Diane Payne
Fort Worth,TX
Summary
Detail-oriented Licensed Vocational Nurse (LVN) with 30+ years of direct patient care and 3+ years in clinical review and utilization management. Expert in medical necessity reviews,Proven ability to reduce denial rates by 18% through accurate documentation and appeals support. Seeking to leverage clinical judgment and analytical skills in a Clinical Review Nurse capacity.
Knowledgeable LVN with solid background in patient care and support, ensuring optimal comfort and safety for all individuals. Proven history of assisting in medical procedures and providing essential patient education. Demonstrated ability to manage patient records accurately and collaborate effectively with healthcare teams.
Overview
16
16
years of professional experience
1
1
Certification
Work History
LVN
Mercy Staffing
05.2021 - Current
- Administered medications and treatments as prescribed by physicians to ensure patient compliance and comfort.
- Monitored vital signs and reported changes in patient conditions to nursing staff for timely interventions.
- Assisted in developing individualized care plans based on patient assessments and preferences, enhancing overall care quality.
- Educated patients and families on health management practices, fostering understanding of treatment regimens and recovery processes.
LVN
CSL Plasma Center
10.2020 - 04.2022
- Screened clients for plasma donation
- Documented Fitness to donate
- Conducted physicals on all new donors
- Identified and escalated potential utilization issues to case management, preventing inappropriate documentation
Utilization Review Nurse (LVN)
Continuous Care Solutions
01.2010 - 03.2022
- Conduct 150+ weekly clinical reviews for inpatient, outpatient, and SNF admissions using InterQual criteria, achieving 97% accuracy in medical necessity determinations.
- Collaborate with physicians and case managers to resolve 85% of pending authorizations within 24 hours, reducing delays in patient care.
- Prepare appeal letters supported by evidence-based rationale, overturning 22% of initial denials (saved $340K in reimbursements YTD).
- Help with new employees to organize work assignments
Education
Vocational Nursing Diploma - Practical Nursing
Trott Vocational High School
Niagara Falls, NY06-1980
Skills
- Medical Necessity & Utilization Review
- MCG Guidelines
- Chart Audits & Documentation Compliance
- Prior Authorization Processing
- Appeals & Denial Management
- HIPAA
- CMS
- State Regulations
- Epic
- Meditech
- Allscripts
- Case Management Collaboration
- Clinical Platforms
- Review Tools
- Change Healthcare
- Microsoft Office
- Adobe Acrobat
Certification
- Licensed Vocational Nurse (LVN), Texas Board of Nursing, 155684 2026-31-01
- BLS (AHA), IV Therapy & Blood Withdrawal Certified
Timeline
LVN
Mercy Staffing
05.2021 - Current
LVN
CSL Plasma Center
10.2020 - 04.2022
Utilization Review Nurse (LVN)
Continuous Care Solutions
01.2010 - 03.2022
Vocational Nursing Diploma - Practical Nursing
Trott Vocational High School
Professional Development
- NCQA Standards for Utilization Management - Webinar Series, 2023
- HIPAA Compliance & Documentation, Relias Learning, 2023