Detail-oriented Clinical Information Review Analyst skilled in verbal communication and teamwork. Successfully conducted patient, concurrent reviews with assigned insurance company care advocates; coordinated peer reviews and arranged appeals when necessary. Demonstrated ability to train new staff, while implementing best practices that enhanced documentation accuracy and improved patient care outcomes.
Work History
Clinical Information Review Analyst
11 Years
Banner Thunderbird Medical Center | 05.2015 - 05.2026
Analyzed patient information, reviewed same with insurance care advocate, in order to gain authorization for patient's continued treatment on behavioral health unit.
Coordinated with provider's to schedule Peer-to-Peer reviews, and also scheduled appeal reviews as necessary.
Documented results of each in assigned patient records.
Collaborated with healthcare teams to develop and implement best practices for documentation accuracy.
Trained new staff on review protocols and regulatory requirements to enhance team performance.
Mentored junior analysts in data analysis techniques, fostering professional development within the team.
Implemented new analytical tools and techniques for more effective reviews and assessments.
Psychiatric Registered Nurse
3 Years 1 Month
Banner Thunderbird Medical Center | 04.2012 - 05.2015
Administered psychiatric assessments to evaluate patient mental health needs.
Developed and implemented individualized care plans for diverse patient populations.
Administered medication and monitored medication adherence and provided education on potential side effects.
Collaborated with multidisciplinary teams to enhance patient treatment outcomes.
Ensured patient safety by closely monitoring behaviors, administering medications as prescribed, and intervening during incidents of aggression or self harm.
Demonstrated adaptability by providing coverage in various psychiatric units as needed, maintaining high standards of care across diverse patient populations.
Psychiatric Registered Nurse
13 Years 1 Month
Banner Behavioral Health Hospital -Scottsdale | 03.1999 - 04.2012
Led crisis intervention strategies to manage acute psychiatric episodes effectively.
Mentored junior nursing staff on best practices in psychiatric care delivery.
Utilized electronic health record systems to document patient progress accurately.
Responded to numerous volatile situations and violent outbreaks to restore safety and security of patients and staff.
Oversaw care of suicidal patients and acted swiftly to reduce risk of harm to themselves or others.
Collaborated proactively with psychiatrists to adjust treatment plans based on observed changes in symptoms or behavior patterns among patients.
Education
Associate of Science - Nursing
Lasell Junior College | Auburndale, MA
Skills
Verbal communication
Problem-solving abilities
Effective communication
Task prioritization
Self motivation
Professionalism
Attention to detail
Teamwork and collaboration
Affiliations
Arizona Nurse's Association
American Institute of Certified Public Accountants
ANCC Certification as Psychiatric and Mental Health Nurse
Certification
ANCC Certification as Psychiatric and Mental Health Nurse
Utilization Clinical Review Analyst at EviCore Healthcare formerly Care Core NationalUtilization Clinical Review Analyst at EviCore Healthcare formerly Care Core National