Detail-oriented Nurse with clinical experience in Internal Medicine and Family Practice, complemented by recent utilization review expertise. Strong critical thinking skills and a solid knowledge base enable effective application of evidence-based guidelines in assessments. Proven ability to navigate primary care environments enhances the capacity for informed decision-making in utilization review.
Work History
Case Management Specialist
3 Years 8 Months
HealthSpring | 03.2023 - Current
Coordinated care plans with multidisciplinary teams to align services, referrals, and member needs.
Collaborated with providers to secure appropriate services and resolve care barriers.
Reviewed case documentation for accuracy, compliance, and timely follow-up actions.
Experience working genetic, home health, inpatient, outpatient, DME and Behavioral health cases
Experience with MHK and CarewebQI
Teacher’s Aide
6 Months
Renhill/ Northmor Local School | 09.2022 - 03.2023
Provided support to two boys during their work sessions with work, note taking, and anything else they may have required assistance.
Supported classroom instruction by reinforcing lesson plans and guiding students through assigned activities.
Assisted lead teacher with daily classroom routines, materials preparation, and student organization.
Monitored student behavior, promoting safe, respectful learning environment throughout classroom and transitions.
LPN-Teacher’s Aide/ Substitute Nurse
8 Months
Renhill/ Mount Gilead School | 10.2021 - 06.2022
Supervised groups of up to 20 children daily during activities.
Addressed medical emergencies promptly within the facility to ensure safety.
Delivered healthcare support services to students in elementary, middle, and high schools.
Licensed Practical Nurse/Community Health
3 Years 6 Months
Ohiohealth | 02.2018 - 08.2021
Organized, updated, and maintained immunization records and patient chart documentation to ensure compliance and accuracy.
Assisted physician as needed with patient care and procedures.
Administered medications and monitored patient responses in alignment with provider orders and care plans.
Documented assessments, interventions, and vital signs accurately in electronic health records.
Collaborated with registered nurses, physicians, and care teams to coordinate daily patient care.
Licensed Practical Nurse/Staff
7 Years 3 Months
Galion Community Hospital | 11.2010 - 02.2018
Educated clients, patients, and caregivers on medical diagnoses and treatment options to enhance understanding and compliance.
Provides direct patient care effectively which includes patients with varied complex needs.
Ability to function independently and exercise clinical judgment
Office Nurse Assistant
1 Year 2 Months
Mohiuddin Ghazi, M.D. | 08.2009 - 10.2010
Initiated contact with patients.
Provided excellent customer service and complied with HIPAA confidentiality.
Administered medications and injections per physician orders and clinic protocols.
Monitored patient vital signs and documented clinical findings in medical records.
Prepared exam rooms and sterilized instruments for daily patient visits.
Office Assistant
2 Years 3 Months
Morrow County Courthouse | 05.2007 - 08.2009
Executed general office tasks, including data input and electronic record updates, to ensure smooth daily operations.
Demonstrated strong communication skills in team meetings.
Managed front desk inquiries, directing visitors, calls, and requests to appropriate courthouse departments.
Processed confidential documents, ensuring accurate filing, distribution, and record retention compliance.
Scheduled hearings, appointments, and meetings, coordinating calendars across judges, clerks, and staff.
Education
Certificate of Completion - Utilization Review-101
Remote Learning Services, LLC | 11-2022
taught by Marie Peppers LPN and Judy Clarke, RN
Associate - RN
Central Ohio Technical College | Mount Vernon, Ohio
Diploma - LPN
Tri-Rivers Career Center | Marion, Ohio
Skills
Utilization Review
Care Management
Patient Advocacy
Retrospective Reviews
Clinical Chart Review
Preauthorization
Appeals/Denials
Medicare/Medicaid
Discharge Planning
Internal Medicine
Family Practice
Attention to detail
EMR/EHR/Epic
Critical Thinking
Member Engagement
Excellent Time Management
Attentive Customer Service
Certification
Licensed Practical Nurse, LPN, Ohio- Current
Timeline
Case Management Specialist
HealthSpring
03.2023 - CurrentRead More
Teacher’s Aide
Renhill/ Northmor Local School
09.2022 - 03.2023Read More
LPN-Teacher’s Aide/ Substitute Nurse
Renhill/ Mount Gilead School
10.2021 - 06.2022Read More
Licensed Practical Nurse/Community Health
Ohiohealth
02.2018 - 08.2021Read More
Licensed Practical Nurse/Staff
Galion Community Hospital
11.2010 - 02.2018Read More
Office Nurse Assistant
Mohiuddin Ghazi, M.D.
08.2009 - 10.2010Read More
Office Assistant
Morrow County Courthouse
05.2007 - 08.2009Read More
Tri-Rivers Career Center
Diploma from LPN
Read More
Central Ohio Technical College
Associate from RN
Read More
Remote Learning Services, LLC
Certificate of Completion from Utilization Review-101
Care Worker (Utilization Management/ Case Management Support) at Magellan HealthCare Worker (Utilization Management/ Case Management Support) at Magellan Health