Elizabeth Burkhart

• Reviewed patient cases for medical necessity and appropriateness of care.
• Collaborated with healthcare providers to determine treatment plans.
• Utilized electronic health records to document and track utilization reviews.
• Communicated with patients regarding their care options and benefits.
• Analyzed data to identify trends in healthcare utilization patterns.
• Developed educational materials for staff on utilization review processes.
• Participated in interdisciplinary team meetings to discuss complex cases.
• Ensured compliance with regulatory standards and company policies in reviews.
• Assessed patient medical records to determine the appropriateness of requested services and procedures.
• Served as a resource for staff members seeking guidance on utilization review matters.
• Evaluated clinical documentation for accuracy and completeness in order to make decisions about coverage determinations.
• Applied medical criteria and clinical judgement to researched cases to evaluate and establish determinations.
• Conducted reviews of inpatient utilization for compliance with admission criteria and concurrent review requirements.
• Provided education to providers regarding utilization management processes and protocols.
• Maintained up-to-date knowledge of health plan benefits, policies, procedures, regulations, coding guidelines.
• Monitored pre-authorization requests to ensure that all necessary information was received prior to approval or denial of services.
• Collaborated with providers to obtain required clinical information, supporting prior authorization determinations and individual inquiries.
• Remained up-to-date on various benefit plans, medical policies and state-specific clinical guidelines or criteria.
• Reviewed denial letters issued by insurance companies to ensure that they were appropriate and timely.
• Developed case management plans based on individual patient needs and eligibility criteria.
• Participated in provider meetings to discuss cases involving complex medical conditions or difficult authorization decisions.
• Collaborated with staff members in group meetings to identify issues and find cost-effective solutions.
• Coordinated with other departments within the organization regarding changes in policy or procedure implementation.
• Communicated with external partners such as managed care organizations or vendors on a regular basis.
• Attended conferences and training sessions related to utilization review topics such as best practices or new technologies.
• Analyzed data from patient surveys, interviews and other sources to assess healthcare service quality.
• Performed discharge planning including referrals for post-acute care services when appropriate.
• Generated reports related to utilization management activities such as length of stay trends, denials rates.
• Collaborated with multidisciplinary teams on developing strategies for improving care quality and controlling costs.
• Achieved departmental goals and objectives by instituting new processes and standards for in-patient care.
• Collaborated with health groups to plan or implement programs designed to improve overall health of communities.
• Referred patients to specialized health resources or community agencies to furnish additional assistance.
• Advocated for patient needs with interdisciplinary team and implemented outlined treatment plans.
• Utilized computerized Resource and Patient Management System (RPMS) and Electronic Health Record (EHR) system.
• Interpreted and evaluated diagnostic tests to identify and assess patient's condition.
• Maintained strict patient data procedures to comply with HIPAA laws and prevent information breaches.
• Monitored patient admissions and discharges to optimize care coordination and resource utilization.
• Reviewed and updated utilization review criteria and guidelines to reflect current standards of practice.
• Collaborated with case managers to facilitate timely discharge planning and transition of care.
• Ensured compliance with federal, state, and accreditation requirements related to utilization management.
• Performed pre-certification, concurrent, and retrospective reviews of inpatient and outpatient services.

