Colleen States
Gilbertsville,PA
Summary
Experienced Registered Nurse with 18 years in insurance consulting for auto injury and workers compensation claims, complemented by 4 years in inpatient medical-surgical nursing and 2 years in primary care pediatrics. Expertise in medication utilization reviews and prior authorization processes, driving healthcare cost savings and improved patient outcomes. Ready to leverage diverse clinical experience in a Case Management role.
Overview
25
25
years of professional experience
Work History
Primary Care Staff Nurse
Pediatric Associates of Plymouth
05.2002 - 05.2004
- Cared for patients in primary care setting, ages newborn to 18, ensuring comprehensive health assessments and individualized care plans. Administered vaccines, provided first aid, and managed clinic schedules.
- Assessed pediatric patients, collected vitals, and documented findings in electronic health records.
- Administered immunizations and medications while following pediatric safety protocols.
- Educated families on treatment plans, preventive care, and follow-up instructions.
Preservice Review Nurse
Optum
02.2008 - Current
- Reviewed medication prior authorization requests for workers compensation injury claims, resulting in healthcare cost savings and improved patient outcomes. Additionally, reviewed treatment prior authorization requests for auto injury claims, resulting in cost savings and improved healthcare efficiency.
- Developed workflow documents and job aides for contract development, enhancing mentoring and guiding of determinations.
- Collaborated with coworkers, management, leadership, IT, and clients to streamline workflow processes, ensuring accuracy and transparency.
- Utilized Excel, Microsoft Word, and Microsoft Teams for effective teamwork and project coordination.
Medical-Surgical Staff Nurse
Montgomery Hospital
07.2004 - 02.2008
- Cared for patients with diverse medical-surgical needs, focusing on cancer patients and those requiring chronic mechanical ventilation, ensuring comprehensive and compassionate care.
- Managed staffing schedules for the unit and assigned patients before shift changes. Mentored many new staff members.
- Performed comprehensive patient assessments and documented findings in electronic health record
- Administered medications and monitored responses for changes in condition
- Coordinated care with physicians, respiratory therapists, and interdisciplinary team members
Education
Master of Science - Nursing
Drexel University
Philadelphia, PA09-2012
Bachelor of Science - Nursing
Gwynedd-Mercy University
Gwynedd Valley, PA05-2004
Associate of Science - Nursing
Gwynedd-Mercy University
Gwynedd Valley, PA01-2002
Skills
- Workflow organization
- Tools: Excel, Windows, Teams
- Additional: Clinical Review Expertise, Subject Matter Expert for California Workers ComprehensiveHealthcare Policy knowledge of mechanical ventilationChronic Care Management
- Patient education
- Patient safety
- Direct patient care
- Patient assessment
Personal Information
Title: Registered Nurse
Timeline
Preservice Review Nurse
Optum
02.2008 - Current
Medical-Surgical Staff Nurse
Montgomery Hospital
07.2004 - 02.2008
Primary Care Staff Nurse
Pediatric Associates of Plymouth
05.2002 - 05.2004
Associate of Science - Nursing
Gwynedd-Mercy University
Bachelor of Science - Nursing
Gwynedd-Mercy University
Master of Science - Nursing
Drexel University