Amy J. Bullock
Grand Rapids,MN
Summary
Skilled utilization review nurse offering talents in continuous assessments and clinical records oversight. Pleasant individual with several years in the nursing field. Ready to join new company that appreciates attention to detail and exemplary clinical review skills.
Overview
1
1
Certification
26
26
years of professional experience
Work History
Managed Care/Utilization Management Nurse
Itasca County Human Services-Itasca Medical Care (IMCare) Managed Care/Utilization Management Nurse
Grand Rapids, Minnesota
02.2025 - 08.2026
- Evaluated inpatient and outpatient service requests against utilization management criteria to ensure appropriate care.
- Pre-service and post-service prior authorization requests for Medicare and Medicaid members were processed efficiently.
- Medication prior authorization requests for Medicare and Medicaid members were completed accurately.
- Communicated utilization decisions to members, providers, and internal teams to facilitate timely care delivery.
- Approved services and treatments using managed care guidelines.
- Maintained compliance with organizational policies and procedures throughout utilization management activities.
- Medical necessity and benefit alignment were confirmed for Medicare and Medicaid members through IMCare utilization review.
- Analyzed claims system data to identify utilization trends that supported quality improvement initiatives.
- Documented utilization management activities in an electronic medical record system to support accurate case tracking.
- Recorded nursing review findings in utilization management records and case files to support continuity and review.
- IMCare members were guided through referrals, transitions, and service coordination to support access to care.
- Physicians and providers received regular communication regarding care appropriateness within established parameters.
- Quality assurance audits were completed on utilization review cases to support process integrity.
- Supported the appropriate level of care in a cost-effective manner through partnerships with healthcare providers.
ICU/Medical Surgical RN
Fairview Range Hospital
Hibbing , MN
06.2024 - 09.2024
- Provided safe care for 2-6 high-acuity patients on medical-surgical and ICU units, including inpatient and post-surgical status monitoring.
- Facilitated admissions from emergency department and other facilities, performed initial assessments, monitored patient conditions, and managed treatment needs from medication administration to wound care through discharge.
- Monitored vital signs and administered intravenous fluids, medications, blood transfusions, and other treatments according to physician orders.
- Administered medications and monitored treatment responses.
- Collaborated with interdisciplinary team members to support optimal patient outcomes.
- Coordinated discharge planning with providers and families to ensure continuity of care and patient understanding.
- Reported patient changes to physicians and care team members.
- Provided compassionate end-of-life support to patients and their families in a clinical setting.
- Applied evidence-based practice standards to daily practice decisions.
Travel RN at Hennepin County Medical Center ED
Aureus Medical Group
Omaha, Nebraska
01.2023 - 05.2024
- Delivered direct patient care during Aureus Medical Group travel nursing assignments
- Performed assessments and evaluations of patients' health condition, while providing comprehensive nursing services.
- Administered medications prescribed by physicians and monitored patients' conditions.
- Coordinated care plans with physicians and interdisciplinary teams
- Responded quickly and effectively to emergency situations or changes in a patient's condition.
- Managed emergency care situations, applying critical thinking and rapid decision-making skills.
- Adapted quickly to changing hospital environments and protocols for new hospital policies and unit workflows
Registered Nurse
Essentia Health Deer River Hospital
Deer River, Minnesota
03.2021 - 12.2022
- Delivered safe care for 4-6 high-acuity patients on a medical-surgical unit, including inpatient swing and post-surgical cases, while assisting with emergency department triage.
- Admitted patients from emergency department and outside facilities, completing initial contact, admission assessment, and discharge preparation, while monitoring conditions, administering medications, and providing wound care.
- Collaborated with multidisciplinary healthcare team to develop and implement individualized treatment plans, which enhanced patient-centered care.
- Utilized critical thinking skills to assess clinical situations quickly and accurately.
- Ensured safe patient environment by strictly adhering to infection control policies and procedures.
- Advocated for patients by supporting and respecting basic rights, values, and beliefs.
- Provided emotional support and comfort to families during difficult times.
- Provided comfort-focused end-of-life care and supported patient dignity during final stages of treatment.
