Cheryl Gaines
Shelby,NC
Summary
Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Overview
13
13
years of professional experience
Work History
Dispensing Nurse
New Seasons Treatment Center
06.2023 - Current
- Dispense medications as per physicians'' orders.
- Improved patient safety through rigorous adherence to proper dispensing procedures and protocols.
- Streamlined inventory management by conducting regular audits and maintaining accurate records of all controlled substances.
- Enhanced patient care by administering medication in a timely and accurate manner.
- Contributed to a positive work environment by providing support and assistance to fellow nursing staff members as needed.
- Reduced medication errors by maintaining precise documentation of dispensed medications.
- Ensured patient confidentiality by adhering to HIPAA regulations when handling sensitive information.
- Increased efficiency of the dispensing process by effectively utilizing automated dispensing systems.
Utilization Management Nurse
Humana Insurance Company
01.2011 - 01.2023
- Applied critical thinking skills to assess complex medical cases and determine appropriate levels of care in accordance with industry benchmarks.
- Facilitated communication between healthcare providers and patients.
- Ensured compliance with regulatory guidelines by staying current on industry standards and participating in ongoing education opportunities.
- Coordinated seamless transitions of care across multiple settings including acute care hospitals, rehabilitation facilities, and home care services.
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Performed prior authorization review of services requiring notification.
- Submitted cases for criteria failures and helped facilitate resolutions and approvals.
- Performed admission reviews based for medical necessity based upon Milliman Care Guidelines.
Education
High School Diploma -
Jane Addams VHS
Bronx, New York06.1977
Skills
- Medical History Documenting
- Milliman Care Guidelines and Interqual Criteria
- Benefit Verification
- Data Entry
- Customer Service
Timeline
Dispensing Nurse
New Seasons Treatment Center
06.2023 - Current
Utilization Management Nurse
Humana Insurance Company
01.2011 - 01.2023
High School Diploma -
Jane Addams VHS
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