Holly Durbin
Des Moines,IA
Summary
Dedicated and well-qualified NICU RN with over 5 years experience in a managed care organization. Highly-motivated employee with desire to take on new challenges. Strong work ethic, adaptability, and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills. Proficient in reviewing requests for inpatient medical services requiring clinical review against insurance protocols and criteria. Sound knowledge of Medicaid.
Overview
16
16
years of professional experience
Work History
Concurrent Review Nurse
Centene, Iowa Total Care
Des Moines , IA
06.2019 - Current
- Experience in both adult and NICU inpatient reviews
- Conduct concurrent and retrospective reviews of medical records to determine appropriateness of requested services.
- Performed concurrent review activities to ensure that treatments are medically necessary and meet quality standards.
- Determine appropriate level of care using InterQual criteria
- Provided feedback on utilization management cases to providers as needed.
- Utilize knowledge of the principles of managed care organizations while performing concurrent review activities.
- Communicate with utilization review and care management staff at healthcare facilities.
- Identify potential care management beneficiaries and provide referrals
- Collaborate with case managers to coordinate post-acute patient care
NICU Clinical Nurse
MercyOne Medical Center - Des Moines
Des Moines , IA
08.2008 - 06.2019
- Responsible for the direct patient care of 3-4 complex patients per shift in the NICU environment
- Monitored closely for infections or any status change by performing thorough head to toe assessment every three hours
- Implemented physician orders for all assigned patients safely
- Provided support and education to parents and family members
- Established goals for each patents and provider developmentally appropriate care to reach those goals
- Identify parents educational needs and teach safe infant care upon discharge
- Performed medical procedures such as inserting intravenous lines, drawing labs and cultures, and administering medications
- Mentored new nurses on practices and procedures to drive patient outcome goals.
Education
Bachelor of Science - Nursing
Mercy College of Health Sciences
Des Moines, IA05.2008
Bachelor of Science - Sociology
Iowa State University
Ames, IA08.1998
Skills
- Strong computer and documentation skills
- Strong verbal communication
- Interpersonal and written communication
- Extremely organized
- Self-motivated
- Strong clinical judgement
- Patient and family advocacy
- Patient-focused care
- Conflict resolution
- Critical Care Nursing
- Attention to Detail
- Work Planning and Prioritization
- Care Coordination
- Medicaid knowledge
- Healthcare regulations
- Clinical assessment
- Utilization review
- Medical record review
- HIPAA knowledge
Timeline
Concurrent Review Nurse
Centene, Iowa Total Care
06.2019 - Current
NICU Clinical Nurse
MercyOne Medical Center - Des Moines
08.2008 - 06.2019
Bachelor of Science - Nursing
Mercy College of Health Sciences
Bachelor of Science - Sociology
Iowa State University
Similar Profiles
Alicia JacksonAlicia Jackson
Program Coordinator at Centene, Iowa Total CareProgram Coordinator at Centene, Iowa Total Care
Jennifer JohannesJennifer Johannes
CLINICAL QUALITY CONSULTANT at Centene - Iowa Total CareCLINICAL QUALITY CONSULTANT at Centene - Iowa Total Care
Melinda HalbloomMelinda Halbloom
RN Case Manager at Centene Iowa Total CareRN Case Manager at Centene Iowa Total Care