Emily Swanson
Chubbuck,USA
Summary
Compassionate Utilization Review Nurse with diverse experience in nursing and home health care case management. Achieved effective patient care through strong clinical judgment and critical thinking skills, ensuring services align with medical necessity and established protocols. Focused on optimizing patient care management by promoting best practices and leveraging medical software for data analysis.
Compassionate Utilization Review Nurse with diversified experience in healthcare settings. Proficient in ensuring patient care services are medically necessary and within the parameters of prescribed protocols. Strengths include strong clinical judgment, critical thinking skills, and proficiency in using medical software for data analysis. Known for contributing to team success by promoting best practices in patient care management.
Overview
1
1
Certification
1
1
year of post-secondary education
21
21
years of professional experience
Work History
Utilization Review Nurse Lead
AmeriBen
Meridian, ID
08.2020 - Current
- Conduct precertification for inpatient authorizations, outpatient authorizations, and post-service authorizations for appropriateness based on medical policies and clinical guidelines.
- Collaborated with healthcare providers to review and preauthorize services, ensuring assessment of medical necessity and appropriateness of treatment.
- Promoted to team lead, supported team through regular lead meetings, 1:1 sessions, and weekly team meetings, addressing day-to-day questions and concerns.
- Facilitated RN training for newly hired employees to enhance onboarding and integration into the team.
- Engaged in career pathways to enhance professional development.
- Participated in and completed Medical Management Academy as well as Fundamentals of Management and Community.
RN Clinical Team Lead
Encompass Home Health
Pocatello, ID
09.2019 - 08.2020
- Reviewed and approved all assessments for appropriate documentation prior to sending to MD for review/signature.
- Reviewed and approved all clinician entered orders prior to sending to MD for review/signature.
- Approved clinician-entered orders for accuracy and compliance before sending to MD for review/signature.
- Ensured assessments had appropriate documentation before submitting to MD for review/signature.
- Monitored documentation for admissions, recertifications, transfers, discharges, and evaluations across all disciplines to ensure compliance.
- Facilitated daily operations for clinical manager to enhance team efficiency.
- Provided support to clinical manager with daily tasks to maintain operational effectiveness.
- Conducted occasional ICD-10 coding to ensure accurate billing.
- Delivered patient care during shifts to ensure comfort and support.
RN Quality Assurance
Blackfoot Home Health and Hospice (Aspen)
Blackfoot, ID
10.2015 - 09.2019
- Reviewed all oasis assessments to ensure appropriate documentation prior to submitting to Medicare.
- Reviewed oasis assessments to confirm accurate documentation before submission to Medicare.
- Reviewed and approved all clinicians entered orders prior to sending to MD for review/signature.
- Reviewed documentation to ensure completeness for admissions, recertifications, transfers, and discharges across all disciplines.
- Monitored documentation for admissions, recertifications, transfers, discharges, and evaluations across all disciplines to ensure compliance and quality.
- Contributed to Quality Assurance & Performance Improvement (QAPI) program by identifying areas for enhancement and supporting initiatives.
- Supported clinical manager with various operational tasks to enhance efficiency.
- Executed ICD-10 coding tasks during patient documentation review.
- Delivered patient care support during clinical shifts.
RN Case Manager
Portneuf Wound Care and Hyperbarics
Pocatello, ID
03.2015 - 10.2015
- Oversaw patient care cases to ensure proper treatment.
- Facilitated referrals to outlying clinics to ensure continuity of care.
- Delivered patient care in the clinic setting.
RN Case Manager
Blackfoot Home Health and Hospice (Aspen)
Blackfoot, ID
05.2013 - 03.2015
- Provided patient care per physician orders.
- Performed numerous RN tasks including, various types of wound care including wound vacs, phlebotomy, PICC line cares, medication management, pain management, disease management, patient/family education, end of life cares, and death visits.
- Conducted home health and hospice admissions including initial head to toe assessment, OASIS, plan of care, and goals.
- Executed diverse RN responsibilities, including wound care (wound vacs), phlebotomy, PICC line care, medication and pain management, disease management, patient and family education, end-of-life care, and death visits.
- Facilitated effective communication with physicians and home health disciplines to enhance coordination of quality patient care.
- Delegated appropriate tasks to home health aide to maintain quality of care.
RN Case Manager
Access Home Health and Hospice
Pocatello, ID
02.2013 - 05.2013
- Provided patient care according to physician orders.
- Administered a range of RN tasks, such as wound care, phlebotomy, PICC line care, medication management, pain management, disease management, and educating patients and families.
- Provided patient care in the home setting.
- Performed numerous RN tasks including, various types of wound care including wound vacs, phlebotomy, PICC line cares, medication management, pain management, disease management, patient/family education, etc.
- Facilitated communication with physicians and home health disciplines to promote coordinated and effective patient care.
- Delegated appropriate tasks to home health aides to maintain quality care.
RN Case Manager
Portneuf Home Health (Amedisys)
Pocatello, ID
03.2012 - 02.2013
- Provided patient care following physician orders.
- Performed numerous RN tasks including, various types of wound care including wound vacs, phlebotomy, PICC line cares, medication management, pain management, disease management, patient/family education, ect.