• Assessed competency of clinical staff to promote quality, continuity and safety.
• Implemented and directed clinical services and operations to deliver competent, quality care.
• Implemented changes needed to correct deficiencies found during government inspections.
• Evaluated staff performance and prepared accurate reports detailing findings.
• Developed and maintained staffing schedule in accordance with contract terms, budget mandates and accreditation standards for nursing coverage.
• Set and monitored achievement goals for nursing department consistent with established philosophy and standards of practice.
• Administered executive supervision, exercising independent judgment to select proper course of action in policies and procedures.
• Monitored development, implementation and updates of individualized care plans.
• Conducted recruitment and retention activities to develop highly skilled nursing team.
• Oversaw explanation of personnel policies and job descriptions as part of nursing employee orientation process.
• Reviewed daily documentation of dispensing of controlled substances, immediately noting discrepancies from shift to shift.
• Coordinated medical and health services in compliance with government regulations and policies set by board of trustees.
• Communicated with patients with compassion while keeping medical information private.
• Explained policies, procedures and services to patients.
• Collaborated with multi-disciplinary staff to improve overall patient care and response times.
• Built work schedules and staff assignments, taking workload, space and equipment availability into consideration.
• Maintained records management system to process personnel information and produce reports.
• Maintained communication and transparency with governing boards, department heads and medical staff.
• Recruited, hired and trained new medical and facility staff.
• Established solid relations with leadership and staff by attending board meetings and coordinating interdepartmental information exchanges.
• Maintained awareness of government regulations, health insurance changes and financing options.
• Directed, supervised and evaluated medical, clerical or maintenance personnel.
• Managed changes in integrated health care delivery systems and technological innovations while keeping focus on quality of care.
• Coordinated work activities and scheduling of medical, nursing and physical plant staff.
• Assessed need for additional staff, equipment and services based on historical data and seasonal trends.
• Planned and implemented programs for health care or medical facilities supporting personnel administration and training.
• Administered fiscal operations for accounting, budget planning, authorizing expenditures and coordinating reporting.
• Developed medical programs that promoted community health and research.
• Kept informed of advances in medicine and computerized diagnostic and treatment equipment.
• Updated procedures necessary for compounding, mixing, packaging and labeling medications.
• Reviewed non-contracted instrumentation for spine surgeries and initiated vendor contract evaluations in conjunction with operations staff and orthopedic spine and neurological spine specialists.
• Consulted with local and state health departments to report infectious cases.
• Investigated clusters and outbreaks to identify source of infection, educating healthcare personnel regarding short and long term control measures.
• Utilized graphic tools to present quality performance improvement projects.
• Communicated trend data and analysis to implement process improvement initiatives.
• Created and implemented new and improved procedures for controlling infections.
• Led working groups, investigations and continuous surveillance with specific focus on minimizing or eliminating infection spread.
• Trained staff on strategies for preventing outbreaks and procedural complications.
• Recognized areas for improved performance to protect employees, patients and visitors from infectious and communicable conditions.
• Collaborated with interdisciplinary teams to control specific disease entities and support quality initiatives.
• Conducted renovation inspections to comply with health requirements and assessed infection control and safety issues.
• Maintained continuous and stringent safety levels and took preventive measures to avoid spread of disease and infection.
• Managed files on procedures, infection rates and patient outcomes.
• Compiled, reviewed and modeled diverse infection information.
• Researched and developed methodologies, instrumentation and procedures to promote medical application and data analysis.
• Provided expertise over design, management and evaluation of study protocols and health status questionnaires to assist sample selection and analysis.
• Conferred with health department, industry personnel and physicians to plan, administer and evaluate health safety standards and programs that improve public health.
• Oversaw public health statistical analysis, health care planning and surveillance systems.
• Upheld requirements for data collection, reporting and quality control for duration of investigations.
• Compiled and arranged case data to complete weekly summaries.
• Wrote and submitted final reports detailing successes and failures in each investigation and recommended corrective actions.
• Identified key findings for each case, including location, severity and clinical findings.

• Assessed and prepared patients for procedures, performing initial and ongoing patient assessments.
• Monitored and managed various treatment and care interventions.
• Observed surgical procedures to closely monitor patient and quickly assist physician with potential complications or additional needs.
• Maintained aseptic environment to prevent patient infections or other unwanted outcomes.
• Cared expertly for individuals with wide array of medical issues such as pulmonary, cardiology and infectious disease patients.
• Informed patients, family members and caregivers of physician instructions for post-operative at-home care.
• Delivered physician-ordered treatments and monitored responses to quickly spot complications and side effects.
• Assessed patients using comprehensive evaluation techniques and sound clinical judgment.
• Developed and implemented individualized care plans to meet each patients' unique needs.
• Improved care outcomes with proactive education, communication and guidance for patients and family members.
• Coordinated with patient and attending physician in facilitating discharge and continuing needs for home care or transfer to extended care facility.
• Contributed toward meeting department financial targets on unit-based scorecard through decreasing length of stay and operating according to department specifications.
• Demonstrated high degree of confidentiality, positive interpersonal skills and adaptability in fast-paced and unpredictable medical environment.
• Deployed therapeutic communication and active listening and teaching to establish relationships with patients, families and health care team for optimum patient care.
• Supported patients receiving treatment by carefully listening and offering comfort.
• Championed new nursing care pathways and trends and improved health service to community.
• Monitored unexpected patient events, interactions or outcomes and recorded incident report in certain situations.
• Supported successful administration of care plans by communicating with cross-functional teams.
• Administered treatments, therapies and medication according to prescribed methods and protocols.

• Coordinated care with physicians and other clinical staff to prepare for treatment, carry out interventions and enhance continuum of care.
• Recorded patient condition, vital signs, recovery progress and medication side effects.
• Observed nurse administration of oral, intramuscular and IV medications to patients as prescribed, monitoring responses for adverse reactions.
• Conducted patient assessments and diagnostic tests to provide physician with important patient health information.
• Oversaw patient immunization, supporting nurses through vaccine-specific training and supervising administration.
• Maintained comprehensive base of unit supplies to meet expected patient demands, public health emergencies and mass casualty incidences.
• Trained other nurses on patient care and daily tasks, supporting growth and professional development.
• Delivered optimum treatments to critical-care patients following prescribed rules, policies, protocol and procedures.
• Developed and maintained professional relationship with members of health care team, patient and patient's family.
• Monitored patients' respiration activity, blood pressure and blood glucose levels in response to medical administration.
• Established and implemented nursing care plans for each patient using protocols of assessment, development, activation and evaluation.
• Completed patient assessments, triaged and recorded patient histories, symptoms and observations.
• Helped monitor, maintain and improve nursing-sensitive indicators, core measures and other identified outcome metrics.
• Functioned as charge nurse and assumed patient care in absence of nurses ending or arriving for shifts.
• Achieved best possible outcomes for nursing sensitive indicators, core measures, HCAPS, patient satisfaction and associate satisfaction.
• Participated in development, implementation and evaluation of action plans for continuous performance improvement.
• Identified problems, assisted in data gathering, proposed solutions and participated in evaluation of quality assurance issues.
• Worked with patients and families to provide in-hospital and after-hospital follow-up through teaching and referrals.
• Supported appropriate orientation, education, credentialing and continued professional development of associates.
• Maintained records, prepared reports and served on special committees.
• Assessed ICU patients each shift to ascertain vitals and key information.

