program - Nursing Assistance
Schoolcraft College
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