Summary
Overview
Work History
Education
Timeline
RegisteredNurse

Joanne Pridgen

Denton,TX

Summary

Dedicated, recently retired Registered Nurse with extensive experience in Case Management, Utilization Review and Clinical Documentation Integrity. Strong communicator, effective collaborator with healthcare teams and insurance providers to improve access and lower costs while navigating the healthcare system to achieve problem resolution, enhanced customer outcomes and excellent customer satisfaction.

Experienced healthcare professional skilled in critical thinking, and communication. Customer service driven, avid patient advocate and problem solver with strong service excellence skills. Strong focus on team collaboration, professionalism and achieving optimal patient satisfaction and protecting patient privacy while complying with federal, state and local laws. Reliable and adaptable, compassionate and proficient in medical terminology, excellent understanding of disease processes and standard treatments.

Skilled in the use of Best Practices, professional standards and ethical principles.

Overview

46
46
years of professional experience

Work History

Registered Nurse

Palomar Health
10.1999 - 02.2023

Worked in several different departments during my 23 years of employment at this hospital.

Case Management

Utilization Review

Clinical Documentation Integrity

  • Negotiated with healthcare providers to ensure services were provided at best possible cost without compromising on quality.
  • Advocated for patients with third party insurance companies, Medicare and MediCal, securing coverage for necessary treatments and medications.
  • Optimized resource utilization by identifying opportunities for cost containment while maintaining quality of care.
  • Ensured compliance with regulations and accreditation standards by maintaining accurate documentation of all utilization review activities.
  • Mitigated potential legal issues related to improper admission or discharge decisions by consulting with physicians regarding complex cases that required further clarification.

RN Case Manager

Palomar Pomerado Medical Associates
01.1998 - 08.1999
  • Provided emotional support to patients coping with chronic illness or end-of-life decisions, fostering resilience during difficult times.
  • Collaborated closely with physicians to develop individualized treatment plans, supporting optimal patient outcomes.
  • Educated patients and families on available community resources, facilitating access to necessary support services.
  • Reduced hospital readmission rates through effective case management and patient education on self-care techniques.

Utilization Review Registered Nurse

FHP Healthcare
11.1992 - 12.1997
  • Maintained detailed records and documentation related to prior authorization requests, ensuring accurate tracking and reporting for both internal and external stakeholders.
  • Proactively identified potential barriers to approval, implementing strategies to address these challenges before they impacted patient care.
  • Conducted thorough reviews of medical records, identifying necessary documentation to support prior authorization requests.
  • Educated patients on their insurance benefits, helping them understand their coverage and limitations regarding specific procedures or medications.
  • Developed strong relationships with insurance representatives, facilitating effective communication and expediting resolution of issues.

Registered Nurse

Palomar Health
07.1990 - 10.1992
  • Intensive Care Unit

LVN

Scripps Memorial Hospital La Jolla
07.1978 - 07.1990

LVN

Santa Ana Tustin Medical Center
06.1977 - 06.1978

Education

Associate of Science - Registered Nurse

Grossmont College
El Cajon, CA
06-1990

No Degree - Licensed Vocational Nurse

Santa Ana College
Santa Ana, CA
06-1977

Timeline

Registered Nurse

Palomar Health
10.1999 - 02.2023

RN Case Manager

Palomar Pomerado Medical Associates
01.1998 - 08.1999

Utilization Review Registered Nurse

FHP Healthcare
11.1992 - 12.1997

Registered Nurse

Palomar Health
07.1990 - 10.1992

LVN

Scripps Memorial Hospital La Jolla
07.1978 - 07.1990

LVN

Santa Ana Tustin Medical Center
06.1977 - 06.1978

Associate of Science - Registered Nurse

Grossmont College

No Degree - Licensed Vocational Nurse

Santa Ana College
Joanne Pridgen