Heather Clickner
Newberry,MI
Summary
High skilled Nurse with over 17 years of nursing expertise, recognized for exceptional critical thinking and problem-solving abilities in patient care planning and a comprehensive understanding of Medicare guidelines. Skilled in coordinating patient admissions and discharges while maintaining effective communication with providers and insurance carriers to foster strong professional relationships. Demonstrates outstanding organizational skills and a keen ability to analyze data collection and performance metrics. Adaptable to fast-paced, ever-evolving environments, ensuring seamless operations and high-quality patient care.
Overview
17
17
years of professional experience
Work History
Prior Authorization Nurse
CVS Caremark
Remote
08.2024 - Current
- Collaborated with quality department team members in CVS mentorship program to foster professional development for 2025.
- Cross trained with Commercial Specialty (PA) 2025.
- Supported training initiatives by serving as a Learning Assistant for two new hire Commercial PA classes for 2024/2025.
- Improved patient satisfaction by providing clear communication regarding insurance approvals and denials.
- Mentored new hires within the team, sharing expertise in navigating complex insurance guidelines and best practices for managing workflow efficiently.
- Collaborated with healthcare providers to ensure accurate submission of required documentation for timely authorizations.
- Evaluated prior authorization requests for medical services and treatments to ensure compliance with guidelines.
- Collaborated with healthcare providers to gather necessary documentation for approval processes.
- Streamlined workflows by implementing best practices in prior authorization procedures.
- Trained and mentored junior staff on effective authorization protocols and system navigation.
- Ensured accuracy of submitted authorizations, minimizing errors and reducing delays in patient care access.
- Expedited urgent requests for prior authorization, ensuring timely access to critical medical treatments.
- Demonstrated commitment to professional development by participating in ongoing training opportunities related to the field of Prior Authorization nursing.
- Streamlined the prior authorization process, reducing wait times and improving overall efficiency.
- Conducted thorough reviews of medical records, identifying necessary documentation to support prior authorization requests.
- Provided exceptional customer service to both patients and healthcare professionals, addressing concerns related to the prior authorization process.
- Promoted a culture of continuous improvement within the Prior Authorization department by regularly reviewing processes and making recommendations for optimization.
Prior Authorization Nurse
Aline Staffing (CVS/Aetna Commercial)
Remote
01.2024 - 08.2024
- Evaluated prior authorization requests for medical services and treatments to ensure compliance with guidelines.
- Collaborated with healthcare providers to gather necessary documentation for approval processes.
- Streamlined workflows by implementing best practices in prior authorization procedures.
- Trained and mentored junior staff on effective authorization protocols and system navigation.
- Ensured accuracy of submitted authorizations, minimizing errors and reducing delays in patient care access.
- Expedited urgent requests for prior authorization, ensuring timely access to critical medical treatments.
- Demonstrated commitment to professional development by participating in ongoing training opportunities related to the field of Prior Authorization nursing.
- Streamlined the prior authorization process, reducing wait times and improving overall efficiency.
- Conducted thorough reviews of medical records, identifying necessary documentation to support prior authorization requests.
- Provided exceptional customer service to both patients and healthcare professionals, addressing concerns related to the prior authorization process.
- Promoted a culture of continuous improvement within the Prior Authorization department by regularly reviewing processes and making recommendations for optimization.
Utilization Review Nurse/Coordinator
Helen Newberry Joy Hospital And Healthcare
Newberry, MI
07.2013 - 12.2023
- Obtain and review authorizations from multiple insurance carriers for various levels of care.
- Submitted cases for criteria failures and helped facilitate resolutions and approvals.
- Performed admission reviews based for medical necessity.
- Supervised and maintained all utilization review documentation through Interqual.
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Established and maintained effective communication with staff, physicians and community organizations to promote high quality patient care.
- Devise or identify solutions for irregular requests and issues.
- Facilitated workgroup meetings with medical personnel to find effective solutions to issues.
- Developed and updated policies and procedures, maintaining compliance with guidelines relating to HIPAA, benefits administration and general liability.
- Liaised with other healthcare professionals to develop comprehensive patient care plans and provide highest quality of care.
- Accomplished multiple tasks within established timeframes.
- Cross-trained existing employees to maximize team agility and performance.
- Maximized performance by monitoring daily activities and mentoring team members.
- Onboarded new employees with training and new hire documentation.
- Defined clear targets and objectives and communicated to other team members.
- Managed and motivated employees to be productive and engaged in work.
- Collaborated with interdisciplinary team of healthcare and social service providers to address patients' needs through effective intervention and care planning.
- Worked with multidisciplinary team to carry out successful treatment plans for diverse acute and chronic conditions.
- Coordinated patient transfers to other facilities.
- Gained knowledge of company policies, protocols and processes.
- Handled day-to-day customer or client questions via telephone or email.
- Acted with integrity, honesty and knowledge to promote culture of company.
- Established open and professional relationships with team members which facilitated communication, quickly resolving issues, and conflicts.
- Used company reports to analyze sales, gross profit and inventory activities.
Home Health/Hospice Nurse
North Wood Home Care And Hospice
Newberry, MI
07.2009 - 07.2013
- Developed and initiated individualized plan of care and assumed responsibility for ongoing development in partnership with patient, family and caregivers.
- Helped to achieve and maintain continuity of patient care by planning and exchanging information with other health professionals.
- Kept abreast of changes and trends affecting nursing care and licensed nurse functions to improve patient mortality, quality of life and enhance patient outcomes.
- Communicated with healthcare team members to plan, implement and enhance treatment strategies.
- Explained course of care and medication side effects to patients and caregivers in easy-to-understand terms.
- Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
- Equipped patients with tools and knowledge needed for speedy and sustained recovery.
- Cared for wounds, provided treatments, and assisted with procedures.
- Managed patient care through closely monitoring respiration, blood pressure, and blood glucose levels.
- Administered controlled narcotics, lab collection, blood draws and performed catheterizations.
- Administered medications and injections to patients.
- Delivered emotional support to patients and families during challenging times.
- Assisted with end-of-life care.
Education
Licensed Practical Nurse - Practical Nursing
Lake Superior State University
Sault Ste. Marie, MI07-2008
Associate of Applied Science - Early Childhood Education
Northern Michigan University
Marquette, MI12-2002
Skills
- InterQual Criteria
- CMS Guidelines
- Determine Medical Necessity
- Obtaining/Reviewing/ Managing Authorizations
- Benefits Guidelines
- Patient Health Information Access / HIPPA compliance
- Patient Admissions/ Discharge Planning
- Microsoft Word
- Patient Transfers and Transitions
- Documentation Review
- CAS
- Physician Consultations
Timeline
Prior Authorization Nurse
CVS Caremark
08.2024 - Current
Prior Authorization Nurse
Aline Staffing (CVS/Aetna Commercial)
01.2024 - 08.2024
Utilization Review Nurse/Coordinator
Helen Newberry Joy Hospital And Healthcare
07.2013 - 12.2023
Home Health/Hospice Nurse
North Wood Home Care And Hospice
07.2009 - 07.2013
Associate of Applied Science - Early Childhood Education
Northern Michigan University
Licensed Practical Nurse - Practical Nursing
Lake Superior State University
Skills
- Interpersonal and Written Communication
- EMR Systems
- Inpatient Services
- Leadership
- Communications