Summary
Overview
Work History
Education
Skills
Timeline
Generic

Amy Sarbaugh

Carrollton,MO

Summary

Dedicated registered nurse with over 28 years of experience in an acute hospital setting. I have more than 15 years of experience as a dedicated utilization review nurse. Strong work ethic, adaptability, and effective communication skills. Expert in clinical assessment, chart reviews, concurrent/retrospective reviews, with a focus on prior authorization, medical necessity, and adherence to InterQual criteria. Mastered electronic health record: Cerner. Effectively communicates with health care providers and documents appropriately in the medical record. Eager to contribute to a dynamic team remotely, to enhance patient care, and to ensure compliance. I have availability to work remotely part-time or per diem, up to 20 hours per two-week pay period, with preferred hours including evenings, weekends, and holidays.

Overview

29
29
years of professional experience

Work History

Utilization Review Nurse

Fitzgibbon Hospital
Marshall, MO
12.1996 - Current
  • Reviews hospital admissions using InterQual criteria and clinical judgment to determine medical necessity.
  • Obtains authorizations from insurance companies, submits supporting documentation, and processes appeals as needed.
  • Refers cases for secondary review when appropriate, and facilitates peer-to-peer reviews for noncompliant cases.
  • Collaborates with case managers to enhance discharge planning and ensure effective transitions of care.
  • Attends daily group meetings to identify cost-effective solutions and address patient care concerns.
  • Documents all utilization review activities, findings, and decisions comprehensively in patient records.
  • Manages medical necessity appeals while communicating effectively with the revenue cycle team.
  • Experienced in Microsoft Word, Excel, and Outlook.
  • Communicates professionally and effectively with physicians and the health care team.

Education

Bachelor Of Science (BS) - Nursing

Central Methodist University
Fayette, Missouri, MO
05-2009

Associate Of Science (AS) - Nursing

State Fair Community College
Sedalia, MO
12-1997

License Practical - Nursing

State Fair Community College
Sedalia, MO
05-1996

Skills

  • Utilization review
  • Prior authorization
  • Insurance verification
  • InterQual criteria
  • Electronic health records
  • Organizational skills
  • Self motivation
  • Clinical assessment
  • Effective communication
  • Remote reviews
  • Case manager
  • Patient care

Timeline

Utilization Review Nurse

Fitzgibbon Hospital
12.1996 - Current

Bachelor Of Science (BS) - Nursing

Central Methodist University

Associate Of Science (AS) - Nursing

State Fair Community College

License Practical - Nursing

State Fair Community College
Amy Sarbaugh