Erin Miller
Dickinson,TX
Summary
Self-motivated professional promoting attention to detail and the drive to resolve issues effectively. Highly adaptable, calm and focused in the most stressful environments. Nearly 20 years of varied nursing experience. Seeking the opportunity to join in the role of Utilization Review Nurse within the UTMB system.
Overview
18
18
years of professional experience
1
1
Certification
Work History
Utilization Review Nurse
HCSC
Houston, TX
04.2023 - Current
- Provided education to providers regarding utilization management processes and protocols.
- Evaluated clinical documentation for accuracy and completeness in order to make decisions about coverage determinations.
- Reviewed denial letters issued by insurance companies to ensure that they were appropriate and timely.
- Monitored pre-authorization requests to ensure that all necessary information was received prior to approval or denial of services.
- Maintained up-to-date knowledge of health plan benefits, policies, procedures, regulations, coding guidelines.
- Communicated with external partners such as managed care organizations or vendors on a regular basis.
- Served as a resource for staff members seeking guidance on utilization review matters.
- Reviewed patient admissions to determine medical necessity as directed by CMS criteria.
- Remained up-to-date on various benefit plans, medical policies and state-specific clinical guidelines or criteria.
- Assessed patient medical records to determine the appropriateness of requested services and procedures.
Interventional Radiology Nurse
UTMB Health
Galveston, TX
09.2022 - 03.2023
- Assisted radiologists in interventional radiology procedures, such as catheterizations, angioplasties and biopsies.
- Administered medications and contrast agents to patients prior to the procedure.
- Assessed patient's condition and prepared them for the intervention by explaining the procedure and answering any questions they may have had.
- Performed nursing assessments of patients prior to each procedure with documentation of findings into the medical record.
- Monitored patients during recovery following interventional radiology procedures.
- Initiated emergency interventions when needed during a procedure or post-procedure recovery period.
- Educated family members on post-operative care instructions for their loved one.
- Collaborated with other healthcare professionals to ensure optimal patient outcomes.
- Cared for patients undergoing complex vascular access procedures such as fistulas, grafts, and central lines placement.
- Documented all care provided in accordance with facility policies and procedures and standards of practice guidelines.
- Recognized potential complications related to interventional radiology procedures and took appropriate action to address them.
ICU Clinical Nurse
MD Anderson
Houston, TX
08.2021 - 08.2022
- Assessed patients for changes in condition and reported any abnormalities to the physician.
- Provided direct patient care, including wound dressing, administering medications, catheterization, and IV therapy.
- Performed assessments of patient's physical, psychosocial and spiritual needs.
- Developed individualized plans of care based on assessment findings and implemented interventions accordingly.
- Monitored vital signs and performed other diagnostic tests as required.
- Educated patients and their families about various aspects of health maintenance and disease prevention.
- Collaborated with interdisciplinary team members to ensure optimal quality of care.
- Maintained accurate documentation in the medical record according to hospital policy.
- Served as a clinical resource for staff nurses regarding evidence-based practice guidelines.
- Communicated effectively with physicians, family members, allied health professionals, and other healthcare providers regarding patient care issues.
- Utilized critical thinking skills to assess complex situations and make appropriate decisions in emergency situations.
- Provided emotional support to patients during difficult times.
- Coordinated discharge planning activities ensuring safe transition from acute care setting.
- Responded quickly to code blue calls providing advanced life support measures as necessary.
- Supported new staff members through orientation process and preceptorship programs.
- Evaluated effectiveness of nursing interventions by monitoring patient responses.
- Managed PA catheters and arterials, vasoactive drug administration and titration, thrombolytic therapy, dysrhythmia interpretation and chest tube management.
ICU Clinical Nurse
UTMB Galveston
League City, TX
09.2020 - 10.2021
- Assessed patients for changes in condition and reported any abnormalities to the physician.
- Provided emotional support to patients during difficult times.
- COVID patients
- Responded quickly to code blue calls providing advanced life support measures as necessary.
- Managed PA catheters and arterials, vasoactive drug administration and titration, thrombolytic therapy, dysrhythmia interpretation and chest tube management.
- Treated patients with broad range of acute, life-threatening diagnoses.
- Mentored new nurses on practices and procedures to drive patient outcome goals.
- Administered oral, IV and intra-muscular medications and monitored patient reactions.
- Helped patients and families feel comfortable during challenging and stressful situations, promoting recovery and reducing compliance issues.
