Gwendolyn D. Rapley
Springhill
Summary
Results-oriented Staff Nurse with extensive experience at Dorn VA Medical Center. Specializes in patient assessment and care coordination, maintaining high safety and quality standards. Demonstrated success in educating patients and managing complex treatment plans. Strong critical thinking skills and commitment to interdisciplinary collaboration enhance patient outcomes.
Overview
38
38
years of professional experience
1
1
Certification
Work History
Lead Concurrent Review Nurse
Wellcare
Raleigh
03.2022 - Current
- Instrumental with the launch of the Healthy Opportunities program in North Carolina
- Monitored team performance metrics during phone queues, breaks, and lunches.
- Ensured adherence to processes for timely completion of assignments.
- Supervised team during supervisor absence to maintain operational continuity.
- Completed daily team assignments efficiently during production shifts.
- Handled escalated calls from members and internal/external partners to resolve issues.
- Supported team by addressing questions and facilitating problem resolution.
- Maintained task bucket for reassessments, rejections, and service authorizations.
- Adhered to strict confidentiality policies when dealing with sensitive information.
- Collaborated with interdisciplinary team members to develop plans of care for patients.
Lead Concurrent Review Nurse
Wellcare
Raleigh
03.2021 - 03.2022
- Reviewed medical information to assess necessity of continued stay based on established standards.
- Determined treatment appropriateness aligning with member's diagnosis and required level of care.
- Ensured services for eligible members adhered to benefit plan criteria and utilized contracted providers.
- Conducted initial reviews of medical records to determine appropriateness of requested services.
- Provided feedback on utilization management cases to providers as needed.
- Assessed patients' eligibility for coverage according to insurance guidelines.
- Researched complex cases involving multiple diagnoses or treatments requiring coordination among multiple providers.
- Performed concurrent review activities to ensure that treatments are medically necessary and meet quality standards.
- Participated in quality assurance initiatives designed to improve patient care outcomes.
- Reviewed requests for prior authorization by gathering pertinent information from medical records, insurance policies, and provider notes, in order to make an informed decision about treatment plans.
Appeal Nurse
Wellcare/Centene
Tampa
02.2019 - 03.2020
- Reviewed medical information to assess necessity for inpatient admission and continued stay.
- Evaluated treatments for consistency with member diagnosis and appropriate care level.
- Ensured eligible member services align with benefit plans and contracted provider requirements.
- Applied CMS criteria, MCG, Interqual criteria, and Clinical Coverage Guidelines for medical necessity determinations.
- Communicated with Medical Directors regarding cases that exceed approval thresholds.
- Analyzed clinical data to determine claim payments in line with company policies and NCQA guidelines.
- Prepared case reviews for Medical Director when criteria were not initially met.
- Generated appeal resolution communications to members and providers per company policies.
- Performed medical necessity reviews of inpatient and outpatient services to ensure compliance with relevant regulations and standards.
- Assessed clinical data from multiple sources including but not limited to medical records, lab results, radiology reports, medication administration records.
- Reviewed patient records for accuracy, completeness, timeliness, and appropriateness of care prior to authorization requests.
Utlization Review Nurse
Wellcare
Tampa
07.2014 - 02.2019
- Ensured services for eligible members complied with benefit plans and utilized appropriate contracted providers.
- Reviewed medical information telephonically to determine necessity of continued stay based on established standards.
- Evaluated treatment consistency with member diagnoses and appropriate levels of care.
- Determined medical necessity and length of stay, applying CMS criteria, Interqual criteria, and Clinical Coverage Guidelines while liaising with Medical Directors for non-approved cases.
- Assessed and coordinated simple discharge planning with physicians, caregivers, and ancillary providers to ensure continuity of care.
- Collaborated with facility discharge planners and utilization management teams to optimize clinical outcomes through specialty care referrals or alternate levels of care.
- Identified high-risk members for complex treatment plans or potential repeat admissions, referring them to case and disease management teams.
- Coordinated authorization and delivery of post-acute care services, including referrals to case management, home health, medical equipment, skilled nursing facilities, and community-based services.
Wellness Director
Brookdale Assisted Living
Springhill
07.2013 - 07.2014
- Collaborated with Health and Wellness Director and Executive Director to ensure resident safety and security.
- Trained and evaluated new medical technicians and nurses on medication administration procedures.
- Monitored daily Medication Administration Records for inaccuracies and omissions.
- Managed scheduling for nurses, resident care aides, and medical technicians.
- Provided resident support through assessments, medication education, lab work, and treatment procedures.
- Administered prescribed medications and immunizations as required.
- Prepared documentation for external facilities regarding resident treatments.
- Coordinated doctor appointments and transportation for residents.
- Managed multiple tasks simultaneously while maintaining quality standards of care.
- Actively participated in departmental meetings, training sessions and educational seminars.
