Summary
Overview
Work History
Education
Skills
Timeline
Generic

Ann Sims

Pearl,MS

Summary

Utilization Review Nurse with extensive experience at Mississippi State Hospital, specializing in utilization management and patient advocacy. Demonstrated ability to enhance care quality through data analysis and effective communication. Expertise in regulatory compliance and InterQual criteria, leading to significant improvements in healthcare processes and outcomes.

Overview

15
15
years of professional experience

Work History

Utilization Review Nurse

Mississippi State Hospital
Whitfield, MS
05.2024 - Current
  • Collaborated with multidisciplinary teams on developing strategies for improving care quality and controlling costs.
  • Reviewed denial letters issued by insurance companies to ensure that they were appropriate and timely.
  • Analyzed data from patient surveys, interviews and other sources to assess healthcare service quality.

Utilization Review Nurse

Alliant Health Solutions
Ridgeland, MS
12.2021 - 03.2025
  • Facilitated communication between payers, providers and patients concerning authorization issues or concerns.
  • Reviewed denial letters issued by insurance companies to ensure that they were appropriate and timely.
  • Identified opportunities for improvement in processes related to utilization management functions.

Case Manager

Sta-Home Health & Hospice
Clinton, MS
02.2020 - 11.2021
  • Acted as an advocate for vulnerable populations by advocating for policy changes at the state level.
  • Provided referrals to appropriate health care providers or other community resources.
  • Provided crisis intervention support for clients in emergency situations.

Registered Nurse, Intensive Care Unit

Baptist Medical Center
Jackson, MS
07.2018 - 02.2020
  • Prioritized multiple tasks while maintaining excellent standards of care delivery.
  • Assessed patient's condition and monitored vital signs.
  • Recognized changes in patient conditions, promptly notified physicians, and implemented appropriate interventions as necessary.

Registered Nurse, Intensive Care Unit

Merit Health Central Hospital
Jackson, MS
11.2013 - 06.2018
  • Participated in quality improvement activities aimed at improving the overall standard of care provided to ICU patients.
  • Prioritized multiple tasks while maintaining excellent standards of care delivery.
  • Assessed patient's condition and monitored vital signs.

Registered Nurse, Medical-Surgical Unit

Regency Hospital Company LLC
Jackson, MS
10.2010 - 10.2013
  • Performed vital signs monitoring for early identification of changes in patient condition or response to treatment plan.
  • Assessed, monitored and documented patient progress on a daily basis.
  • Adhered to hospital policies and procedures while providing quality patient centered care.

Education

Bachelor of Science - Nursing

South University Savannah
GA
12-2016

Associate of Science - Nursing

Hinds Community College
Raymond, MS
05-2010

Associate of Science - Respiratory Care Science

Hinds Community College
Raymond, MS
05-2005

Skills

  • Utilization management
  • Clinical documentation
  • Data analysis
  • Regulatory compliance
  • Patient advocacy
  • Quality improvement
  • InterQual criteria
  • Communication

Timeline

Utilization Review Nurse

Mississippi State Hospital
05.2024 - Current

Utilization Review Nurse

Alliant Health Solutions
12.2021 - 03.2025

Case Manager

Sta-Home Health & Hospice
02.2020 - 11.2021

Registered Nurse, Intensive Care Unit

Baptist Medical Center
07.2018 - 02.2020

Registered Nurse, Intensive Care Unit

Merit Health Central Hospital
11.2013 - 06.2018

Registered Nurse, Medical-Surgical Unit

Regency Hospital Company LLC
10.2010 - 10.2013

Bachelor of Science - Nursing

South University Savannah

Associate of Science - Nursing

Hinds Community College

Associate of Science - Respiratory Care Science

Hinds Community College

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