CHRISTINE ANDERSON
Tampa,FL
Summary
Accomplished Pre-Service Review Nurse with extensive experience at UMR INSURANCE, specializing in Prior Authorization Management and Collaborative Team Management. Demonstrated ability to enhance workflow efficiency by consistently meeting URAC deadlines while ensuring high-quality patient care through meticulous medical documentation. Proven expertise in workflow optimization and comprehensive patient support, effectively combining technical skills with a strong commitment to teamwork.
Overview
10
10
years of professional experience
Work History
Pre-Service Review Nurse
UMR INSURANCE
Tampa, FL
06.2018 - Current
- Utilized clinical guidelines to ensure high-quality, cost-effective patient care.
- Evaluated prior authorization requests for appropriate care and setting.
- Ensured that all documentation was accurate and up-to-date according to established guidelines.
- Submitted cases to physician or medical director for authorization not meeting guidelines.
- Working with the supervisor to address deficiencies and develop ways to better support the team.
- Managed multiple tasks simultaneously while prioritizing urgent requests from providers.
- Adhered to URAC deadlines consistently.
- Distribute daily TAT reports to team members and supervisors.
- Performed daily inventory management, distributing cases to DME, Quantum Health, KAT, Pre-D, and Therapy teams.
Registered Nurse
USF MORSANI SURGERY CENTER
Tampa, FL
02.2017 - 06.2018
- Assessment of patient physiological, psychological, developmental, sociocultural, spiritual, and other lifestyle factors for optimal patient surgical readiness.
- Interpretation of diagnostic data of the patient's actual and potential health conditions for proper patient surgical preparedness and minimization of surgical schedule case cancellations.
- Managed multidisciplinary aspects of patient care among surgical departments.
- Provided recovery support to patients after undergoing various types of surgeries including General and specialized surgical procedures in an outpatient clinic.
- Performed post-patient assessment, review of history, discharge planning, and review of diagnostic studies, with appropriate follow-through and physician consultation.
- Administered treatment protocols for post-surgery patients.
- Reviewed and readied patients, families, significant others for discharge.
- Generated comprehensive reports for hospital transfers.
Registered Nurse
BAYFRONT HEALTH DADE CITY
Dade City, FL
12.2014 - 05.2017
- Assessment of patient physiological, psychological, developmental, sociocultural, spiritual, and other lifestyle factors for optimal patient surgical readiness
- Interpretation of diagnostic data of the patient's actual and potential health conditions for proper patient surgical preparedness and minimization of surgical schedule case cancellations.
- Coordinated patient care across surgical departments, anesthesia team and pre-op staff.
- Managed postoperative care for a variety of surgical procedures such as General Surgery and specialized operations like Orthopedic and Gynecologic.
- Reviewed diagnostic studies with appropriate follow-through and consulted physicians.
- Supervised post-surgery pain and site management.
- Coordinated discharge plans with families and significant others.
- Facilitated patient transfers by implementing treatment plans and providing thorough documentation to relevant nursing departments.
Education
ASSOCIATATES OF SCIENCE - NURSING
GALEN COLLEGE OF NURSING
ST. PETERSBURG, FL06-2014
Skills
- Implementation of Care Plans
- Detailed Medical Documentation
- Workflow and patient management
- HIPAA protocol adherence
- Comprehensive Patient Support
- Prior Authorization Management
- Collaborative Team Management
- Internal Process Auditing
Leadership Experience
- Preceptor for onboarding nurses
- Resource Lead for New and Changing Processes
- Standard Operating Procedures (SOP) for Behavioral Health: Developed guidelines for Level of Care Types and Approval Timeframes
- Application of nursing knowledge and skills in compliance with policies, procedures, and regulatory standards
- Collaborated effectively with an interdisciplinary team of physicians, physical therapists, case management, and floor nurses
- Initiated and managed the Joint Replacement Coordinator position
- Managed personnel and clinical operations for all joint replacement patients
- Developed and maintained senior relationships with hospital joint ventures
Personal Information
- License: Florida Board of Nursing #RN9393860
- Title: Registered Nurse - Nurse Reviewer
Accomplishments
- Completion of Inspire Mentor/Mentee Program
Timeline
Pre-Service Review Nurse
UMR INSURANCE
06.2018 - Current
Registered Nurse
USF MORSANI SURGERY CENTER
02.2017 - 06.2018
Registered Nurse
BAYFRONT HEALTH DADE CITY
12.2014 - 05.2017
ASSOCIATATES OF SCIENCE - NURSING
GALEN COLLEGE OF NURSING
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