Summary
Overview
Work History
Education
Skills
Timeline
Generic

Eumeka Simon

Gonzales

Summary

Experienced Utilization Management Nurse at CVS with strong clinical judgment and excellent communication skills. Utilizes clinical expertise to enhance patient satisfaction and ensure compliance with healthcare regulations. Committed to quality improvement and compliance, successfully adapting to evolving healthcare standards while ensuring patient confidentiality and safety. Effective collaborative teamwork and achieving impactful results in dynamic environments. .

Overview

21
21
years of professional experience

Work History

Utilization Management Nurse

Aetna/CVS
08.2017 - Current
  • Assisted in evaluating medical necessity for healthcare services and treatments.
  • Collaborated with interdisciplinary teams to streamline patient care plans.
  • Learned utilization management protocols and compliance standards effectively.
  • Conducted initial assessments to determine appropriateness of care levels.
  • Adapted quickly to changes in policies impacting utilization review processes.
  • Participated in training sessions to enhance knowledge of clinical guidelines.
  • Improved patient satisfaction scores by providing timely and accurate information on coverage, benefits, and authorization requirements.
  • Documented case reviews and communicated findings with healthcare providers.
  • Contributed to team success by consistently meeting productivity goals while maintaining high-quality standards in job performance.

Charge Nurse/Staff Nurse, Medical Surgical Floor

Our Lady of the Lake Regional Medical Center
01.2005 - 08.2017
  • Supervised nursing staff to ensure compliance with patient care protocols and safety standards.
  • Coordinated patient admissions, discharges, and transfers to optimize workflow efficiency.
  • Trained and mentored new nursing staff on best practices and operational procedures.
  • Led quality improvement initiatives resulting in enhanced patient satisfaction scores and reduced incidents.
  • Managed scheduling for nursing personnel to ensure adequate coverage during peak times.
  • Coordinated nursing care on unit through staff assignments, assisting and rounding with physicians, monitoring patient orders, and communicating with ancillary departments.
  • Participated in evidence-based practice project implementation, nursing competency development and nursing simulation activities.

MDS Coordinator/Registered Nurse Supervisor

Southeast Louisiana War Veteran's Home
01.2008 - 06.2011
  • Supervised nursing staff to ensure compliance with patient care standards and protocols.
  • Implemented quality improvement initiatives to enhance patient outcomes and safety measures.
  • Developed training programs for new nurses, enhancing team competency and patient care delivery.
  • Coordinated comprehensive assessments to ensure compliance with regulatory standards and guidelines.
  • Developed care plans by collaborating with interdisciplinary teams for optimal resident outcomes.
  • Maintained up-to-date knowledge on CMS guidelines and changes to ensure accuracy in reporting and reimbursement processes.
  • Collaborated closely with therapy departments to accurately capture rehabilitation needs within MDS documentation, supporting appropriate resource allocation for residents'' needs.

Education

Bachelor of Science - Nursing

Southern University And A&M College
Baton Rouge, LA
12-2004

Skills

  • Clinical assessment
  • Quality improvement
  • Care coordination
  • Interdisciplinary collaboration
  • Discharge planning
  • Utilization management
  • Strong clinical judgment
  • Excellent communication

Timeline

Utilization Management Nurse

Aetna/CVS
08.2017 - Current

MDS Coordinator/Registered Nurse Supervisor

Southeast Louisiana War Veteran's Home
01.2008 - 06.2011

Charge Nurse/Staff Nurse, Medical Surgical Floor

Our Lady of the Lake Regional Medical Center
01.2005 - 08.2017

Bachelor of Science - Nursing

Southern University And A&M College

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Eumeka Simon