• Assessed ICU patients each shift to ascertain vitals and key information.
• Evaluated patient vital signs and laboratory data to assess needs and provide emergency interventions.
• Identified abnormal and critical respiratory patterns through direct pulmonary assessments.
• Checked on patients regularly to track progress with treatments, changes in symptoms and need for emergency interventions.
• Administered medications by diverse means and tracked responses.
• Kept track of patients' changing pain levels and proactively worked to minimize excess pain or discomfort.
• Supervised cardiac monitors, mechanical ventilators and alarms and oxygen delivery devices.
• Detected emerging problems by monitoring patients' behavior, vital signs and fluid intake and output.
• Utilized computerized Resource and Patient Management System (RPMS) and Electronic Health Record (EHR) system.
• Stocked clinical workstations and procedure rooms with necessary supplies.
• Provided training and supervision to [Number]-member staff in [Type] unit.
• Worked successfully with diverse group of coworkers to accomplish goals and address issues related to our products and services.
• Worked closely with team members to deliver project requirements, develop solutions and meet deadlines.
• Prioritized and organized tasks to efficiently accomplish service goals.
• Juggled multiple projects and tasks to ensure high quality and timely delivery.
• Demonstrated self-reliance by meeting and exceeding workflow needs.
• Demonstrated leadership by making improvements to work processes and helping to train others.
• Provided excellent service and attention to customers when face-to-face or through phone conversations.
• Improved operations by working with team members and customers to find workable solutions.
• Motivated and encouraged team members to communicate more openly and constructively with each other.

Achieved departmental goals and objectives by instituting new processes and standards for in-patient care. Ensured HIPAA compliance. Assisted patients with multiple chronic diagnoses, including COPD and asthma, diabetes and gastrointestinal diseases. Care of pre and post surgical patients. Care for patients with multitude disease processes. Recognize acuity in patients during assessment and made appropriate decisions to transfer patient to ICU for critically ill patients.

Developed patient care plans, including assessments, evaluations, and nursing diagnoses.Helped physicians examine and treat patients by assisting with instruments, injections and suture removal.Worked as part of team to execute proper care of body mechanics and safety of patient.Utilized strong assessment skills to determine necessary patient care.Tested patients' blood glucose levels.Maintained patient privacy and confidential patient information.Provided necessary health education training for patients.Monitored patients with acute conditions.Increased unit productivity for a 33.Partnered with team of Registered Nurses to ensure over all well-being of all patients.Often commended for maintaining the safety, respect and dignity of residents.Prepared for HIPAA and JCAHO reviews, ensuring required brochures and pamphlets were available to patients in all clinics.Evaluated patient care needs, prioritized treatment and maintained patient flow.-bed surgical unit.Served as a liaison between patients and physicians to assist patients in understanding their treatment plans. Served as a liaison between patients and physicians to assist patients in understanding their treatment plans.

Member of trauma team at a level 2 trauma center for over 7 years. I worked in adult and pediatric emergency room. I worked as a paramedic for 5 years. Extensive experience in emergency patient care, to include cardiac, neurological, trauma and pediatrics.Developed patient care plans, including assessments, evaluations, and nursing diagnoses.Assisted patients with multiple chronic diagnoses, including COPD and asthma.Helped physicians examine and treat patients by assisting with instruments, injections and suture removal.Participated in unit based Quality Assurance Program.Ensured efficacy of treatments through monitoring of treatment regimens.Provided treatment within scope of practice as defined by state law.Prepared for HIPAA and JCAHO reviews, ensuring required brochures and pamphlets were available to patients in all clinics.Performed pregnancy tests and sent specimens for laboratory testing.Recorded patients' medical history, vital statistics and test results in medical records.Monitored patient reactions to drugs and carefully documented progress of individuals participating in clinical trials.Ensured HIPAA compliance.Educated patients about their treatments.Provided diagnoses and treated patients with chronic and acute health problems, including MI, arrhythmias, asthma, COPD, pneumonia.Instructed patients and family members on proper discharge care.Monitored patients with acute conditions.