Dominique Levy
Jacksonville,,FL
Summary
Professional nurse with extensive experience in critical care and utilization review. Skilled in analyzing patient care and ensuring compliance with healthcare regulations. Strong focus on team collaboration and achieving optimal patient outcomes. Adaptable and reliable, excelling in dynamic environments requiring precise decision-making and effective communication.
Overview
13
13
years of professional experience
1
1
Certification
Work History
Utilization Review Nurse
NETSMART
Remote
06.2024 - Current
- Conduct Initial and Concurrent reviews for medical necessity
- Review each case under appropriate criteria (InterQual, MCG w/AI)
- Communicate regularly with MD & other members of treatment team
- Send cases to physicians for secondary review
- EMR Systems (EPIC, Cerner)
- Insurance Verification
- Prioritize work que
Concurrent Review Nurse II
WELLCARE/CENTENE
Remote
01.2018 - 12.2023
- Conduct remote concurrent review of CMS, Medicare & Medicaid members using EMR, EPIC, Cerner, InterQual, & MCG to validate medical necessity of facility admissions & talk with members regarding the status and treatment plan
- Provides authorization to facilities using standard clinical criteria guidelines in conjunction with clinical judgment to determine the needed care required within the patient's individualized created care plan
- Initiates and continues direct communication with health care providers involved in the care of members, including treating physicians, IPA and/or hospitals, to share information and collaboratively establish acute and post-acute treatment plans for hospitalized members
- Responsible for coding and applying correct ICD-10-CM
- Interacts with treating physicians and health plan medical directors to evaluate medical treatment plan, and assesses opportunities for optimizing clinical outcomes through referrals to specialty care programs or an alternate level of care
- Documents clinical updates, authorizations and referrals in the health plan medical management system adhering to health plan documentation standards
- Utilizing clinical judgment, assesses and evaluates members at risk for complicated medical comorbidities, and/or repeat admissions potential, and determines individualized care plan for communication and interventions to promote successful discharge and post-acute care treatment plan
- Coordinates authorization and/or delivery of post-acute care services, including, but not limited to referrals to case and disease management, home health, medical equipment, skilled nursing facilities and other community based services
- Provides members with educational resources to enhance their ability to access health care services, including health plan contacts, primary care physician and other pertinent health care provider contacts
- Facilitates referrals for post-discharge follow up with appropriate professional providers and support services (i.e., transportation) to ensure that members are able to access medically necessary services after discharge
- Performs special projects as assigned (i.e., preceptor for new employees, reference point for colleagues on new policies/procedures).
Registered Nurse Emergency Room
UF Health Jacksonville
Jacksonville, FL
01.2015 - 01.2018
- Provide direct nursing care in accordance with hospital policies and procedures
- Triage patients to appropriate areas
- Participate in peer reviews & interviews as requested
- Support Evidence Base Research & Implement best practices
- Participate in annual employee health fair
- Medication Administration
- Coordinate safe discharge & transportation services from Emergency Room
- Facilitate throughput, identify needs & utilization of community resources
- Educate patient on plan of care & include caregiver and treatment team
- Serve as patient advocate by providing compassionate individualized care
- Multi task in a high volume environment
- Informed uninsured patients how to apply for Shands insurance card.
- Prevented the spread of infections by consistently adhering to strict infection control protocols and educating patients on proper hygiene practices.
- Assisted in the training and mentorship of new nursing staff members, contributing to a positive work environment and high-quality patient care.
- Promoted a culture of safety within the healthcare facility by participating in quality improvement initiatives, identifying potential hazards, and advocating for best practices in nursing care delivery.
- Skillfully managed challenging patient situations using de-escalation techniques, crisis intervention strategies, and therapeutic communication skills.
- Provided support for patients'' families during difficult medical decisions or end-of-life care, serving as a liaison between the healthcare team and loved ones.
- Utilized critical thinking skills to prioritize nursing interventions based on patients'' acuity levels and individual needs.
- Participated in ongoing professional development opportunities to stay current on best practices in nursing care and emerging trends in healthcare delivery.
- Conferred with physicians to discuss diagnoses and devise well-coordinated treatment approaches.
Registered Nurse Medical Surgical Unit
Baptist Medical Center Downtown
Jacksonville, FL
01.2014 - 01.2015
- Provide direct nursing care in accordance with hospital policies and procedures
- Process Admissions & Discharges
- Medication Administration
- Conduct bedside rounds with treatment team
- CERNER Super User.
- Improved patient outcomes by providing comprehensive assessments and developing individualized care plans.
- Reduced hospital readmissions by implementing evidence-based discharge planning and coordinating follow-up appointments.
- Collaborated with interdisciplinary teams for optimal patient care, ensuring seamless communication between healthcare providers.
- Contributed to successful Joint Commission accreditation through strict adherence to policies and procedures.
- Mentored new staff members and nursing students, fostering a supportive learning environment within the unit.
- Managed complex wound care, including dressing changes, monitoring for signs of infection, and collaborating with wound care specialists as needed.
- Facilitated timely discharges by proactively addressing potential barriers to transition such as insurance coverage or transportation issues.
- Developed strong rapport with patients and families through active listening, empathy, and clear communication during challenging situations.
- Provided education on disease management strategies to empower patients in self-care activities throughout their recovery journey.
- Implemented fall prevention strategies to minimize patient injuries and promote a safe environment within the medical-surgical unit.
- Consistently maintained accurate documentation of patient assessments, interventions, and outcomes in accordance with regulatory requirements.
- Educated patients and families on medical-surgical procedures, therapeutic regimens, and pain management techniques.
Registered Nurse Behavioral Health
Daniel Memorial
Jacksonville, FL
01.2013 - 01.2015
Education
Bachelor of Science in Nursing - Nursing
Florida A&M University
Tallahassee, FL05-2013
Skills
- InterQual criteria
- Utilization review
- Quality improvement
- Discharge planning
- Medicaid
- Medicare
- Managed care
- Case management
- Teamwork and collaboration
- Time management
- Adaptability and flexibility
- Milliman guidelines
Certification
- RN 9372384
Timeline
Utilization Review Nurse
NETSMART
06.2024 - Current
Concurrent Review Nurse II
WELLCARE/CENTENE
01.2018 - 12.2023
Registered Nurse Emergency Room
UF Health Jacksonville
01.2015 - 01.2018
Registered Nurse Medical Surgical Unit
Baptist Medical Center Downtown
01.2014 - 01.2015
Registered Nurse Behavioral Health
Daniel Memorial
01.2013 - 01.2015
Bachelor of Science in Nursing - Nursing
Florida A&M University