Alexandra hyde-rivers
Severn,MD
Summary
Dynamic Utilization Review Nurse with extensive experience at White Oak Medical Center, skilled in InterQual criteria and documentation. Proven track record in enhancing patient care through effective collaboration and quality improvement initiatives. Strong communicator dedicated to optimizing resource allocation and ensuring compliance with healthcare regulations.
Overview
34
34
years of professional experience
1
1
Certification
Work History
Utilization Review Nurse
White Oak Medical Center
01.2020 - Current
- Conducted comprehensive utilization reviews to ensure adherence to clinical guidelines and regulatory standards.
- Collaborated with healthcare providers to evaluate treatment plans and recommend appropriate interventions.
- Analyzed patient data to assess medical necessity and optimize resource allocation effectively.
- Led interdisciplinary meetings to discuss case outcomes and share best practices among nursing staff.
Manager Medical Surgical Unit
White Oak Medical Center
01.2009 - 01.2020
- Oversaw daily operations, ensuring compliance with healthcare regulations and standards.
- Led cross-functional teams to enhance patient care and operational efficiency.
- Developed and implemented strategic initiatives to improve service delivery and patient satisfaction.
- Mentored staff on best practices in patient management and medical protocols.
- Analyzed performance metrics to identify areas for process improvement and cost reduction.
- Facilitated training sessions to enhance team skills and knowledge in healthcare services.
- Collaborated with executive leadership on budgeting, forecasting, and resource allocation strategies.
- Managed and motivated employees to be productive and engaged in work.
- Maintained professional, organized, and safe environment for employees and patrons.
- Enhanced customer satisfaction by resolving disputes promptly, maintaining open lines of communication, and ensuring high-quality service delivery.
Emergency Room Registered Nurse
St Agnes Hospital
02.1998 - 01.2009
- Administered critical care treatments to stabilize patients in high-pressure emergency situations.
- Collaborated with multidisciplinary teams to develop and implement patient care plans efficiently.
- Assessed patient conditions through comprehensive evaluations and vital sign monitoring.
- Led training sessions for new nursing staff, enhancing team competency and performance standards.
- Mentored junior nurses on best practices for emergency response and patient management techniques.
- Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing conditions.
- Facilitated clear communication with patients, families, and colleagues, fostering a positive environment in a fast-paced setting.
- Provided emotional support to patients and families during crisis situations, helping them cope more effectively with difficult circumstances.
Emergency Room Manager
United States Army
01.1992 - 01.2009
- Led emergency department operations, ensuring efficient patient flow and high-quality care standards.
- Developed and implemented protocols to enhance patient safety and reduce wait times.
- Trained and mentored nursing staff, fostering professional development and teamwork.
- Collaborated with multidisciplinary teams to streamline emergency response procedures.
Education
Bachelor of Science - Nursing
Tuskegee University
Tuskegee, AL05-1991
Skills
- InterQual criteria
- Documentation and reporting
- Utilization review
- Records analysis
- Clinical assessment
- Interpersonal and written communication
- Outpatient care
- Palliative care
- Patient care plans
- Physician consultations
- Prior authorization
- HIPAA compliance
- Discharge planning coordination
- Insurance verification
- Quality improvement
- Inpatient care
- Healthcare regulations
- Managed care
- Discharge planning
- Home health care
- Medicaid
- Utilization management
- Medical coding
- Needs assessment
- Medicare
- Plan of care support
- Patient transfers and transitions
- Compliance procedures
- Telephonic nursing
- Milliman guidelines
- Performing assessments
- Communication
Certification
ACLS AND BLS
EMERGENCY NURSE CERTIFICATION
MS NURSE CERTIFICATION
Timeline
Utilization Review Nurse
White Oak Medical Center
01.2020 - Current
Manager Medical Surgical Unit
White Oak Medical Center
01.2009 - 01.2020
Emergency Room Registered Nurse
St Agnes Hospital
02.1998 - 01.2009
Emergency Room Manager
United States Army
01.1992 - 01.2009
Bachelor of Science - Nursing
Tuskegee University