Abigail Mentor
Fort Worth,Texas
Summary
Newly licensed Registered Nurse with over 10 years of experience as a Licensed Vocational Nurse (LVN). Diverse clinical background in medical-surgical, pediatrics, obstetrics, and mental health, along with extensive work in utilization review. Expertise in patient care, healthcare evaluation, and utilization review, with a strong emphasis on efficiency and compliance. Committed to providing compassionate and patient-centered care while utilizing recent RN education to contribute to a dynamic healthcare team. Seeking a nursing role that combines clinical experience, utilization management skills, and newly acquired RN training to drive positive patient outcomes.
Overview
14
14
years of professional experience
1
1
Certification
Work History
Care Review Clinician-Utilization Management, Prior Authorization
Molina Healthcare
12.2020 - Current
- Assesses service requests for optimal outcomes, cost-effectiveness, and compliance with state and federal regulations
- Review prior authorization requests, ensuring timely processing within established timelines
- Collaborates with providers, requesting additional clinical information as needed to process requests efficiently
- Makes appropriate referrals to clinical programs and collaborates with multidisciplinary teams to align with Molina’s Care Model
- Adheres to utilization management policies, ensuring optimal outcomes for members while ensuring compliance with all guidelines
Case Management Analyst- Utilization Management
Cigna
03.2016 - 12.2020
- Conducted clinical reviews to ensure medical necessity and compliance with Medicaid StarPlus policies
- Verified member eligibility, benefits, and provider network participation, facilitating seamless transitions to in-network providers
- Evaluated clinical documentation using guidelines such as TMPPM, MCG, and MCP to assess the appropriateness of requested procedures and services
- Approved prior authorization requests based on medical necessity and escalated complex cases to the Medical Director
- Ensured adherence to utilization management policies and procedures, maintaining high service quality
Licensed Vocational Nurse (LVN)
Kindred
11.2010 - 03.2016
- Delivered compassionate, patient-focused care on a medical-surgical unit, ensuring patient safety and promoting healing in a fast-paced environment
- Assisted in patient assessment, medication administration, wound care, and progress documentation
- Monitored vital signs, managed patient symptoms, and collaborated with interdisciplinary teams to optimize patient outcomes
- Maintained accurate, compliant patient records in adherence to state and federal regulations
Education
Bachelor of Science in Nursing - Nursing
West Coast University
Richardson, TX12.2024
Licensed Vocational Nurse - undefined
Concorde Career College
Arlington, TX04.2010
Skills
- Clinical Documentation Review & Evaluation
- Critical Thinking & Problem Solving
- Time Management & Task Prioritization
- Utilization Management Software (InterQual, MCG)
- Cross-Functional Team Collaboration
- Clinical documentation
- Clinical assessment
- Multidisciplinary approach
- Therapeutic techniques
Certification
- Registered Nursing License – Texas Board of Nursing (Active through: November 2026)
- Basic Life Support (BLS) – American Heart Association (Renewal Date: August 2025)
CLINICAL ROTATIONS
- Medical Surgical III- Baylor Scott & White
- Public Health- Mission of Arlington
- Pediatrics-Children Hospital
- Obstetrics Methodist Richardson
- Medical Surgical II Texas Health
- Mental Health Nursing Millwood
- Medical Surgical I Encompass Hospital
Timeline
Care Review Clinician-Utilization Management, Prior Authorization
Molina Healthcare
12.2020 - Current
Case Management Analyst- Utilization Management
Cigna
03.2016 - 12.2020
Licensed Vocational Nurse (LVN)
Kindred
11.2010 - 03.2016
Licensed Vocational Nurse - undefined
Concorde Career College
- Registered Nursing License – Texas Board of Nursing (Active through: November 2026)
- Basic Life Support (BLS) – American Heart Association (Renewal Date: August 2025)
Bachelor of Science in Nursing - Nursing
West Coast University
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