CYNTHIA REPINE
Owenton,KY
Summary
Experienced Utilization Review Nurse skilled in necessity assessment, clinical decision-making, and ensuring medical documentation accuracy. Committed to enhancing patient care through meticulous reviews and effective collaboration with healthcare teams.
Overview
23
23
years of professional experience
Work History
Utilization Review Nurse
Lucent Health Solutions
Nashville, Tennessee
09.2019 - 03.2026
- Conducted comprehensive reviews of patient care plans to ensure medical necessity and compliance with organizational standards.
- Assessed patient medical records to determine the appropriateness of requested services and procedures.
- Applied medical criteria and clinical judgement to researched cases to evaluate and establish determinations.
- Reviewed appeals for denied services, providing actionable recommendations that facilitated timely resolutions.
- Trained new staff on utilization review processes, enhancing team understanding and adherence to best practices.
- Served as a resource for staff members seeking guidance on utilization review matters.
CASE MANAGER/UTILIZTION REVIEW RN
Baptist Health Floyd
New Albany, Indiana
02.2018 - 08.2019
- Coordinated communication among patients, families, and medical staff to enhance care delivery.
- Educated clients about available services and resources within the healthcare system.
- Streamlined communication between clients, families, caregivers, and agencies to address client needs effectively.
- Adhered to ethical principles and standards to protect clients' confidential information.
OUTPATIENT CARDIOVASCULAR NURSE
Baptist Health Floyd Hospital
New Albany, IN
04.2014 - 01.2018
- Monitored vital signs pre and post procedure to uphold patient safety and comfort during angiography and stenting.
- Supported diagnostic procedures and cardiac assessments to ensure accurate evaluations and patient care.
- Interpreted and evaluated diagnostic tests to identify and assess patient's condition.
- Identified potential complications from existing conditions to proactively mitigate recovery challenges after cardiovascular procedures.
- Assisted in the insertion of temporary pacemakers for patients experiencing arrhythmias.
- Administered intravenous medications to treat heart failure symptoms such as fluid overload or hypertension.
- Responded to emergency situations with speed, expertise and level-headed approaches to provide optimal care, support and life-saving interventions.
- Coordinated discharge planning to ensure seamless transitions home and optimize patient recovery.
- Delivered compassionate emotional support to patients facing health challenges. to patients facing health challenges.
TCU CHARGE NURSE
Floyd Memorial Hospital
New Albany, Indiana
01.2010 - 04.2014
- Supervised nursing staff to improve patient care quality through effective leadership and guidance.
- Served as a preceptor for new nurses by providing orientation to unit policies and procedures, coaching on clinical skills, and mentoring on professional development issues.
- Managed nursing schedules, ensuring adequate staffing to meet patient needs.
- Coordinated and performed patient admissions, transfers and discharges.
- Organized and delegated tasks during rapid response and high-pressure code situations to ensure timely patient interventions.
- Oversaw staffing levels to maintain optimal patient care and provide necessary support for nursing staff.
Registered Nurse, PCU
Floyd Memorial Hospital
New Albany, IN
12.2005 - 01.2010
- Responded quickly to emergent situations in order to provide prompt interventions for critically ill patients.
- Delivered direct patient care in progressive care unit, enhancing patient recovery and comfort.
- Monitored and documented symptoms, reactions, and progress of patients, facilitating timely interventions and improving patient outcomes.
- Administered medications and ensured accurate documentation of therapies.
- Regulated medications and treatments according to physician orders.
- Collaborated with interdisciplinary teams to develop patient care plans.
- Collaborated with healthcare team during daily rounds to assess patient status and adjust care plans.
- Educated patients and families on treatment procedures and discharge instructions, empowering them for effective post-discharge management.
- Utilized electronic health record systems for patient data management.
- Observed strict safety measures, including checking medication dosages before administration to patients.
- Implemented new processes and standards that aligned with departmental goals, enhancing in-patient care quality.
MED SURG RN
Floyd Memorial Hospital
New Albany, Indiana
05.2003 - 12.2005
- Assessed patient needs, prioritized treatment, and streamlined patient flow while assisting physicians with non-invasive procedures to enhance care delivery.
- Assessed clinical situations quickly and accurately using critical thinking skills to inform timely interventions.
- Evaluated effectiveness of interventions through ongoing assessment of patient responses.
- Collaborated with multidisciplinary team to develop and implement individualized treatment plans, ensuring comprehensive patient care.
- Maintained accurate patient charts throughout shifts, supporting compliance with recordkeeping standards and facilitating effective communication among care team.
- Conducted intake assessments with patients and relatives to gather case history.
- Collaborated effectively with team members while also demonstrating independence in patient care.
Education
Associate of Science - Nursing
Ivy Tech Community College
Sellersburg, IN05-2003
Skills
- Necessity assessment and utilization management
- Medical necessity evaluation
- Clinical decision making and critical thinking
- Milliman guidelines adherence
- Prior authorization processes
- Inpatient care coordination
- Electronic health records management
- Medical documentation accuracy
- Team collaboration and communication
- Time management and scheduling
- Attention to detail
Timeline
Utilization Review Nurse
Lucent Health Solutions
09.2019 - 03.2026
CASE MANAGER/UTILIZTION REVIEW RN
Baptist Health Floyd
02.2018 - 08.2019
OUTPATIENT CARDIOVASCULAR NURSE
Baptist Health Floyd Hospital
04.2014 - 01.2018
TCU CHARGE NURSE
Floyd Memorial Hospital
01.2010 - 04.2014
Registered Nurse, PCU
Floyd Memorial Hospital
12.2005 - 01.2010
MED SURG RN
Floyd Memorial Hospital
05.2003 - 12.2005
Associate of Science - Nursing
Ivy Tech Community College