Highly-motivated employee with desire to take on new challenges. Strong worth ethic, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
11
11
years of professional experience
Work History
Utilization Management Nurse
InGenesis
Columbia, SC
10.2023 - Current
Monitored pre-authorization requests to ensure that all necessary information was received prior to approval or denial of services.
Evaluated clinical documentation for accuracy and completeness in order to make decisions about coverage determinations.
Assessed patient medical records to determine the appropriateness of requested services and procedures.
Maintained strict patient data procedures to comply with HIPAA laws and prevent information breaches.
Documented all utilization review activities, findings, and decisions in patient records and databases.
Performed pre-certification, and concurrent reviews outpatient services.
Applied medical criteria and clinical judgement to researched cases to evaluate and establish determinations.
Licensed Practical Nurse
Cooperative Health
Columbia, SC
10.2020 - Current
Coordinated with doctors to develop care plans for patients.
Rendered telephone advice according to established guidelines and protocols.
Worked as part of healthcare team to assess patient needs, plan and modify care and implement interventions.
Maintained strict patient data procedures to comply with HIPAA laws and prevent information breaches.
Answered patient calls, identified issues and determined how best to provide assistance within parameters established by facility and supervisor.
Create patient cases to notify provider for the need of high alert medications.
Send refill request for medications to pharmacy.
Emergency Room Technician
Newberry County Memorial Hospital
Newberry, SC
11.2013 - 10.2020
Took patients' vital signs, collected medical specimens and updated information in patient charts.
Facilitated communication patients, visitors, nurses, physicians and other hospital personnel.
Assisted billing department with supply charges.
Conducted patient assessments under supervision of staff nurses and physicians.
Maintained compliance with HIPAA protocols to safeguard patient privacy.
Assisted administrative departments with paperwork, errands and other clerical duties.
Worked on variety of projects to provide supplemental support to unit staff and enhance department.
Education
Some College (No Degree) - Licensed Practical Nurse
Piedmont Technical College
Greenwood, SC
Skills
Multi-Tasking and Prioritization
Patient Triaging
Patient Charting
Information Compiling and Auditing
Utilization Management
Communication
Medicaid knowledge
HIPAA Compliance
Timeline
Utilization Management Nurse
InGenesis
10.2023 - Current
Licensed Practical Nurse
Cooperative Health
10.2020 - Current
Emergency Room Technician
Newberry County Memorial Hospital
11.2013 - 10.2020
Some College (No Degree) - Licensed Practical Nurse