Erica Hicks
Springville ,AL
Summary
Developed valuable skills in clinical setting, ready to transition into new field. Demonstrated expertise in analyzing patient data and optimizing care plans. Seeking to leverage strong analytical and communication skills in new professional environment.
Overview
8
8
years of professional experience
Work History
Utilization Review Nurse
Viva Health Care
Birmingham, AL
12.2024 - Current
- Reduced healthcare costs through efficient utilization of resources and identification of unnecessary treatments or procedures.
- Ensured compliance with regulations and accreditation standards by maintaining accurate documentation of all utilization review activities.
- Maintained professional competence by staying current on industry trends, best practices, and regulatory requirements specific to utilization review nursing.
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Performed prior authorization review of services requiring notification.
- Improved patient care quality by conducting thorough utilization reviews and making recommendations for optimal treatment plans.
Account Executive
Alabama Home Care
Oneonta, AL
08.2023 - 12.2024
- Provided exceptional customer service, addressing client concerns promptly and effectively to ensure long-term loyalty.
- Managed multiple accounts simultaneously while maintaining organization and prioritizing tasks efficiently.
- Exceeded sales targets consistently by identifying new business opportunities and creating customized solutions for clients.
- Boosted client satisfaction by developing and maintaining strong relationships through effective communication.
- Established long-lasting relationships with key decision-makers within client organizations, solidifying the company''s reputation as a trusted partner in their respective industries.
- Conducted regular check-ins with existing clients to assess their needs and identify upselling opportunities.
- Delivered informative presentations to potential clients, showcasing the unique value of products or services offered.
- Assisted in the onboarding process for new clients, ensuring a smooth transition into the company''s roster of accounts.
Clinical Liaison
Ascension at Home
Birmingham, AL
07.2017 - 08.2023
- Responded to and investigated complaints and concerns of patients.
- Evaluated patient satisfaction and made suggestions for changes or improvements.
- Educated health care professionals on ways to humanize patients' experiences.
- Assisted in staff education and development by sharing clinical expertise in relevant areas such as wound care, respiratory therapy, or disease management.
- Enhanced patient safety measures throughout the entire continuum of care via regular audits on infection control procedures/tools implementation at the facility level.
- Conducted thorough assessments of patients'' medical histories, diagnoses, prognoses, medications, and treatment goals to determine eligibility for specific programs or services.
- Promoted positive patient outcomes by identifying potential barriers to recovery and addressing them proactively with the treatment team.
- Reduced hospital readmission rates by closely monitoring patients'' progress and ensuring appropriate follow-up care upon discharge.
- Collaborated with marketing efforts to showcase facility strengths and attract new referral sources from local hospitals or community-based organizations.
Education
Associate of Science - Nursing
Gadsden State Community College
Gadsden, AL05-2013
Skills
- InterQual criteria
- Client relationship building
- Medical record review
- Documentation and reporting
- Account management
- Physical assessments
- Utilization review
- Relationship building and management
- Patient account management
- Medical terminology expertise
- Clinical assessment
- Written and verbal communication
- Interpersonal and written communication
- Customer service
- Patient advocacy
- Insurance coverage verification
- New business opportunities
- Patient evaluation
- Physician consultations
- CRM software expertise
- Palliative care
- Customer relations
- Patient eligibility requirements
- Prior authorization
- Territory management
- Medical records maintenance
- HIPAA compliance
- Customer relationship management (CRM)
- Healthcare facility coordination
- Discharge planning coordination
Timeline
Utilization Review Nurse
Viva Health Care
12.2024 - Current
Account Executive
Alabama Home Care
08.2023 - 12.2024
Clinical Liaison
Ascension at Home
07.2017 - 08.2023
Associate of Science - Nursing
Gadsden State Community College
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