Summary
Overview
Work History
Education
Skills
Affiliations
Certification
Timeline
Generic

Adaobi Ezeokon MSN, RN

GEORGIA

Summary



Dedicated Utilization Review Nurse with 3 years of experience in healthcare settings. Expertise in assessing medical records for appropriateness, efficiency, and quality of healthcare services. Skilled in ensuring compliance with insurance regulations and healthcare policies. Seeking to leverage clinical knowledge and analytical skills to contribute effectively to a dynamic healthcare organization.

Overview

3
3
years of professional experience
1
1
Certification

Work History

Utilization Review Nurse

Stars Of Hope
02.2021 - Current
  • Performed utilization review activities, including precertification, and retrospective reviews according to guidelines.
  • Determined the medical necessity of requests by performing first level reviews using approved evidence based guidelines/criteria.
  • Answered Utilization Management directed telephone calls; managing them in a professional and competent way.
  • Referred cases to reviewing physician when the treatment request did not meet necessity per guidelines, or when guidelines were not available.
  • Conducted and documented rate negotiations with out of network providers, utilizing appropriate reimbursement methodologies.
  • Identified and referred potential cases to Disease Management and Case Management appropriately for proper follow up.

Utilization Management Nurse

Augusta University Medical Center
03.2022 - 05.2024
  • Participated in quality improvement initiatives to enhance the overall standard of care within the organization.
  • Enhanced patient care by conducting comprehensive assessments and implementing appropriate interventions.
  • Contributed to team success by consistently meeting productivity goals while maintaining high-quality standards in job performance.
  • Increased efficiency in case management documentation by maintaining organized records and utilizing electronic medical record systems.
  • Reduced hospital readmissions through effective discharge planning and coordination of post-discharge care.
  • Provided exceptional patient advocacy through active listening, empathy, and support during challenging situations.
  • Ensured compliance with regulatory guidelines by staying current on industry standards and participating in ongoing education opportunities.

Education

Master of Science - Nursing

Augusta University
Augusta, Georgia
2021

Skills

  • HIPAA Compliance
  • Clinical assessment
  • Medicaid knowledge
  • Quality Improvement
  • Records analysis
  • Utilization review
  • Documentation And Reporting
  • Insurance Verification
  • Chart Review
  • Clinical Review

Affiliations

  • American Case Management Association (ACMA)
  • American Nurses Association (ANA)

Certification


  • Registered Professional Nurse License (MultiState/Compact)
  • BLS (Basic Life Support) Certification

Timeline

Utilization Management Nurse

Augusta University Medical Center
03.2022 - 05.2024

Utilization Review Nurse

Stars Of Hope
02.2021 - Current

Master of Science - Nursing

Augusta University

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Adaobi Ezeokon MSN, RN