Carie Whitaker
Overview
15
15
years of professional experience
Work History
Utilization Review Nurse Specialist
Community Health Systems
11.2021 - Current
- Assists with gathering and reviewing patient medical records for utilization review processes.
- Supports clinical staff in understanding utilization management protocols and guidelines.
- Collaborates with interdisciplinary teams to ensure adherence to treatment plans and policies.
- Learns electronic health record systems to document reviews and outcomes efficiently.
- Maintains organized documentation for utilization review cases to support audit readiness.
- Engages in continuous education regarding best practices in utilization management and nursing standards.
- Evaluates medical guidelines and benefit coverage to determine appropriateness of services.
- Conducts complex research, review, and analysis of medical records, treatment plans, and claim information. Using Cerner, Morcare, Medhost, HMS, Centricity, and various other systems and portals.
- Reaches out to the medical provider/director when relevant, according to facility protocol.
Appeals and Grievances Nurse Analyst
Blue Cross And Blue Shield Of Tennessee
04.2021 - 11.2021
- Collaborated with multidisciplinary teams to develop and implement individualized care strategies.
- Maintained accurate patient records using electronic health record systems, ensuring compliance with regulations.
- Remained calm during high-stress, critical situations, demonstrating sustained focus and problem-solving in real-time.
- Evaluated and researched medical necessity documentation submitted for clinical review, including complex situations. Conducted outreach as applicable for clinical information and prepared case files for the Medical Director to review
- Utilized multiple systems in order to appropriately research and document the substance and validity of the appeal or quality of care.
- Conducted complex research, review and analysis of medical records, treatment plans and claim information.
- Created reports detailing findings and recommendations.
- Worked/collaborated with other clinical/non clinical staff with issues related to coding, medical records/documentation, precertification, and claim denials and appeals.
Patient Intake/Call Center/Charge Nurse
CHI Memorial Hospital
05.2019 - 04.2021
- Trained and mentored new nursing personnel on best practices and hospital procedures.
- Served as a liaison between nursing staff, physicians, and management, fostering open communication channels among all parties involved in patient care.
- Maintained accurate documentation of patient information, enabling informed decision-making among the healthcare team members.
- Aided non-clinical staff in performance of administrative evaluation.
- Used clinical judgment for patient placement, hospitalist assignment & critical test results.
- Reached out to the medical provider/director when relevant, according to facility protocol.
- Used critical thinking skills to assist physicians in screening patients for medical appropriateness of admission or transfer.
- Initiated referrals for assured appropriate coordination of care.
Med-Surge Registered Nurse
CHI Memorial
10.2018 - 05.2019
- Administered patient assessments and developed individualized care plans to enhance patient outcomes.
- Collaborated with interdisciplinary teams to ensure effective communication and coordinated patient care.
- Trained and mentored junior nursing staff in best practices and clinical protocols for improved performance.
- Implemented quality improvement initiatives that streamlined patient workflows, enhancing operational efficiency.
- Monitored vital signs and administered medications, ensuring adherence to established safety standards.
- Delivered patient education on health management strategies, promoting self-care and wellness initiatives.
- Conducted thorough documentation of patient records to maintain compliance with regulatory requirements.
Registered Nurse
National Healthcare Corp
11.2010 - 10.2018
- Collaborated with multidisciplinary teams to develop patient care plans and enhance treatment outcomes.
- Administered medications and monitored patient responses, ensuring adherence to safety protocols and best practices.
- Educated patients and families on health management, promoting self-care strategies for improved recovery.
- Implemented quality improvement initiatives, streamlining processes for enhanced operational efficiency in patient care delivery.
- Conducted comprehensive assessments of patient conditions, ensuring timely interventions based on evolving needs.
- Utilized critical thinking skills to prioritize nursing interventions based on patients'' acuity levels and individual needs.
- Administered medications safely according to established guidelines while closely monitoring for side effects or adverse reactions requiring intervention.
Education
Associate of Science - Nursing
Southern Adventist University
Collegedale, TN08-2016
Licensed Practical Nurse - Nursing
Tennessee Technology Center of Crossville
08-2009
Skills
- Adept at acquiring new skills
- Dependable and proactive
- Experience in motivating others positively
- Guided by core nursing principles
- Ability to prioritize strategic goals
- Experienced across multiple nursing fields
Credentials
Registered Nursing License, TN - Current
Timeline
Utilization Review Nurse Specialist
Community Health Systems
11.2021 - Current
Appeals and Grievances Nurse Analyst
Blue Cross And Blue Shield Of Tennessee
04.2021 - 11.2021
Patient Intake/Call Center/Charge Nurse
CHI Memorial Hospital
05.2019 - 04.2021
Med-Surge Registered Nurse
CHI Memorial
10.2018 - 05.2019
Registered Nurse
National Healthcare Corp
11.2010 - 10.2018
Associate of Science - Nursing
Southern Adventist University
Licensed Practical Nurse - Nursing
Tennessee Technology Center of Crossville
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