Summary
Overview
Work History
Education
Skills
Affiliations
Timeline
Generic

Amber Soots

Innsbrook,MO

Summary

Dedicated Registered Nurse with over five years of expertise in utilization management, recognized for streamlining processes that enhance patient care and optimize resource allocation. Proven track record of collaborating with multidisciplinary teams to ensure quality outcomes while adhering to compliance standards. Aiming to transition into a supervisory role to further develop leadership skills and contribute to healthcare excellence.

Overview

16
16
years of professional experience

Work History

Utilization Management Nurse

Lumeris
Maryland Heights, MO
05.2019 - 12.2024
  • Collaborated with providers to obtain required clinical information, supporting prior authorization determinations and individual inquiries.
  • Determined medical necessity and cost-effectiveness of services through utilization review processes.
  • Applied medical criteria and clinical judgment to researched cases to evaluate and establish determinations.
  • Remained up-to-date on various benefit plans, medical policies and state-specific clinical guidelines or criteria, including Medicare guidelines.
  • Referred cases to secondary review for failure to meet Interqual criteria.
  • Reviewed patient admissions to determine medical necessity as directed by Interqual criteria.
  • Kept detailed documentation on all utilization reviews by using Jiva
  • Proficient in acute and post acute concurrent reviews, post acute authorizations, and benefit determinations
  • Communicated regularly with physicians and providers regarding appropriateness of care delivery within established parameters.
  • Trained co-workers in acute concurrent reviews and post acute authorizations
  • Coordinated with external agencies such as home health agencies or skilled nursing facilities regarding patient placement needs.

Registered Nurse

Mercy Hospital
Saint Louis, MO
08.2015 - 05.2019
  • Assessed patient needs including, taking vital signs and blood draws and inserting peripheral IVs and PICC.
  • Planned and managed patient care in alignment with hospital standards of care.
  • Followed all physician orders for treatment and care and managed medication administration.
  • Treated patients with strokes, head traumas, comas and intracranial hematomas.
  • Trained and mentored newly hired nursing personnel on policies, protocols and requirements.
  • Achieved departmental goals and objectives by instituting new processes and standards for in-patient care.
  • Performed all tasks with a patient-centered focus while seeking opportunities for improvement of processes and treatments.
  • Interviewed patients to obtain medical information and measure their vital signs, weight and height.
  • Prepared for HIPAA and JCAHO reviews, ensuring required brochures and pamphlets were available to patients in all clinics.
  • Educated and counseled patients and caregivers on discharge plan objectives, wound management, disease management and medication self-administration.
  • Developed and implemented successful patient care plans.
  • Observed and reported patient reactions and improvements or deteriorations.
  • Responded to life-threatening emergencies.
  • Counseled caregivers and families on end-of-life planning and informed them of patient care options.
  • Collaborated with multidisciplinary healthcare teams to develop and adapt individualized plans of care to achieve patient care and recovery goals.

Office Coordinator

Cornerstone Contracting
Warrenton, MO
04.2009 - 01.2015
  •  Coordinated employee payroll with accounting
  • Managed receivable accounts and billing
  • Communicated and scheduled with vendors

Education

Associate of Science - Nursing

St. Charles Community College
Cottleville, MO
2015

Skills

  • Utilization review
  • Organization
  • Computer skills
  • Multitasking
  • Proficient use of Interqual
  • Policy adherence
  • Healthcare regulations
  • Interdisciplinary collaboration

Affiliations

  • Nominated for 2017 March of Dimes Nurse of the Year
  • Graduated with High Honors and the highest GPA of 3.96 in my graduating class
  • Awarded St. Charles Community College Trustee Scholarship, August 2014
  • Awarded Friends of SSM Scholarship, August 2014
  • Awarded Certificate of Leadership from St. Charles Community College Nursing Department for Outstanding Service to the Student Nurse Organization, April 2015 

Timeline

Utilization Management Nurse

Lumeris
05.2019 - 12.2024

Registered Nurse

Mercy Hospital
08.2015 - 05.2019

Office Coordinator

Cornerstone Contracting
04.2009 - 01.2015

Associate of Science - Nursing

St. Charles Community College

Similar Profiles

CREATE PROFILE
Amber Soots