- Participated in multidisciplinary team meetings to discuss patient care plans.
Registered Nurse
St Croix Hospice
Grand Rapids, Minnesota
08.2020 - 03.2021
- Provided comprehensive hospice care to patients and families, including assessment of physical, emotional, social, spiritual and cultural needs.
- Managed hospice patient care in home or residential facility settings.
- Reviewed patient symptoms and updated nursing interventions during home visits to ensure optimal care and support
- Communicated care needs with physicians, social workers, and interdisciplinary hospice teams
- Documented assessments, visit notes, and plan changes in electronic health records to maintain accurate patient information and continuity of care
- Educated families on symptom management, medications, and end-of-life care support
- Monitored pain control, comfort measures, and medication reconciliation across caseload
- Supervised hospice care transitions and addressed urgent patient concerns promptly
- Facilitated hospice admissions by gathering necessary documentation, patient information, and developing individualized care plans to streamline the onboarding process
Emeralds at Grand Rapids Skilled Nursing Facility- (Registered Nurse)
Monarch Healthcare Management
Grand Rapids, Minnesota
06.2019 - 08.2020
- Delivered compassionate nursing support for skilled and long-term care residents, enhancing overall patient comfort and well-being.
- Delivered direct nursing care for residents with tracheostomies and ventilator support.
- Administered medications and treatments while monitoring for reactions and side effects.
- Oversaw nursing assistants during daily resident care, ensuring adherence to care protocols and maintaining high standards of patient safety.
- Documented assessments and care updates in electronic health records to ensure accurate and timely information sharing among the care team.
- Communicated resident condition changes to the care team and escalated concerns.
- Collaborated with physicians, nurses, therapists, social workers, and other healthcare professionals on individualized treatment plans.
- Followed infection control procedures to maintain a safe, clean patient environment.
Licensed Practical Nurse
River Grand Senior Living Assisted Living Facility
Grand Rapids, MN
02.2018 - 06.2019
- Administered medications and treatments for assisted living residents at River Grand Senior Living.
- Monitored vital signs and communicated significant changes to supervising nurses to facilitate timely medical interventions.
- Maintained accurate and up-to-date clinical documentation in an electronic medical record system to support quality resident care.
- Communicated resident needs with families and senior living care teams.
- Observed condition changes and reported significant updates to a registered nurse or a physician.
- Provided personal hygiene assistance, including bathing, dressing, grooming, and toileting, to enhance residents' comfort and dignity.
- Followed infection control and safety procedures during daily resident care.
- Maintained a safe environment by following infection control policies and procedures.
- Supported care plans for memory care and long-term senior living residents.
Certified Nursing Assistant and Licensed Practical Nurse
Grand Village
Grand Rapids, MN
11.2015 - 01.2016
- Delivered comprehensive nursing care to long-term and short-term residents as a Licensed Practical Nurse, ensuring effective floor and medication support.
- Monitored and recorded vital signs, including blood pressure, pulse rate, and respiration rate, to ensure residents' health and safety.
- Delivered wound care and monitored healing progress in collaboration with care team.
- Facilitated residents' independence by assisting with activities of daily living as a certified nursing assistant.
- Assisted patients with activities of daily living such as bathing, grooming, and dressing.
- Supported meal service and assisted residents with safe feeding.
- Repositioned residents in beds to enhance comfort and prevent pressure injuries. to support comfort and prevent pressure injuries.
- Responded to call lights and provided timely bedside support.
Claims Processor and Appeals Analyst
UnitedHealth Group (UHG)
Minneapolis, MN
11.2000 - 08.2013
- Reviewed prior authorization and pre-certification appeals for approval or denial while following policies and procedures.
- Analyzed appeals cases to ensure compliance with employer policy and regulatory guidelines
- Communicated with members and providers about appeal status and requirements
- Processed medical claims using UnitedHealth Group claims systems and policy guidelines.
- Communicated with members and providers about claim and appeal status and required documentation.