- Conducted home health admissions with initial head-to-toe assessment, OASIS completion, and development of plan of care and goals.
- Performed numerous RN tasks including, various types of wound care including wound vacs, phlebotomy, PICC line cares, medication management, pain management, disease management, patient/family education, etc.
- Communicated effectively with physicians and home health disciplines to enhance patient care. with physicians as well as other home health disciplines to ensure quality patient care.
- Delegated appropriate tasks to licensed practical nurses as well as home health aides to maintain quality care.
RN Case Manager
St. Alphonsus Home Health (Amedisys)
Boise, ID
07.2011 - 03.2012
- Provided patient care under physician orders.
- Performed numerous RN tasks including, various types of wound care including wound vacs, phlebotomy, PICC line cares, medication management, pain management, disease management, patient/family education, ect.
- Conducted home health admissions in accordance with agency protocols. including initial head to toe assessment, OASIS, plan of care, and goals.
- Performed numerous RN tasks including, various types of wound care including wound vacs, phlebotomy, PICC line cares, medication management, pain management, disease management, patient/family education, etc..
- Communicated effectively with physicians and home health disciplines to coordinate and enhance patient care.
- Delegated tasks to licensed practical nurses and home health aides to ensure quality care.
Licensed Practical Nurse
St. Alphonsus Home Health (Amedisys)
Boise, ID
03.2010 - 07.2011
- Delivered comprehensive patient care in home setting.
- Performed numerous LPN tasks: various types of wound care, phlebotomy, disease management, medication management, pain management, patient teaching, etc.
- Coordinated communication with physicians and home health disciplines to ensure optimal patient care.
- Ensured effective information exchange between team members with physicians and home health disciplines to ensure optimal patient care.
Licensed Practical Nurse
Tri Cities Home Health (Amedisys)
Kennewick, WA
10.2008 - 03.2010
- Delivered patient care in alignment with physician directives.
- Provided patient care according to physician orders.
- Executed diverse LPN responsibilities, including wound care, blood draws, disease management, medication management, pain management, and patient education.
- Facilitated communication with physicians and interdisciplinary teams to enhance quality of patient care.
Licensed Practical Nurse
Kadlec Medical Clinic
Kennewick, WA
03.2008 - 10.2008
- Supported physician in delivering quality patient care in clinical setting.
- Executed diverse nursing tasks to ensure efficient clinical operations.
- Supported provider during patient examinations in clinical setting.
- Performed a variety of clinical setting nursing tasks.
- Provided pediatric and adult immunizations and injections.
- Arranged and set up patient referrals.
Certified Nursing Assistant
Need a Nurse Medical Staffing
Pocatello, ID
08.2005 - 12.2007
- Assisted patients with ADLs, bathing, toileting, dressing, and eating.
- Cared for patients' needs in various healthcare settings, ensuring personalized support.
- Provided patient care under guidance of licensed nurse.
- Traveled to various health care settings and provided care according to instructions.
Education
Associate Degree in Nursing - Registered Nursing
Carrington College
Boise, ID 06.2009 - 12.2010
Certified nurses assistant -
Idaho State University - School of nursing
Idaho State University
Pocatello, IDSkills
- Preauthorization reviews
- Medical necessity evaluations
- Utilization review
- Quality assurance
- Compliance procedures
- Regulatory compliance
- Clinical assessments
- Documentation review
- Patient care plans
- Discharge planning coordination
- Case management
- Patient care coordination
- Needs assessment
- Workflow optimization
- Critical thinking
- Effective communication
- Organizational skills
- Managed care
- HIPAA compliance
- Team leadership
Certification
- Registered Nursing License of Idaho, N-42603
- Healthcare Provider CPR, Idaho
- Certified OASIS Quality Specialist, 2019
Timeline
Utilization Review Nurse Lead
AmeriBen
08.2020 - Current
RN Clinical Team Lead
Encompass Home Health
09.2019 - 08.2020
RN Quality Assurance
Blackfoot Home Health and Hospice (Aspen)
10.2015 - 09.2019
RN Case Manager
Portneuf Wound Care and Hyperbarics
03.2015 - 10.2015
RN Case Manager
Blackfoot Home Health and Hospice (Aspen)
05.2013 - 03.2015
RN Case Manager
Access Home Health and Hospice
02.2013 - 05.2013
RN Case Manager
Portneuf Home Health (Amedisys)
03.2012 - 02.2013
RN Case Manager
St. Alphonsus Home Health (Amedisys)
07.2011 - 03.2012
Licensed Practical Nurse
St. Alphonsus Home Health (Amedisys)
03.2010 - 07.2011
Associate Degree in Nursing - Registered Nursing
Carrington College
06.2009 - 12.2010
Licensed Practical Nurse
Tri Cities Home Health (Amedisys)
10.2008 - 03.2010
Licensed Practical Nurse
Kadlec Medical Clinic
03.2008 - 10.2008
Certified Nursing Assistant
Need a Nurse Medical Staffing
08.2005 - 12.2007
Certified nurses assistant -
Idaho State University - School of nursing
Idaho State University