Clinical Outpatient Staff Nurse
Bay Pines VA Healthcare System
Bay Pines
09.2012 - 07.2013
- Delivered comprehensive patient support in outpatient clinic through assessment and counseling.
- Administered prescribed medications and immunizations, monitoring patient responses for safety.
- Initiated IVs and collected specimens for routine lab analyses, including urine and sputum.
- Educated patients on medications, treatments, and care plans to enhance effective management.
- Scheduled appointments with primary care providers, ensuring timely access to care.
- Documented treatment procedures and maintained accurate records of patient interactions.
- Monitored vital signs such as blood pressure and temperature.
- Adhered to strict confidentiality policies when dealing with sensitive information.
- Conducted patient education on medical treatments and procedures.
- Utilized an electronic medical record system to store patient information securely.
- Maintained accurate records of patient progress notes, medications administered and other relevant data.
Clincial Outpatient Staff Nurse
Orlando VA Medical Center
Orlando
08.2011 - 09.2012
- Provided patient support in outpatient clinic, including assessments and treatment education.
- Administered prescribed medications and immunizations while monitoring patient responses.
- Initiated IVs and collected specimens for laboratory analysis.
- Conducted patient teaching sessions and scheduled appointments with primary care providers.
- Documented care plans based on diagnoses and treatment procedures.
- Drew lab samples from scheduled patients for diagnostic purposes.
Staff Nurse- Outpatient Clinic
Vanderbilt University Hospital
Nashville
06.2002 - 08.2009
- Provided patient support in outpatient clinic through assessments, counseling, and medication education.
- Administered prescribed medications and immunizations while monitoring patient outcomes.
- Initiated IVs and collected specimens for lab analysis, ensuring accurate processing.
- Conducted patient education sessions and scheduled appointments with primary care providers.
- Trained and oriented new nurses to enhance team efficiency and service quality.
Agency Licensed Practical Nurse
Starmed Nursing Agency
Nashville
09.1998 - 06.2002
- Provided patient support in outpatient clinic and hospital units through assessment and counseling.
- Educated patients on medications, treatments, and care plans for diagnoses.
- Prepared and administered prescribed medications or immunizations while monitoring patients.
- Initiated IVs and collected specimens for laboratory analysis including urine, stool, and sputum.
- Conducted patient education across medical and surgical units, enhancing understanding of treatment plans.
Staff Nurse, Nursing Home
Wesley Commons Nursing Home
Greenwood
05.2000 - 06.2001
- Provided patient support through assessment, counseling, and education on medications and treatment.
- Administered prescribed medications and immunizations while monitoring patient progress.
- Collected and prepared specimens for lab analysis, including urine, stool, and sputum.
- Supervised Certified Nursing Assistants to ensure quality care for residents in facility.
Clincial Outpatient Staff Nurse
Tennessee Valley VA HealthCare System
Nashville
12.1998 - 02.2000
- Provided comprehensive patient support through assessments, counseling, and education on medications and treatments.
- Prepared and administered prescribed medications and immunizations while monitoring patient responses.
- Initiated IVs and collected specimens for lab analysis, including urine, stool, and sputum samples.
- Conducted patient education on medical and surgical procedures to enhance understanding.
- Supervised health technicians and CNAs to ensure high standards of care were met.
- Executed lab draws on scheduled patients to facilitate timely diagnosis and treatment.
- Developed documentation for care plans aligned with patient diagnoses and treatment protocols.
Home Health Nurse
Beverly Home Health Care
Clarksville
08.1997 - 08.1998
- Provided comprehensive patient support, including assessments and counseling on medications and treatments.
- Educated patients and families about disease management, lifestyle changes, nutrition, and preventive healthcare measures.
- Initiated referrals to appropriate community resources when needed.
- Adhered strictly to infection control protocols while caring for clients in their homes.
- Administered prescribed medications and immunizations while monitoring patient responses.
- Initiated IVs and collected specimens for laboratory analysis, ensuring proper preparation.
- Maintained accurate documentation and records to uphold patient confidentiality.
- Coordinated patient discharge planning with physicians, social workers, case managers, therapists, pharmacists and other healthcare professionals involved in the patient's care plan.
Supervior, Home Health Aides
Plan Home Health
Laurens
06.1996 - 06.1997
- Provided patient support in home setting, including assessment, counseling, and medication education.
- Resolved customer complaints in a timely manner while ensuring customer satisfaction.
- Evaluated employee performance through periodic reviews and documented results accordingly.
- Conducted weekly meetings with team members to discuss upcoming tasks and project deadlines.
- Performed monthly inventory checks to ensure sufficient stock levels for all products.
- Trained new employees on company policies and procedures.
- Monitored care for homebound patients to ensure nursing aides delivered quality services.
- Conducted new employee orientation to facilitate smooth onboarding processes.
- Supervised division's CNAs to maintain high standards of patient care in homes.
- Scheduled and evaluated all CNAs to optimize workforce performance.
