Carrey Strickland
Tooele,UT
Summary
Professional nurse with extensive experience in utilization review. Skilled in analyzing patient care and ensuring compliance with healthcare regulations. Strong focus on team collaboration and achieving optimal patient outcomes. Adaptable and reliable, excelling in dynamic environments requiring precise decision-making and effective communication.
Overview
12
12
years of professional experience
Work History
Utilization Review Nurse
Medical Review Institute of America (MRIoA)
07.2019 - Current
- Performed reviews based for medical necessity based upon InterQual, and Insurance specification.
- Performed prior authorization review of services requiring notification.
- Performed Retro reviews, Concurrent, Ancillary, Pharmacy and Appeals.
- Collaborated with insurance companies to verify coverage, clarify benefits, and facilitate authorization for medical services, reducing delays in patient care delivery.
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Submitted cases for criteria failures and helped facilitate resolutions and approvals.
- Facilitated workgroup meetings with medical personnel to find effective solutions to issues.
- Facilitated compliance with federal and state regulations, maintaining high standards of healthcare delivery
- Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
- Ensured compliance with regulations and accreditation standards by maintaining accurate documentation of all utilization review activities.
- Obtained authorizations from multiple insurance carriers for various levels of care.
- Followed established auditing processes to meet internal and regulatory requirements.
- Self-motivated, with a strong sense of personal responsibility.
- Devised and deployed predictive models using machine learning algorithms to drive business decisions.
Utilzation Review
Western State Hospital
08.2015 - 06.2019
- Excellent communication skills, both verbal and written.
- Skilled at working independently and collaboratively in a team environment.
- Proven ability to learn quickly and adapt to new situations.
- Worked well in a team setting, providing support and guidance.
- Initial Inpatient Reviews, Retro,Continued Stay, Peer Review, Discharge Review and LOS.
- Morality Review
- Internal Record Review
- Chart Review
- NRI Global and Diagnostic Review for every discharged patient
- Abstracted and inputted Data reported Joint Commission and CMS
- Time Keeping, Scheduling
- Scribed
- Clarified/Reviewed documentation for Transcriptionist for accuracy and completeness
- Committees: EMR, Pharmacy Med-Use, Billing for Service, Pain Management and Chaired IRR committee.
LPN
Western State Hospital
08.2013 - 06.2019
- Documented patient progress thoroughly and accurately, facilitating effective communication among healthcare team members.
- Participated in ongoing professional development opportunities related to mental health nursing practice, staying current on industry advancements and trends.
- Decreased the risk of patient self-harm through continuous monitoring and creating a safe environment.
- Managed complex caseloads while maintaining high levels of organization and efficiency in daily tasks.
- Administered psychiatric medications accurately and safely, contributing to the stabilization of patients'' symptoms.
- Coordinated discharge planning for patients transitioning back into their communities, ensuring continuity of care posthospitalization.
- Collaborated with psychiatrists to develop individualized treatment plans, ensuring optimal patient care.
CNA Instructor
TN Health Careers LLC
05.2017 - 03.2019
- Mentored new CNA Instructors, guiding them through the teaching process and ensuring quality instruction for all students.
- Delivered engaging lectures that effectively conveyed complex concepts related to patient care responsibilities and procedures.
- Improved pass rates for certification exams by providing comprehensive instruction and targeted feedback.
- Conducted regular evaluations of course content, identifying areas for improvement and updating materials accordingly.
Education
Licensed Practical Nurse - LPN
Augusta Technical College
Augusta, Georgia, GA12-2003
Phlebotomy - Phlebotomy
Aiken Technical Colloge
Aiken, SC10-2000
Skills
- HIPAA compliance
- Quality improvement
- Records analysis
- Medical coding
- Milliman guidelines, and InterQual Criteria
- Medicaid, and Medicare
- Telephonic nursing
- Microsoft office
Timeline
Utilization Review Nurse
Medical Review Institute of America (MRIoA)
07.2019 - Current
CNA Instructor
TN Health Careers LLC
05.2017 - 03.2019
Utilzation Review
Western State Hospital
08.2015 - 06.2019
LPN
Western State Hospital
08.2013 - 06.2019
Licensed Practical Nurse - LPN
Augusta Technical College
Phlebotomy - Phlebotomy
Aiken Technical Colloge