Katelyn Radabaugh
Morgantown,WV
Summary
Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Overview
6
6
years of professional experience
Work History
Utilization Review Nurse
WVU Medicine
05.2023 - Current
- Performed prior authorization review of services requiring notification.
- Submitted cases for criteria failures and helped facilitate resolutions and approvals.
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Obtained authorizations from multiple insurance carriers for various levels of care.
- Provide appropriate and timely clinical reviews per payer guidelines.
- Communicate with Payer Specialist regarding certification for patients and criteria of payor. • Provide efficient and cost-effective requirements for patient progress.
- Communicate denials with Denial Coordinator, Physician, as necessary, and Case Management team.
- Collaborates with Physician Advisor regarding appropriate status change, as necessary.
- Apply appropriate utilization criteria to provide appropriate medical necessity for admission and continued stay.
- Work independently and in a team environment to ensure appropriate timeliness of assigned workload.
- Provide the utmost professional behavior on a consistent basis.
Utilization Review Nurse
Marietta Memorial Hospital
03.2022 - 05.2023
- Performed admission reviews based for medical necessity based upon criteria specification.
- Determines appropriateness of admission and severity of illness compared to pre-established criteria standards utilized by all third-party payers.
- Collects and records all clinical data, based on predetermined quality and outcome indicators developed by the Medica staff and Directors.
- Compliance with SQL, Interqual, Milliman, Citrix, BOLT
- Ensure efficient methods of ensuring the medical necessity and appropriateness of hospital admission.
Case Manager
Camden Clark Medical Center
03.2022 - 03.2022
- Developed and implemented comprehensive case management plans to address client needs and goals.
- Coordinated services with other agencies, community-based organizations, and healthcare professionals to provide useful benefits to clients.
- Assisted clients in navigating housing, legal services and public benefits to gain access to valuable resources.
- Monitored clients' progress and tracked client services to provide crisis interventions.
- Partnered with physicians, social workers, activity therapists, nutritionists, and case managers to develop and implement individualized care plans and documented patient interactions and interventions in electronic charting systems.
- Developed comprehensive discharge plans to transition clients to appropriate service providers in community.
- Collaborated with an interdisciplinary team to determine timely delivery of services.
Registered Nurse
Camden Clark Medical Center
01.2020 - 03.2021
- Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing conditions.
- Administered medications via oral, IV, and intramuscular injections and monitored responses.
- Administered medications and treatment to patients and monitored responses while working with healthcare teams to adjust care plans.
- Educated patients, families and caregivers on diagnosis and prognosis, treatment options, disease process, and management and lifestyle options.
- Renders professional collaborative nursing care to a caseload of patients in accordance with the health care practitioner's treatment plan, standards of care/practice and professional code of ethics.
- Committed to promoting the health potential of the whole person assuring optimal care through being responsible for prescribing (assessing, planning, implementing, and evaluating) patient care.
- Takes action to ensure a safe patient care environment.
Registered Nurse, Emergency Department
Marietta Memorial Hospital
05.2019 - 01.2020
- Obtains required patient assessments and reassessments per nursing policy. •
- Coordinates timely, adequate teaching to patient/family/significant other in preparation for discharge and documents appropriately. •
- Implements and monitors nursing interventions.
- Consistently documents assessments, interventions and outcomes in Meditech within required timeframe.
- Participates in interdisciplinary rounding and collaborates with team members to identify patient needs.
- Recognizes changes in patient conditions and communicates with physician using SBAR.
- Effectively manages patient care and delegates appropriately according to the needs of the patient and the skill of the caregiver.
- Utilizes appropriate interpersonal communication which facilitates productive relationships with other team members.
- Facilitates a positive and caring relationship with others by utilizing trust and mutual respect.
- Establishes a therapeutic relationship between patient, family and self, based on empathy and trust.
- Promotes a positive patient experience
Emergency Room Nurse Technician
Marietta Memorial Hospital
07.2017 - 05.2019
- Communicated openly and collaboratively with all healthcare staff to organize successful patient care.
- Followed directions of licensed nurses to administer medications and treatments.
- Answered codes quickly and orchestrated efficient, skilled medical care.
- Educated family members and caregivers on patient care instructions.
- Completed activities of daily living for patients unable to self-care, and assisted those with limited mobility in completing tasks.
- Documented patient information and care activities in electronic health record.
- Assisted nursing staff with completing daily rounds, documenting vital signs and answering calls.
- Maintained patient stability by checking vital signs and weight and recording intake and outtake information.
- Upheld infection control and prevention policies across different patient-facing areas.
- Reduced risks of patient infection and cross-contamination by cleaning and sterilizing equipment.
Education
Master of Science - Healthcare Administration
Western Governors University
Salt Lake City, UT05.2024
Bachelor of Science - Nursing
West Virginia University At Parkersburg
Parkersburg, WV05.2023
Associate of Science - Nursing
West Virginia University At Parkersburg
Parkersburg, WV05.2019
Bachelor of Science - Accounting
West Virginia University At Parkersburg
Parkersburg, WV05.2014
Bachelor of Arts - Finance
West Virginia University At Parkersburg
Parkersburg, WV08.2013
Skills
- Documentation and Reporting
- Utilization Review
- Patient Care Plans
- Records Analysis
- Interpersonal and Written Communication
- Case Management
- EMR / EHR
- Critical Thinking
- Strong Clinical Judgment
- Discharge Planning Coordination
Timeline
Utilization Review Nurse
WVU Medicine
05.2023 - Current
Utilization Review Nurse
Marietta Memorial Hospital
03.2022 - 05.2023
Case Manager
Camden Clark Medical Center
03.2022 - 03.2022
Registered Nurse
Camden Clark Medical Center
01.2020 - 03.2021
Registered Nurse, Emergency Department
Marietta Memorial Hospital
05.2019 - 01.2020
Emergency Room Nurse Technician
Marietta Memorial Hospital
07.2017 - 05.2019
Master of Science - Healthcare Administration
Western Governors University
Bachelor of Science - Nursing
West Virginia University At Parkersburg
Associate of Science - Nursing
West Virginia University At Parkersburg
Bachelor of Science - Accounting
West Virginia University At Parkersburg
Bachelor of Arts - Finance
West Virginia University At Parkersburg
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