Alkileya Ransom
Fleming Island,FL
Summary
Dedicated Registered Nurse with over four years of comprehensive clinical and administrative healthcare experience, specializing in prior authorization, utilization review, and remote triage. Expertise in meticulously reviewing medical records for accuracy and facilitating authorization workflows while effectively communicating with payers and providers to ensure timely access to essential care. A robust background in critical care, oncology/hematology, transplant/urology, and long-term care complements a commitment to enhancing patient outcomes through efficient and compliant authorization processes. Eager to leverage skills and knowledge to contribute to CVS Health as a Utilization Review Nurse.
Overview
8
8
years of professional experience
1
1
Certification
Work History
Progressive Care Nurse
Baptist Medical Center South
07.2023 - Current
- Utilized digital health platforms to monitor real-time oxygenation trends and adjust high-flow oxygen protocols for patients in sub-acute settings
- interpreted real-time biometric data and EKG transmissions to identify and escalate critical changes, such as a-fib RVR or hypertensive crises, to on-site medical teams.
- Monitor patient individually postoperative cardiac catheterization with PICC, Cardioversion, EGD etc.
- Use HIPAA-compliant secure messaging platforms for quick communication with physicians regarding changes in a patient's condition, reducing the need for constant phone calls.
- Monitored and calibrated infusion rates for medications including nitroglycerin, amiodarone, diltiazem, heparin, and Lasix to maintain therapeutic effectiveness.
Medical Surgical Unit
Baptist Medical Center Clay
11.2024 - 09.2025
- Reviewed and analyzed care procedures in alignment with clinical benchmarks to ensure compliance with required care standards.
- Engaged with interdisciplinary teams to ensure effective discharge planning, promoting patient safety and optimizing hospital resource utilization.
- Reviewed clinical documentation meticulously to verify accuracy and consistency, ensuring compliance with all relevant regulations and payer requirements.
- Engaged with providers to ensure acquisition of required documentation supporting medical necessity authorization.
- Analyzed patient medical records and processed prior authorization requests for diagnostic treatments and medications, maintaining compliance with payer standards.
Progressive Care CNA
Baptist Medical Center South
07.2022 - 07.2023
- Conducted thorough evaluations of vital signs and maintained accurate documentation of results.
- Supported patients with essential daily care routines, ensuring their health and safety.
- Monitored and enforced safety protocols and hospital regulations to safeguard patient and staff well-being.
- Performed glucose assessments to maintain accurate health records and inform treatment decisions.
- Coordinated and supervised patient ambulation activities to ensure safety and comfort.
- Performed simple dressing changes, adhering to best practices for infection control and patient safety.
Transplant/Urology CNA
UF Health Shands Hospital
02.2019 - 01.2022
- Assisted in emptying drains including foley catheters, nephrostomy tubes, urostomy tubes, and JP drains. Helped maintain patient comfort and hygiene during drain management. Supported healthcare team in ensuring proper drainage procedures were followed.
- Facilitated surgical preparation processes to ensure optimal patient outcomes.
- Assisted in maintaining hygiene standards through regular handwashing practices. Supported team members in adhering to health protocols. Contributed to a clean and safe environment for all individuals.
Long Term Care Facility Front Office Assistant
The Plaza health & Rehab
04.2018 - 01.2019
- Provided direct patient care in long-term care environments, overseeing management of chronic conditions.
- Facilitated development of care plans and monitored patients for clinical changes necessitating escalation.
- Facilitated billing and service approvals by documenting and verifying medical necessity.
- Provided comprehensive education to patients and families regarding health conditions, medication usage, and post-care instructions to enhance understanding and compliance.
Education
Associate’s degree - nursing
Rasmussen University
Ocala, FL01.2022
Nurse Residency Group- X - undefined
Baptist Medical Center South
Jacksonville, FL01.2023
Skills
- Experience with all types of Microsoft Office including PowerPoint, Excel, and Word
- Strong telephonic communication skills
- Chart review
- Coordinated with physicians and interdisciplinary teams for comprehensive patient care plans
- proficiency in Electronic Health Record (EHR) systems
- Effective time management
- Flexible in approach
Certification
- Registered Nurse (RN)
- Advanced Life Support (ACLS)
- Basic Life Support (BLS)
- Certified Nursing Assistant (CNA)
Timeline
Medical Surgical Unit
Baptist Medical Center Clay
11.2024 - 09.2025
Progressive Care Nurse
Baptist Medical Center South
07.2023 - Current
Progressive Care CNA
Baptist Medical Center South
07.2022 - 07.2023
Transplant/Urology CNA
UF Health Shands Hospital
02.2019 - 01.2022
Long Term Care Facility Front Office Assistant
The Plaza health & Rehab
04.2018 - 01.2019
Nurse Residency Group- X - undefined
Baptist Medical Center South
Associate’s degree - nursing
Rasmussen University