Crystal Richard
Nederland,TX
Summary
Accomplished Utilization Review Nurse with a proven track record at Managed Care Concepts, adept in reducing healthcare costs by efficiently utilizing resources and eliminating unnecessary procedures. Expert in HIPAA compliance and critical thinking, I excel in improving patient care quality through meticulous reviews and adherence to medical guidelines. Skilled in fostering teamwork and collaboration, I ensure compliance with regulatory standards.
Overview
19
19
years of professional experience
Work History
Utilization Review Nurse
Managed Care Concepts
06.2009 - Current
- Reduced healthcare costs through efficient utilization of resources and identification of unnecessary treatments or procedures.
- Ensured compliance with regulations and accreditation standards by maintaining accurate documentation of all utilization review activities.
- Maintained professional competence by staying current on industry trends, best practices, and regulatory requirements specific to utilization review nursing.
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Improved patient care quality by conducting thorough utilization reviews and making recommendations for optimal treatment plans.
- Submitted cases for criteria failures and helped facilitate resolutions and approvals.
Charge Nurse
Arboretum of Winnie
12.2005 - 11.2008
- Trained new nurses in proper techniques, care standards, operational procedures, and safety protocols.
- Coordinated nursing care on unit through staff assignments, assisting and rounding with physicians, monitoring patient orders, and communicating with appropriate departments.
- Conducted daily shift briefs to inform staff of changes in patient care assignments.
Education
LVN - Health Care
Lamar State College
Orange, TX12.2005
Skills
- Documentation And Reporting
- Records analysis
- Interpersonal and written communication
- HIPAA Compliance
- Medical Coding
- Milliman Guidelines
- Teamwork and Collaboration
- Time Management
- Attention to Detail
- Critical Thinking
Timeline
Utilization Review Nurse
Managed Care Concepts
06.2009 - Current
Charge Nurse
Arboretum of Winnie
12.2005 - 11.2008
LVN - Health Care
Lamar State College
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