Smart Utilization Review Nurse considered critical thinker and problem-solver due to dynamic patient care planning and understanding of Medicare guidelines. Known for having great rapport with providers and insurance carriers.
Overview
29
29
years of professional experience
1
1
Certification
Work History
Utilization Review Coordinator
Onslow Memorial Hospital
Jacksonville, NC
12.2019 - 08.2024
Identified potential areas of risk or non-compliance through regular audits, implementing corrective action plans as needed to mitigate concerns.
Provided ongoing education to clinical staff on the importance of proper documentation for optimal reimbursement and compliance with regulations.
Championed the importance of ethical decision-making within the Utilization Review Department, fostering an environment where all team members felt empowered to advocate for high-quality patient care.
Served as a trusted resource for clinical staff seeking guidance on appropriate levels of care, alternate treatment options, or clarification on insurance coverage requirements.
School Nurse
Onslow County Schools
01.2018 - 01.2019
Case management, Immunization records, Educating Staff, Medication Administration
Staff Nurse
Lifecare Hospitals of North Carolina
01.2011 - 01.2019
Preceptor, Direct Patient Care, Wound Care, Admission and discharge process, Critical Care Nurse
ICU Nurse
Onslow Memorial Hospital
01.2018 - 07.2018
School Nurse
Edgecombe County Health Department
01.2014 - 01.2015
Reviewing Immunizations, Writing Emergency Action Plans for Students, Managing Chronic Health Problems, Training Staff on Medications, Procedures, Diabetes, Bloodborne Pathogens, Maintaining Health Records on Students, Managing an Onsite Health Clinic, Vision Screenings
Emergency Room Nurse
Wilson Medical Center
10.2011 - 01.2012
Triage, Patient Care of all ages
Case managing chronic illnesses
Nash Rocky Mount Public Schools
08.2006 - 02.2011
Direct medical care for the children, Education for staff and children, Represented the Nash Rocky Mount School System on the Nash County Emergency Preparedness Committee, Vision and hearing screenings
ICCU Staff Nurse (W/E Option)
Nash Health Care Systems
01.2001 - 01.2006
CCU Float, Charge Nurse, Preceptor (new employees and nursing students), Duties included patient care, staff assignments, calendar coverage for call outs, glucose monitoring controls, bed assignments for new admissions and transfers, assisting other staff members as needed, orienting new staff members, precepting nursing students and checking Medsure for discrepancies.
Lead Nurse in the Nash County Detention Center
Nash County Health Department
01.1999 - 01.2001
In charge of staff training (Blood Borne Pathogens, diabetes and medications), Administering medication to the inmates, checking medications they came in with, ordering medications for inmates that had not been on medication prior to incarceration, Stabilizing inmates that came in with a crisis due to noncompliance on the streets, Attending to inmates in withdrawal and recognizing when hospitalization was needed, Following standing orders while running a sick clinic, Assisting with weekly STD clinics, Assisted in updating and writing the medical policies for the jail
PCU-South (now CPSU) Staff Nurse
Nash Health Care Systems
01.1997 - 01.1999
Duties included patient care, monitoring NA duties, reading and posting EKG strips, assisting in transferring patients and any other duties as assigned by the charge nurse.
PCU-South (CPSU)
Nash Health Care Systems
01.1996 - 01.1997
NAII, Duties included assisting the nurse, baths, vital signs, walking the patients, bathroom assistance and any other duties as assigned by the nurse within my scope of practice.
Education
College Prep Classes -
Southwest Edgecombe High School
BSN - BSN
Barton College
Wilson, NC
05.1997
Skills
HIPAA Compliance
Quality Improvement
Healthcare regulations
Interdisciplinary Collaboration
Utilization Management
Case Review Expertise
Medical Necessity Assessment
Insurance Verification
Medicare knowledge
Documentation And Reporting
Interpersonal and written communication
Medicaid knowledge
Utilization review
Teamwork and Collaboration
Time Management
Multitasking
Excellent Communication
Critical Thinking
Organizational Skills
Team Collaboration
Certification
ACLS Certification current
PALS certified in the past
National School Nurse Certification (expired)
Affiliations
Barton College Association of Nursing Students, 1995-1997, President my senior year
North Carolina Association of Nursing Students, 1995-1997, District 3 Director on the State Board my senior year
Volunteer Experience
Stony Creek Fire and Rescue Squad, 1985-1995, Rescue Captain, In charge of special events and public relations
Utilization Review Coordinator at MaineHealth Maine Medical Center BiddefordUtilization Review Coordinator at MaineHealth Maine Medical Center Biddeford