- Observed strict safety measures, including checking medication dosages before administration to patients.
- Utilized computerized Resource and Patient Management System (RPMS) and Electronic Health Record (EHR) system.
- Collaborated with health groups to plan or implement programs designed to improve overall health of communities.
Case Manager
Medical University Of South Carolina
Charlest, SC
01.2016 - 06.2019
- Consulted with staff on resolution of complex service issues.
- Collaborated with healthcare team to improve care quality, reduce costs and gauge patient progress.
- Monitored and kept meticulous records of patient treatment plans and response of patient to medication.
- Reviewed treatment plans against individual goals and healthcare standards.
- Coordinated support services and optimized communication between healthcare workers and patients.
- Transitioned clients to different providers based on progress or needs.
- Assisted individuals with eligibility for available benefits.
- Developed trusting relationships with social services, health care providers and governmental agencies.
- Linked clients with social services, health care providers and governmental agencies to help claim or reclaim individual autonomy.
- Maintained up-to-date case records with case activity status.
- Provided case management services including intake, assessment, crisis intervention, advocacy, referral and monitoring of families.
- Participated in interdisciplinary team meetings to discuss treatment options.
- Provided referrals to appropriate health care providers or other community resources.
- Compiled reports on cases and submitted them to supervisors as required.
- Collaborated with medical professionals to coordinate treatment plans for clients.
RN, Neonatal ICU
Pocono Medical Center
East Stroudsburg, PA
04.2013 - 12.2015
- Developed, implemented and documented individualized patient plan of care based on assessment findings.
- Provided family-centered neonatal intensive care services including education, support and counseling.
- Administered medications, treatments and therapies as prescribed by the physician or nurse practitioner.
- Performed daily physical assessments of critically ill infants in the NICU setting.
- Monitored vital signs, lab values and other indicators of infant condition; initiated interventions when necessary.
- Collaborated with multidisciplinary team members to ensure best practice for patient outcomes.
- Ensured safety protocols were followed throughout all aspects of patient care delivery.
ICU Clinical Nurse
Medical University Of South Carolina
Charleston, SC
01.2006 - 02.2013
- Assessed patients for changes in condition and reported any abnormalities to the physician.
- Ensured compliance with all regulatory standards related to nursing practice within ICU setting.
- Communicated effectively with physicians, family members, allied health professionals, and other healthcare providers regarding patient care issues.
- Utilized critical thinking skills to assess complex situations and make appropriate decisions in emergency situations.
- Worked in the Surgical and Neuro Trauma Unit and the Pediatric Cardiology ICU
- Supported new staff members through orientation process and preceptorship programs.
- Participated in educational activities such as continuing education courses or seminars.
- Evaluated effectiveness of nursing interventions by monitoring patient responses.
- Prioritized patient care assignments based on patient conditions to achieve optimal outcomes.
- Treated patients with broad range of acute, life-threatening diagnoses.
- Collaborated with interdisciplinary healthcare professionals to create, implement and adapt individualized care plans.
Education
Bachelor of Science - Nursing
Misericordia University
Dallas, PA05-2005
Skills
- Documentation and Reporting
- Needs Assessment
- Utilization Management
- Patient Care Plans
- Discharge Planning
- Healthcare Regulations
- Interpersonal and Written Communication
- HIPAA Compliance
- Inpatient Care
- Home Health Care
- Utilization Review
- Ambulatory Surgery Care
Affiliations
- Before becoming an RN, managed a small automotive business supervising 6-10 people
- Involved in my church and volunteer work
- Involved in the rescue and care of dogs and cats
Certification
- Trauma certified in 2006
- Critical Care certified in 2008
- Currently BLS certified and have help ACLS,PALS and NRP certifications
- Emergency Medicine Certified in 2013
References
References available upon request.
Timeline
Utilization Review Nurse
HCSC
04.2023 - Current
Interventional Radiology Nurse
UTMB Health
09.2022 - 03.2023
ICU Clinical Nurse
MD Anderson
08.2021 - 08.2022
ICU Clinical Nurse
UTMB Galveston
09.2020 - 10.2021
Case Manager
Medical University Of South Carolina
01.2016 - 06.2019
RN, Neonatal ICU
Pocono Medical Center
04.2013 - 12.2015
ICU Clinical Nurse
Medical University Of South Carolina
01.2006 - 02.2013
Bachelor of Science - Nursing
Misericordia University
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