Jennifer Montanez
Mesa,AZ
Summary
Seasoned Registered Nurse with a robust background in utilization review and patient care, notably at Aetna. Excelled in healthcare regulations and interpersonal communication, significantly enhancing patient outcomes and streamlining care coordination. Demonstrated expertise in Medicare and insurance verification, driving efficient approval processes and optimal care strategies. Hardworking Registered Nurse with success providing individualized patient care. Committed to delivering best-in-class patient care through effective education and counseling. Proven leadership focused on increasing and enhancing patient care and satisfaction. Streamline safety protocols for comprehensive patient care. Dedicated and compassionate Registered Nurse (RN) with progressive career history in direct patient care, triage and care coordination in fast-paced environment. Proven to remain calm under pressure and skillfully handle difficult patients and high-stress situations. Consistently developing strong relationships with patients and families through empathetic communication, respectful attitude and excellent customer service.
Overview
9
9
years of professional experience
Work History
Utilization Review Nurse
Aetna
10.2012 - 05.2017
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Devise or identify solutions for irregular requests and issues.
- Obtained authorizations from multiple insurance carriers for various levels of care.
- Facilitated workgroup meetings with medical personnel to find effective solutions to issues.
- Submitted cases for criteria failures and helped facilitate resolutions and approvals.
Registered Nurse
Davis Medical Center
03.2008 - 10.2012
- Advised patients and caregivers of proper wound management, discharge plan objectives, safe medication use, and disease management.
- Communicated with healthcare team members to plan, implement and enhance treatment strategies.
- Used first-hand knowledge and clinical expertise to advocate for patients under care and enacted prescribed treatment strategies.
- Monitored patient reactions after administering medications and IV therapies.
- Observed and documented patient factors such as diets, physical activity levels, and behaviors to understand conditions and effectively modify treatment plans.
- Promoted patient and family comfort during challenging recoveries to enhance healing and eliminate non-compliance problems.
- Performed triage on incoming patients and determined severity of injuries and illnesses.
- Educated family members and caregivers on patient care instructions.
- Quickly responded to situations impacting safety and security to unit, actualizing crisis prevention interventions to control and de-escalate situations.
- Explained course of care and medication side effects to patients and caregivers in easy-to-understand terms.
- Conducted ongoing monitoring and evaluations of behaviors and conditions, and updated clinical supervisors with current information.
- Offered exceptional care and support to individuals recovering from acute incidents and dealing with chronic conditions.
- Performed frequent checks on life support equipment and made necessary adjustments to preserve optimal patient conditions.
- Led teams in driving successful patient outcomes by prioritizing standard of care and best practices.
- Evaluated patient histories, complaints, and current symptoms.
- Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
- Provided skilled, timely and level-headed emergency response to critically-ill patients.
- Documented treatments delivered, medications and IVs administered, discharge instructions, and follow-up care.
- Facilitated therapeutic communication, conflict resolution and crisis intervention by redirecting negative behaviors and helping patients regain or improve coping abilities.
- Recorded details regarding therapies to keep patient charts updated.
- Started intravenous fluids, administered medications, and documented patient charts by recording food and fluid output and intake.
- Educated patients and families on medical-surgical procedures, therapeutic regimens, and pain management techniques.
- Managed patients' pain by implementing pharmacological and non-pharmacological pain management interventions.
- Administered blood products and monitored vital signs to address immediate concerns.
- Assisted with wound care, dressing changes and NG tube placement to maintain stable patient conditions.
- Monitored and managed pain levels of post-surgical patients to reduce unnecessary opiate usage.
- Administered IV medications, monitoring and documenting patient responses to address complications.
- Advocated for and strived to protect health, safety, and rights of patient.
- Performed emergency medical procedures such as BLS, ACLS and other condition stabilizing interventions.
- Provided health education to patients and families regarding discharge instructions and plans of care.
- Performed intravenous therapy procedures and monitored chest tubes.
- Monitored patient vital signs to perform thorough condition assessments.
Education
Associate of Applied Science - Nursing
Broadview University
West Jordan, UT05.2008
Associate of Science - Medical Assisting
Stevens-Henager College-Ogden
Ogden, UT06.2004
Skills
- Healthcare regulations
- Palliative Care
- Inpatient Care
- Physician consultations
- Medicare knowledge
- Insurance Verification
- Utilization review
- Discharge Planning
- Discharge planning coordination
- Home Health Care
- Outpatient Care
- Needs Assessment
- Records analysis
- Documentation And Reporting
- Patient Care Plans
- Medical Coding
- Interpersonal and written communication
Timeline
Utilization Review Nurse
Aetna
10.2012 - 05.2017
Registered Nurse
Davis Medical Center
03.2008 - 10.2012
Associate of Applied Science - Nursing
Broadview University
Associate of Science - Medical Assisting
Stevens-Henager College-Ogden
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