Deborah Winter, BSN, RN
Waterville,OH
Summary
Highly motivated and knowledgeable nursing professional with greater then 25 years of clinical experience. Reliable and responsible problem solver with excellent multitasking skills, attention to detail, and ability to work independently or as part of a team to coordinate high quality patient services and care. Possesses effective communication and organizational skills, with ability to gain a rapport with patients, families, coworkers and physicians.
Overview
25
25
years of professional experience
1
1
Certification
Work History
Utilization Management Nurse 2- Front End Review
Humana, Inc.
05.2023 - 04.2024
- Reviewed clinical information from hospitals via faxes and various EHR's, including Epic.
- Conducted UM concurrent inpatient admission reviews for Medicare population for medical necessity using MCG guidelines.
- Collaborated and communicated with Regional Medical Director as needed for appropriate determination of cases.
- Applied clinical knowledge, communication and critical thinking skills while working independently to interpret criteria, policies and procedures to provide appropriate treatment, care and services for members.
Utilization Management Nurse
St. Luke's Hospital
01.2016 - 05.2023
- Performed concurrent and retrospective utilization management documentation to ensure appropriate data is tracked, evaluated, and reported.
- Reviewed cases for medical necessity using InterQual to determine proper level of care and necessity of services provided.
- Facilitated peer to peer reviews.
- Collaborated with providers/ physicians when medical necessity or appropriateness of care is questioned in accordance with established standards of practice.
Patient Care Coordinator, Cardiac Stepdown Unit
St. Luke's Hospital
12.2007 - 12.2015
- Supervised a 23 bed unit using best practice standards and quality management. In addition, performed scheduling, staffing, payroll and performance appraisals.
- Ensured collaborated care of patients from the time of admission to the time of discharge with high quality of care performed for best patient outcomes.
- Maintained effective communication between physicians, care team, patients and families in order to have a shared understanding of goals and expectations of care.
- Responsible for managing a patient assignment in order to meet the demands of a fast paced unit when short staffed.
Staff Nurse, Cardiac Stepdown Unit
St. Luke's Hospital
09.1999 - 12.2007
- Assessed physical, psychological, physiologic, and cognitive status of patients.
- Directed patient care by initiating and following through with plan of care, continuing care, and discharge instructions.
- Educated patients, families, and caregivers on diagnosis and prognosis, treatment options, disease process and management, and lifestyle options.
- Assisted with onboarding new staff members, providing guidance and mentorship.
Education
Bachelor of Science - Nursing
Chamberlain College of Nursing
Downers Grove, ILAssociate of Science - Nursing
Owens Community College
Perrysburg, OHSkills
- Detail oriented
- Effective communication
- Problem solving
- Critical thinking
- Strong clinical judgement
- Organization
- Flexible
- Teamwork
- Care coordination
- EHR/EMR
- Microsoft Office
Certification
- Basic Life Support (BLS), American Heart Association
- Advance Cardiovascular Life Support (ACLS), American Heart Association.
Timeline
Utilization Management Nurse 2- Front End Review
Humana, Inc.
05.2023 - 04.2024
Utilization Management Nurse
St. Luke's Hospital
01.2016 - 05.2023
Patient Care Coordinator, Cardiac Stepdown Unit
St. Luke's Hospital
12.2007 - 12.2015
Staff Nurse, Cardiac Stepdown Unit
St. Luke's Hospital
09.1999 - 12.2007
Bachelor of Science - Nursing
Chamberlain College of Nursing
Associate of Science - Nursing
Owens Community College
- Basic Life Support (BLS), American Heart Association
- Advance Cardiovascular Life Support (ACLS), American Heart Association.
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