Army Hospital/Field Nurse
US Army
Ft Campbell
07.1992 - 04.1996
- Established patient support systems in outpatient clinics and hospital settings, including assessments and treatment education.
- Managed daily patient volume with expertise in telephone triage, appointment scheduling, and referrals.
- Performed comprehensive documentation to maintain accurate records and ensure patient confidentiality.
- Administered prescribed medications and immunizations while monitoring patient responses.
- Initiated IVs and prepared specimens for lab analysis, ensuring quality control.
- Executed various treatments and procedures in both surgical and outpatient environments.
- Provided emotional support to patients and families during critical situations.
- Facilitated effective communication among patients, family members, and healthcare teams regarding care plans.
Inpatient Staff Nurse
Self Memorial Hospital
Greenwood
03.1988 - 07.1992
- Work in hospital units to provide patient support, including assessment, counseling, education regarding medications and treatment, lab work, documentation with a care plan for diagnosis, and administration of treatment procedures.
- Prepare and administer prescribed medications or immunizations, and monitor patients.
- Initiate IVs, collect, and prepare specimens such as routine urine, stool, and sputum for lab analysis.
- Patient teaching, and worked in medical and surgical units.
- Monitored vital signs such as blood pressure and temperature.
- Adhered to strict confidentiality policies when dealing with sensitive information.
- Performed diagnostic tests such as blood draws, urine analysis and electrocardiograms.
- Conducted patient education on medical treatments and procedures.
- Administered medications as prescribed by physicians.
- Utilized an electronic medical record system to store patient information securely.
Inpatient Staff Nurse
Dorn VA Hospital
Columbia
09.1987 - 07.1988
- Provided patient support through assessment, counseling, and education on medications and treatments.
- Prepared and administered prescribed medications and immunizations while monitoring patient responses.
- Initiated IVs and collected specimens for lab analysis, including urine, stool, and sputum.
- Documented care plans for diagnoses and treatment procedures to ensure continuity of care.
- Managed multiple tasks simultaneously while maintaining quality standards of care.
- Assisted physicians with exams, lab tests or other procedures as requested.
Education
Health Benefit Advisor -
Bay Pines, FL
Bay Pines, FL01.2013
Train the Trainer, Accudose Pyxis -
Nashville, TN
Nashville, TN01.2006
Primary Leadership Course -
Ft Campbell, Kentucky
Ft Campbell, Kentucky01.1994
Personnel Management -
Ft Campbell, Kentucky
Ft Campbell, Kentucky01.1992
Diploma - Nursing
Greenwood, South Carolina
Greenwood, South Carolina01.1987
Skills
- Patient assessment and care coordination
- Medication administration and IV therapy
- Clinical documentation and EMR management
- Interdisciplinary collaboration and communication
- Patient education and disease prevention
- Critical thinking and problem solving
- Conflict resolution and patient safety
- Intake, discharge, and specimen collection
- Wound care management and tracheostomy care
- Home health care and community health
- Vaccine administration and diabetes management
- Direct patient care and chronic disease management
- Vitals monitoring and health assessments
Certification
- Licensed Practical Nurse compact State License
Timeline
Lead Concurrent Review Nurse
Wellcare
03.2022 - Current
Lead Concurrent Review Nurse
Wellcare
03.2021 - 03.2022
Appeal Nurse
Wellcare/Centene
02.2019 - 03.2020
Utlization Review Nurse
Wellcare
07.2014 - 02.2019
Wellness Director
Brookdale Assisted Living
07.2013 - 07.2014
Clinical Outpatient Staff Nurse
Bay Pines VA Healthcare System
09.2012 - 07.2013
Clincial Outpatient Staff Nurse
Orlando VA Medical Center
08.2011 - 09.2012
Staff Nurse- Outpatient Clinic
Vanderbilt University Hospital
06.2002 - 08.2009
Staff Nurse, Nursing Home
Wesley Commons Nursing Home
05.2000 - 06.2001
Clincial Outpatient Staff Nurse
Tennessee Valley VA HealthCare System
12.1998 - 02.2000
Agency Licensed Practical Nurse
Starmed Nursing Agency
09.1998 - 06.2002
Home Health Nurse
Beverly Home Health Care
08.1997 - 08.1998
Supervior, Home Health Aides
Plan Home Health
06.1996 - 06.1997
Army Hospital/Field Nurse
US Army
07.1992 - 04.1996
Inpatient Staff Nurse
Self Memorial Hospital
03.1988 - 07.1992
Inpatient Staff Nurse
Dorn VA Hospital
09.1987 - 07.1988
Health Benefit Advisor -
Bay Pines, FL
Train the Trainer, Accudose Pyxis -
Nashville, TN
Primary Leadership Course -
Ft Campbell, Kentucky
Personnel Management -
Ft Campbell, Kentucky
Diploma - Nursing
Greenwood, South Carolina
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