Amanda Hix-RN
Oak Harbor,WA
Summary
Smart Utilization Review Nurse considered critical thinker and problem-solver due to dynamic patient care planning and understanding of Medicare guidelines. Known for having great rapport with providers and insurance carriers.
Overview
14
14
years of professional experience
Work History
RN Case Manager/Utilization Review Nurse/Resource Nurse
Optima
01.2016 - Current
- Telephonic case management of complex cases
- Transplant authorization review
- Authorization review for hospital review team including commercial lines of business and government lines of business
- Proficient with Milliman Criteria Guidelines, Jiva and QNEXT
- Denial process completion including denial letter drafting
- Completion of 30+ denial letters daily for both Medicaid and Medicare members
- Appeals authorizations processes including QIO coordination
- Coordination with providers and network management for single case agreements.
RN
Baptist North Little Rock
01.2012 - 01.2014
- Oncology/orthopedic unit
- Post orthopedic and general surgical care.
RN Case Manager
Hospice Homecare
01.2012
- 15 to 20 patient caseload
- Medication management to include palliative medications
- Skilled nursing interventions
- Interdisciplinary team coordination of patient care.
RN
PSA Healthcare
01.2010
- Care for pediatric patients in the home
- Trach & g-tube care.
RN Case Manager
Heartland Hospice
01.2015 - 01.2016
- 15 patient case load
- Medication management to include palliative medications
- Skilled nursing interventions
- Interdisciplinary team coordination of patient care.
RN
St. Vincent's Infirmary
01.2011 - 01.2012
- Nursing care on medical/surgical floor specializing in GI surgery.
RN Case Manager
Heartland Hospice
01.2010 - 01.2011
- 12-15 patient caseload
- Medication management to include palliative medications
- Skilled nursing interventions
- Interdisciplinary team coordination of patient care.
Education
BSN -
Radford University
Radford, VA08.2016
ADN -
Florida Community College at Jacksonville
Jacksonville, FL08.2009
Skills
- ELNEC Core Training
- RN LICENSE VA 0001256165 (multistate license)
- HIPAA Compliance
- Multidisciplinary Approach
- Regulatory Compliance
- Documentation
Timeline
RN Case Manager/Utilization Review Nurse/Resource Nurse
Optima
01.2016 - Current
RN Case Manager
Heartland Hospice
01.2015 - 01.2016
RN
Baptist North Little Rock
01.2012 - 01.2014
RN Case Manager
Hospice Homecare
01.2012
RN
St. Vincent's Infirmary
01.2011 - 01.2012
RN
PSA Healthcare
01.2010
RN Case Manager
Heartland Hospice
01.2010 - 01.2011
BSN -
Radford University
ADN -
Florida Community College at Jacksonville
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