- Managed high volume of incoming claims and appeals, ensuring adherence to established policies and procedures
- Verified insurance policy information to assess coverage and determine claims and appeals processing procedures
- Revised standard operating procedures and collaborated with members, providers, and health plans across commercial, Medicaid, Medicare, and managed plan settings.
- Worked closely with members, providers, and health plans (commercial, Medicaid, Medicare, Managed plans).
- Drafted professional correspondence for internal and external communication.
- Applied HIPAA standards while handling sensitive health information.
Insurance Billing Representative
Grand Itasca Clinic and Hospital
Grand Rapids, MN
05.2005 - 05.2006
- Processed patient insurance claims for Grand Itasca Clinic and Hospital billing accounts.
- Verified coverage details and coordinated benefits with payers and patients.
- Followed up on unpaid claims with insurance carriers and internal departments to expedite resolution.
- Maintained accurate billing records in electronic health and revenue systems to ensure compliance and facilitate audits.
- Submitted appeals to insurance companies to recover denied claims and secure payment.
- Monitored past due accounts and pursued collections on outstanding invoices.
- Interpreted Explanation of Benefits documents from various insurers.
Education
Associates in Nursing Degree - Nursing
Hibbing Community College
Hibbing, MN05-2019
License Practical Nursing Diploma -
Itasca Community College
Grand Rapids, MN05-2017
Associates of Arts Degree -
Itasca Community College
Grand Rapids, MN05-2016
Certified Nursing Assistant, Certification -
Itasca Community College
Grand Rapids, MN08-1995
Diploma -
Grand Rapids High School
Grand Rapids, MN06-1995
Skills
- Utilization review
- Prior authorization
- Medical necessity
- InterQual criteria application
- Claims Processing
- Appeals processing
- Medicaid
- Medicare
- Commercial Insurance
- Milliman guidelines expertise
- Care coordination
- Interdisciplinary communication
- Clinical judgment
- Critical thinking
- EMR documentation
- Neurological care coordination
- Respiratory care management
- Colostomy care
- Phlebotomy
- Intravenous therapy
- Dementia care
- Stroke patient care
- Tracheostomy care
- Nursing best practices
Certification
State of Minnesota Board of Nursing Registered Nurse License # 2474050, BLS expires 7/25, ACLS expires 9/25, TNCC expires 3/31/2026, PALS expires 9/25
Awards/Achievements
Daisy award- https://www.daisyfoundation.org/daisy-award, Received three Daisy nomination awards while employed at Essentia Health
Received quarterly bonuses for exceeding quality and production standards, UHG, MSP, MN 2000-2013, Received 100% quality and production awards, UHG, MSP, MN 2000-2013
System Experience
- Epic
- Interqual
- Point Click Care
- CaseTrakker/Dynamo
- Microsoft Office
- UpToDate
Timeline
Managed Care/Utilization Management Nurse
Itasca County Human Services-Itasca Medical Care (IMCare) Managed Care/Utilization Management Nurse
02.2025 - 08.2026
ICU/Medical Surgical RN
Fairview Range Hospital
06.2024 - 09.2024
Travel RN at Hennepin County Medical Center ED
Aureus Medical Group
01.2023 - 05.2024
Registered Nurse
Essentia Health Deer River Hospital
03.2021 - 12.2022
Registered Nurse
St Croix Hospice
08.2020 - 03.2021
Emeralds at Grand Rapids Skilled Nursing Facility- (Registered Nurse)
Monarch Healthcare Management
06.2019 - 08.2020
Licensed Practical Nurse
River Grand Senior Living Assisted Living Facility
02.2018 - 06.2019
Certified Nursing Assistant and Licensed Practical Nurse
Grand Village
11.2015 - 01.2016
Insurance Billing Representative
Grand Itasca Clinic and Hospital
05.2005 - 05.2006
Claims Processor and Appeals Analyst
UnitedHealth Group (UHG)
11.2000 - 08.2013
Associates in Nursing Degree - Nursing
Hibbing Community College
License Practical Nursing Diploma -
Itasca Community College
Associates of Arts Degree -
Itasca Community College
Certified Nursing Assistant, Certification -
Itasca Community College
Diploma -
Grand Rapids High School