Fair Arbee Banks
Avon,IN
Summary
Registered Nurse with years of experience on Medical-Surgical Nursing inpatient care, case management and wound care in Home Health, and clinical reviews for Hospice, Home Health and Prior Authorization. Skills and knowledge include patient care coordination, post-surgery recovery, discharge planning and clinical review with efficiency in completing tasks. Specialize in patient care assessment, medical chart review, and clinical documentation improvement. Excel in communication, teamwork, and critical thinking skills, ensuring optimal outcomes in fast-paced environments.
Overview
19
19
years of professional experience
1
1
Certification
Work History
Clinical Review Nurse, Appeals and Prior Auth
Elevance Health
Avon, IN
06.2020 - 07.2025
- Compiled detailed reports outlining findings after reviewing cases.
- Reviewed patient records for accuracy, completeness, timeliness, and appropriateness of care prior to authorization requests.
- Advised providers on the best course of action according to established protocols and guidelines.
- Performed medical necessity reviews of home health and hospice services to ensure compliance with relevant regulations and standards.
- Ensured timely completion of all assigned tasks within required deadlines.
- Developed strategies aimed at improving efficiency within the prior authorization process while maintaining high standards of accuracy and compliance.
- Maintained accurate documentation of all prior authorization activities in accordance with established policies and procedures.
- Provided education materials on topics such as prior authorization processes, coding guidelines, and reimbursement policies to internal staff members as well as external stakeholders.
- Reviewed patient medical records to determine if requested services are medically necessary and appropriate for the diagnosis.
Registered Nurse Case Manager, Home Health
Home Health Care Solutions
Indianapolis, IN
05.2015 - 08.2022
- Developed relationships with patients to ensure they received the highest quality of care.
- Coordinated discharge planning with multidisciplinary teams ensuring safe transitions back into the community.
- Assessed, planned, implemented and evaluated individualized nursing care plans for each patient.
- Conducted home visits to assess the physical and mental condition of assigned patients.
- Maintained accurate records of all patient interactions according to established protocols.
- Implemented interventions based on evidence-based practice guidelines while working collaboratively with interdisciplinary teams.
- Participated in team meetings to discuss treatment options for complex cases.
- Utilized critical thinking skills when assessing new information or changes in a patient's condition.
- Monitored patient progress through regular follow-up appointments and assessments.
Registered Nurse, Medical-Surgical Unit
Community Hospital Network
Indianapolis, IN
05.2006 - 05.2016
- Delivered high-quality nursing care to patients on medical-surgical unit.
- Educated patients and families on treatment strategies and at-home care.
- Administered medications, tracked dosages and documented patient conditions.
- Developed and adapted individualized treatment plans according to patient recovery goals.
- Coordinated care with physicians and other clinical staff to prepare for treatment, carry out interventions and enhance continuum of care to deliver comprehensive services.
- Administered oral, intramuscular and IV medications to patients and monitored responses.
- Monitored and recorded patient condition, vital signs, recovery progress and medication side effects.
- Assessed patients' response to treatment and suggested ways to combat side effects.
- Conducted post-op reviews, tracked patients' vitals and monitored fluids to reach optimal care targets.
- Participated in hospital-wide initiatives and committees to improve patient care, satisfaction and safety.
Education
Bachelor of Science - Nursing
University of The Visayas
Cebu, Philippines03.2005
Bachelor of Arts - English
Saint Joseph College
Maasin City, Southern Leyte, Philippines03.1998
Skills
- Medical screening
- Wound cleaning/care expertise
- Unit administration
- Patient monitoring
- Organization and planning
- Administering medicines
- Nursing Plan Development and Modification
- Follow-up calls
- Documented on current OASIS
- Patient education
- Patient advocacy
- Data analysis
- Healthcare regulations
- HIPAA compliance
- Problem-solving abilities
- Multitasking capacity
Certification
- Indiana Registered Nurse License: 28171760A
- California Registered Nurse License: 693427
Additional Information
Referrences:
Tonisha Harrington RN, DON (former manager)
Mobile Number: 1-765-760-2504
Krystal Lewis (former coworker-home care nursing)
Mobile Number: 1-317-332-8497
Timeline
Clinical Review Nurse, Appeals and Prior Auth
Elevance Health
06.2020 - 07.2025
Registered Nurse Case Manager, Home Health
Home Health Care Solutions
05.2015 - 08.2022
Registered Nurse, Medical-Surgical Unit
Community Hospital Network
05.2006 - 05.2016
Bachelor of Science - Nursing
University of The Visayas
Bachelor of Arts - English
Saint Joseph College
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