Susan Burke
Summary
Dependable Nursing Professional with 25 Years of expertise in the healthcare industry. A seasoned nurse offering proven clinical knowledge, strong interpersonal and organizational skills. As well as, extensive knowledge specializing in Acute Care, and Utilization Management. Looking for a position in a top-notch organization with a commitment to innovative processes.
Overview
25
25
years of professional experience
1
1
Certification
Work History
RN Floor Nurse
UCF Lake Nona Hospital
05.2023 - Current
- Provide excellent care to patients on a medical surgical telemetry floor.
- Nursing responsibilities include: assessing, planning, implementing, evaluating patient care plans in consultation with other healthcare professionals.
- Monitoring vital signs, administering medications, and maintaining patient records.
- Change dressings, insert catheters, and start IVs. Adjust specialized medical equipment as needed.
- Collaborate on discharge planning with healthcare team.
- Answer questions and educate patients and their families on their medical care.
- Adhere to best nursing practices, standards and protocols.
RN Utilization Management
WellMed Medical Management - United Health Group
10.2020 - 02.2023
- Remotely perform initial and concurrent reviews of patients using MCG Guidelines paying close attention to Turn Around Times.
- Collaborate with Medical Director on patients not meeting criteria for possible denial. Responsible for Verifying Benefits and addressing incorrect Diagnosis Codes.
- Familiar with Microsoft Word, Outlook, Webex, Excel. Microsoft teams and Trucare.
RN High Risk Inpatient Case Manager
WellMed Medical Management - United Health Group
01.2018 - 10.2020
- Responsible for all High Risk Members Concurrent Reviews.
- Communication with Hospital CM, SW for DC Planning needs.
- Communicating to facilities/hospitals auth approvals for all LTACs, ARUs and SNFs using InterQual and MCG Guidelines.
RN Utilization Management Lead Nurse
Nemours Children's Hospital
06.2017 - 09.2017
- Conduct initial clinical reviews within 24 hours of patient admission. All reviews are to follow unit standards as per UM concurrent review guidelines.
- Provide concurrent admission, continued stay and retrospective review to insurance company staff as contractually required.
- Communicate anticipated Length of Stay and insurance review results to interdisciplinary team. Participate in interdisciplinary rounds daily.
- Identify patients who do not meet current patient class criteria and take action to communicate and change to appropriate level of care as indicated with attending physician and interdisciplinary team.
- Convert observation to admission and, conversely, admission to observation status; communicate change to team and others as needed
- Mediate between physicians and insurance companies to avoid denials by monitoring patient plan of care and intervening as needed to assure timely completion of care at appropriate level of care.
- Facilitate the timely completion of diagnostic tests, procedures and treatment services, consultations and discharge planning activities in collaboration with the social work staff.
- Monitor payor authorization for continued stay.
- Monitor and facilitate correct patient class and accommodation codes via the EMR for every patient.
- .Collaborate with patient care team to ensure efficient patient throughput. Communicate length of stay authorizations and barriers to discharge to unit based team daily; working within the team to identify and resolve issues.
RN Utilization Management Team
Florida Hospital East
07.2009 - 06.2012
- Perform On Site Concurrent Reviews/Discharge Planning of patients using InterQual Level of Care Criteria.
- Collaborate with physicians and hospital personnel to facilitate and coordinate care needs across the continuum of care.
- Enter data assessments, authorizations and reviews into system. (System used are Cerner/I-Extend and Suncare/Sunport).
RN Floor Nurse
Florida Hospital East Orlando
01.2002 - 01.2009
- Managed quality care for patients on a Medical/Surgical/Telemetry Floor for 7 years.
- Significantly improved facility's public image by ensuring exceptional patient satisfaction.
RN/Medical Surgical Floor With Float to Pediatrics
Health Central Hospital
01.1999 - 01.2000
Education
Associate of Science - Nursing
Daytona Beach Community College
Daytona Beach, FL05.1998
Skills
- Acute Care
- Utilization Management
- Case Management
- Computer efficient using Microsoft Word
- Experience with MCG and InterQual Guidelines
- Experience with EMR/EHR
- Excellent interpersonal and organizational skills
Certification
BLS and ACLS Certified
Timeline
RN Floor Nurse
UCF Lake Nona Hospital
05.2023 - Current
RN Utilization Management
WellMed Medical Management - United Health Group
10.2020 - 02.2023
RN High Risk Inpatient Case Manager
WellMed Medical Management - United Health Group
01.2018 - 10.2020
RN Utilization Management Lead Nurse
Nemours Children's Hospital
06.2017 - 09.2017
RN Utilization Management Team
Florida Hospital East
07.2009 - 06.2012
RN Floor Nurse
Florida Hospital East Orlando
01.2002 - 01.2009
RN/Medical Surgical Floor With Float to Pediatrics
Health Central Hospital
01.1999 - 01.2000
Associate of Science - Nursing
Daytona Beach Community College
BLS and ACLS Certified
Similar Profiles
Darrell L. WashingtonDarrell L. Washington
Floor Technician at UCF Lake Nona HospitalFloor Technician at UCF Lake Nona Hospital
Jennifer TrinidadJennifer Trinidad
Hospital Registrar at UCF Lake Nona HospitalHospital Registrar at UCF Lake Nona Hospital
Giana OrtizGiana Ortiz
Charge Nurse, Medical Surgical Telemetry at HCA Healthcare - UCF Lake Nona HospitalCharge Nurse, Medical Surgical Telemetry at HCA Healthcare - UCF Lake Nona Hospital