Summary
Overview
Work History
Education
Skills
Certification
References
Timeline
Generic

Donnese Clark

Pottsboro,Tx

Summary

A self-motivated, dedicated, and hardworking individual with a strong desire to acquire new skills and techniques in the clinical setting. Flexible team player excelling in interpersonal communication and thriving in dynamic environments. Exceptional time management and prioritization skills, coupled with a keen eye for detail and strong organizational abilities. Demonstrates a caring and compassionate nature, committed to delivering high-quality healthcare to diverse patient populations.

Overview

13
13
years of professional experience
1
1
Certification

Work History

Prior Authorization Nurse

Cigna
05.2022 - Current
  • Streamlined the prior authorization process, reducing wait times and improving overall efficiency.
  • Assisted in maintaining compliance with changing regulations and policies by staying up-to-date on industry trends and best practices.
  • Mentored new hires within the team, sharing expertise in navigating complex insurance guidelines and best practices for managing workflow efficiently.
  • Participated in interdisciplinary team meetings, collaborating with other healthcare professionals to ensure seamless coordination of care for patients requiring prior authorizations.
  • Worked closely with case managers to facilitate appropriate utilization of healthcare resources through the prior authorization process.

Utilization Review Nurse

Cigna
10.2018 - Current
  • Request key information that could influence the outcome of an appeal decision
  • Conducts IP and OP clinical reviews on all failure to secure authorization claims
  • Applies the appropriate nationally established medical necessity clinical criteria guidelines and policies to render pre or post service clinical decision based on customer’s clinical information.
  • Improved patient care quality by conducting thorough utilization reviews and making recommendations for optimal treatment plans.

Registered Nurse, Pediatrics

Texoma Medical Center
05.2011 - 10.2018
  • 3 years Acute Med-Surg, 4 Years Acute Care Pediatrics, Pediatric Charge nurse, Cross trained to Newborn Nursery.

Education

Bachelors of Science in Nursing -

University of Cincinnati
05.2016

Associates Degree in Nursing -

Grayson County College
05.2011

Skills

  • HIPAA Compliance
  • Clinical Documentation
  • Training and mentoring
  • Clinical assessment
  • Care Coordination
  • Healthcare regulations
  • Professional Demeanor
  • Adaptability
  • Time management abilities

Certification

  • Texas Registered Nurse License, 803319
  • Basic Life Care Support for Providers (BLS)
  • Advanced Cardiac Life Support for Providers (ACLS)
  • Pediatric Advanced Life Support for Providers (PALS)
  • Neonatal Resuscitation Program (NRP)

References

Available upon request

Timeline

Prior Authorization Nurse

Cigna
05.2022 - Current

Utilization Review Nurse

Cigna
10.2018 - Current

Registered Nurse, Pediatrics

Texoma Medical Center
05.2011 - 10.2018

Bachelors of Science in Nursing -

University of Cincinnati

Associates Degree in Nursing -

Grayson County College

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Donnese Clark