Brenda Shinaul
Renton,WA
Summary
Experienced Nurse with a demonstrated history of working in the hospital, clinics, insurance industry, Medicare/Medicaid and Population Health. My current role is a Utilization Review Nurse at a insurance company. Skilled in EPIC, Super User with implementation and Go-Live for the clinic. Skilled in Microsoft Word, Nursing Education, Nursing Leadership, Medical-Surgical, Utilization Review and Case Management. Strong professional with over thirty years of Nursing experience. Have Nursing Licenses in 4 states. Currently a student at WGU Washington for B.S. in Healthcare Management 2024-2025
Overview
12
12
years of professional experience
Work History
Appeals Nurse
Conifer Healthcare Solutions
11.2023 - 07.2024
- Performed clinical review on all claims that required appeals, and constructed appeal letters to insurance companies Medicare, Medicaid, and TPA. Utilized medical necessity criteria for appeal requests. Reviewed all clinical documentation from Cerner, EPIC and AllScripts. Presented cases to physician for guidance on denials that were upheld or overturned. Met TAT on all aspects of appeal process, used clinical guidelines from CMS, InterQual and MCG. Collaborated with other team members, including claims, billing, and utilization review departments.
- Performed accurate documentation of patient assessments, interventions, and outcomes in compliance with regulatory standards.
Utilization Review Nurse
UnitedHealthcare/Optumn Care Network
07.2021 - 08.2023
- Reduced healthcare costs through efficient utilization of resources and identification of unnecessary treatments or procedures.
- Maintained professional competence by staying current on industry trends, best practices, and regulatory requirements specific to utilization review nursing.
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Ensured compliance with regulations and accreditation standards by maintaining accurate documentation of all utilization review activities.
Nurse Manager
Sea Mar Community Health Centers
07.2019 - 06.2021
- Led staff meetings to keep team informed of departmental changes and provide opportunities for nurses to share ideas and concerns.
- Conducted performance evaluations and provided constructive feedback to support professional growth of nursing staff members.
- Trained new nurses in proper techniques, care standards, operational procedures, and safety protocols.
- Managed budgets and controlled costs, achieving financial targets without compromising patient care quality.
- Developed and implemented quality improvement initiatives to provide best possible patient care and identify and address areas of concern.
- Managed 10-12 medical assistants, and lab staff by providing comprehensive nursing guidance and maintaining outstanding patient satisfaction and care standards.
Utilization Management/ Utilization Review-Nursing Licenses in Arkansas, Kentucky, Nebraska, Ohio, WA
Catholic Health Initiatives
08.2015 - 12.2018
- Self-motivated, with a strong sense of personal responsibility.
- Worked effectively in fast-paced environments.
- Skilled at working independently and collaboratively in a team environment.
- Proven ability to learn quickly and adapt to new situations.
- Excellent communication skills, both verbal and written.
- Worked well in a team setting, providing support and guidance.
- Assisted with day-to-day operations, working efficiently and productively with all team members.
Medical Claim Review Coordinator
Healthcare Management Administrators
07.2014 - 05.2015
- Conducted thorough quality assurance checks on completed reviews before submission for final approval from senior management or clients as required.
- Evaluated the performance of team members regularly, providing constructive feedback for improvement opportunities as needed.
- Acted as a subject matter expert in review coordination, providing guidance and support to colleagues both within the team and across the organization.
- Contributed to continuous improvement initiatives aimed at enhancing overall operational efficiency within the organization.
Access Review Case Manager
Valley Medical Center
02.2012 - 12.2012
- Maintained accurate documentation on all cases, ensuring compliance with regulations and confidentiality requirements.
- Conducted thorough assessments of clients'' situations, identifying issues, goals, and necessary interventions.
- Monitored ongoing cases closely, adjusting case management strategies as needed based on evolving circumstances or new information.
- Educated clients on available programs, benefits, and services, empowering them to make informed decisions about their care needs.
- Coordinated services with other agencies, community-based organizations, and healthcare professionals to provide useful benefits to clients.
Education
Some College (No Degree) - Nursing
North Seattle College
SeattleNursing Degree - Mother/Baby NICU, GYN, Med/Surg, ER, ICU Labor and delivery, Midwifery, Telemetry
Oldchurch Hospital School of Nursing
London, England01.1983
Labor and Delivery and NICU Certification - Nursing Education
Rush Green Hospital
Romford, Essex01.1982
Pre nursing degree - Pre-Nursing Studies
West Ham College
London, England01.1980
High school certification - English Education
Stratford High School
London, England01.1978
Skills
- Microsoft Word
- Healthcare
- PowerPoint
- Patient Care
- Clinical Documentation
- Care plan implementation
- Critical Care Nursing
- Mental health care
- Nursing staff leadership
- Workflow and Patient Management
- Discharge coordination
- Strong Clinical Judgment
- EMR Systems
- Patient Discharge
- Chronic Disease Management
Personal Information
Title: Utilization Review Nurse
Timeline
Appeals Nurse
Conifer Healthcare Solutions
11.2023 - 07.2024
Utilization Review Nurse
UnitedHealthcare/Optumn Care Network
07.2021 - 08.2023
Nurse Manager
Sea Mar Community Health Centers
07.2019 - 06.2021
Utilization Management/ Utilization Review-Nursing Licenses in Arkansas, Kentucky, Nebraska, Ohio, WA
Catholic Health Initiatives
08.2015 - 12.2018
Medical Claim Review Coordinator
Healthcare Management Administrators
07.2014 - 05.2015
Access Review Case Manager
Valley Medical Center
02.2012 - 12.2012
Labor and Delivery and NICU Certification - Nursing Education
Rush Green Hospital
Some College (No Degree) - Nursing
North Seattle College
Nursing Degree - Mother/Baby NICU, GYN, Med/Surg, ER, ICU Labor and delivery, Midwifery, Telemetry
Oldchurch Hospital School of Nursing
Pre nursing degree - Pre-Nursing Studies
West Ham College
High school certification - English Education
Stratford High School
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