Eileen Anderson
Media,PA
Summary
Registered nurse with 18+ years of critical care and utilization management experience. Trained in First level/concurrent review, denial/appeals, and condition code 44 workflows for inpatient and outpatient stays. Proficient in Medicare requirements, Interqual and MCG criteria, and HIPAA-compliant documentation. Familiar with Microsoft Office, electronic medical records, and healthcare databases.
Overview
2027
2027
years of professional experience
Work History
FLR RN
Optum Physician Advisor Solutions and UM
Newtown Square, Pennsylvania
01.2024 - Current
- Applied InterQual and MCG criteria to ensure appropriate patient care during inpatient and observation reviews
- Documented clinical findings in Optum utilization review systems to facilitate accurate utilization assessments
- Escalated complex cases to physician advisors for further review
- Collaborated with team members on departmental chart review projects and participated in Review Partner collaborations and new annotation pilot to enhance review processes
Nurse Manager
Optum Physician Advisor Solutions and UM
Newtown Square, Pennsylvania
02.2009 - 06.2020
- Promoted to Manager of Concurrent Nursing team, overseeing nursing supervisors and collaborating with departments on pilots and projects.
- Oversaw a team of nurses as Nursing Supervisor, managing daily work queue to ensure efficient case handling.
- Developed NCC case process and contributed to global expansion and creation of a Nursing quality tool with company leadership.
- Assisted in the creation of the new Nursing Concurrent Denial process and role expansion.
- Initially hired for frontline client facing telephonic nurse responsible for new case intake, denials and continued stay case updates while upholding confidentiality per company and HIPAA regulations.
Emergency Room Nurse
Lankenau Hospital
Wynnewood, Pennsylvania
2008 - 2009
- Provided direct critical care and triage in a fast-paced emergency room, ensuring timely patient interventions
- Conducted initial nursing assessments using standing orders to stabilize patients and initiate ongoing care
- Executed vital sign assessments, IV placements, blood draws, medication administration, wound care, and EKGs while maintaining comprehensive nursing documentation and patient charting
Staff Registered Nurse, Emergency Room
Roxborough Memorial Hospital
Philadelphia, Pennsylvania
2005 - 2008
- Provided direct critical care and triage in fast-paced Emergency Room, performing initial nursing assessments and utilizing standing orders to stabilize patients and initiate care.
- Delivered emergency nursing care in Roxborough Memorial Hospital emergency department.
- Assessed patient conditions and prioritized care for acute cases.
- Assessed vital signs, placed IVs, drew blood, administered medications, provided wound care, and performed EKGs while training newly hired nursing staff and maintaining detailed nursing documentation.
- Administered medications and treatments following hospital protocols.
Education
Diploma - Nursing
Roxborough School of Nursing
Philadelphia, PA05-2003
Master of Science - Secondary Education
Saint Joseph's University
Philadelphia, PA05-2003
Bachelor of Arts - English Literature
Saint Joseph's University
Philadelphia, PA05-1999
Skills
- Process Development and Training
- InterQual and MCG criteria
- Utilization review
- Optum systems
- Clinical documentation
- Case management
- Quality improvement initiatives
- Clinical judgment
- Cross-functional collaboration
- Electronic Medical Record Systems
Timeline
FLR RN
Optum Physician Advisor Solutions and UM
01.2024 - Current
Nurse Manager
Optum Physician Advisor Solutions and UM
02.2009 - 06.2020
Emergency Room Nurse
Lankenau Hospital
2008 - 2009
Staff Registered Nurse, Emergency Room
Roxborough Memorial Hospital
2005 - 2008
Diploma - Nursing
Roxborough School of Nursing
Master of Science - Secondary Education
Saint Joseph's University
Bachelor of Arts - English Literature
Saint Joseph's University