Jennifer A Stummer
Flat Rock,MI
Summary
Skilled Utilization Review Nurse offering talents in continuous assessments and clinical records oversight. Pleasant individual with over 19 years in the nursing field. Ready to join new company that appreciates attention to detail and exemplary clinical review skills.
Overview
20
20
years of professional experience
Work History
Utilization Review Registered Nurse
UST Healthproof
Aliso Viejo, CA
09.2015 - Current
- Referred cases to secondary review for failure to meet InterQual criteria.
- Determined medical necessity and cost-effectiveness of services through utilization review processes.
- Responded promptly to inquiries regarding authorization requests from providers or patients.
- Conducted retrospective reviews of medical cases as needed to evaluate appropriateness of care provided.
- Assessed the accuracy of coding procedures used by providers for reimbursement purposes.
- Maintained strict patient data procedures to comply with HIPAA laws and prevent information breaches.
- Reviewed patient admissions to determine medical necessity as directed by InterQual criteria.
- Collaborated with providers to obtain required clinical information, supporting prior authorization determinations and individual inquiries.
- Participated in interdisciplinary team meetings to discuss complex cases requiring authorization for specialized services or equipment.
- Remained up-to-date on various benefit plans, medical policies and state-specific clinical guidelines or criteria.
- Reviewed proposed treatments for appropriateness and adherence to established criteria.
- Collaborated with physicians, case managers and other healthcare professionals to ensure appropriate utilization of services.
- Maintained detailed documentation of all utilization review activities according to applicable standards.
- Applied medical criteria and clinical judgement to researched cases to evaluate and establish determinations.
- Performed concurrent reviews of medical records during active episodes of care.
Case Manager
Emergent Holdings
Detroit, MI
12.2019 - 05.2022
- Reviewed treatment plans against individual goals and healthcare standards.
- Participated in professional development activities related to case management best practices.
- Acted as an advocate for vulnerable populations by advocating for policy changes at the state level.
- Coordinated transportation services for clients who lacked access to reliable transportation.
- Collaborated with healthcare team to improve care quality, reduce costs and gauge patient progress.
- Advocated for clients by obtaining information regarding treatment options and clinical status.
- Linked clients with social services, health care providers and governmental agencies to help claim or reclaim individual autonomy.
- Monitored client progress through regular follow-up contacts.
- Assessed clients' needs, developed service plans and monitored progress towards goals.
- Provided case management services including intake, assessment, crisis intervention, advocacy, referral and monitoring of families.
Staff Nurse
Beaumont Hospital
Wayne, MI
05.2012 - 09.2015
- Provided emotional support to patients during difficult times.
- Maintained strict patient data procedures to comply with HIPAA laws and prevent information breaches.
- Advocated for patient needs with interdisciplinary team and implemented outlined treatment plans.
- Stocked clinical workstations and procedure rooms with necessary supplies.
- Coordinated with healthcare team to establish, enact and evaluate patient care plans.
- Assessed patient conditions, monitored behaviors and updated supervising physicians with observations and concerns.
- Prioritized patient care assignments based on patient conditions to achieve optimal outcomes.
- Mentored new nurses on practices and procedures to drive patient outcome goals.
- Provided direct patient care, including wound dressing, administering medications, catheterization, and IV therapy.
- Delivered information regarding care and medications to patients and caregivers in comprehendible terminology.
- Provided direct care in surgical, cardiac and neurological critical care units.
- Administered oral, IV and intra-muscular medications and monitored patient reactions.
- Communicated effectively with physicians, family members, allied health professionals, and other healthcare providers regarding patient care issues.
- Utilized critical thinking skills to assess complex situations and make appropriate decisions in emergency situations.
- Responded quickly to code blue calls providing advanced life support measures as necessary.
- Treated patients with broad range of acute, life-threatening diagnoses.
- Managed PA catheters and arterials, vasoactive drug administration and titration, thrombolytic therapy, dysrhythmia interpretation, and chest tube management.
Staff Nurse
Beaumont Hospital
Dearborn, MI
10.2009 - 05.2012
- Assessed patient needs before starting hemodialysis procedure and monitored vital signs throughout treatment process.
- Coordinated with multidisciplinary team members to provide comprehensive care for patients undergoing dialysis treatments.
- Stocked clinical workstations and procedure rooms with necessary supplies.
- Maintained accurate records of patient progress, medications, treatments, laboratory results and other relevant information in electronic health records system.
- Utilized computerized Resource and Patient Management System (RPMS) and Electronic Health Record (EHR) system.
- Advocated for patient needs with interdisciplinary team and implemented outlined treatment plans.
- Maintained strict patient data procedures to comply with HIPAA laws and prevent information breaches.
- Interpreted and evaluated diagnostic tests to identify and assess patient's condition.
Float Pool Staff Nurse
Beaumont Hospital
Dearborn, MI
07.2006 - 10.2009
- Implemented infection control measures according to hospital policies and procedures.
- Utilized computerized Resource and Patient Management System (RPMS) and Electronic Health Record (EHR) system.
- Monitored vital signs, performed physical assessments, and administered medications to patients as needed.
- Assessed, planned, implemented and evaluated nursing care for assigned patients.
- Performed emergency interventions such as cardiopulmonary resuscitation if necessary.
- Utilized evidence-based practice guidelines when providing patient care.
- Acted as a resource nurse for staff nurses who had questions about patient care issues or procedures.
- Provided emotional support for patients dealing with life-threatening illness or injury.
- Responded to emergency situations with speed, expertise and level-headed approaches to provide optimal care, support and life-saving interventions.
- Collaborated with physicians, other healthcare professionals, and family members to ensure optimal patient outcomes.
Staff Nurse
Beaumont Hospital
Dearborn, MI
07.2004 - 07.2006
- Educated patients about their condition and disease process and post-discharge care instructions.
- Assessed, monitored, and documented patients' progress in the medical record.
- Developed collaborative relationships with multidisciplinary teams including physicians, pharmacists, respiratory therapists.
- Advocated for patient needs with interdisciplinary team and implemented outlined treatment plans.
- Recognized early signs and symptoms of possible complications related to cardiac conditions or treatments and reported them immediately to physician team members.
- Implemented appropriate pain management strategies based on individual patient needs.
- Administered medications safely within scope of practice according to hospital policies and procedures.
- Demonstrated knowledge of cardiac pathophysiology through competent performance of nursing skills related to cardiovascular assessments and interventions.
Education
Nursing
Wayne State University
Detroit, MI05-2004
Skills
- Communication
- Interpersonal and Written Communication
- Documentation and Reporting
- Utilization Review
- Case Management
- Chronic Disease Management
- Care Coordination
- Critical thinking
- Microsoft Office
- Proficient in InterQual
- Knowledge of NCQA requirements
- Computer literacy
- Team Player
- Proficient Time management
- QIO Appeals
- Pat B chart review
Timeline
Case Manager
Emergent Holdings
12.2019 - 05.2022
Utilization Review Registered Nurse
UST Healthproof
09.2015 - Current
Staff Nurse
Beaumont Hospital
05.2012 - 09.2015
Staff Nurse
Beaumont Hospital
10.2009 - 05.2012
Float Pool Staff Nurse
Beaumont Hospital
07.2006 - 10.2009
Staff Nurse
Beaumont Hospital
07.2004 - 07.2006
Nursing
Wayne State University