Summary
Overview
Work History
Education
Skills
Certification
Timeline
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Kathy Ann Woods

Chicago,IL

Summary

Professional nurse with extensive experience in utilization review. Skilled in analyzing patient care and ensuring compliance with healthcare regulations. Strong focus on team collaboration and achieving optimal patient outcomes. Adaptable and reliable, excelling in dynamic environments requiring precise decision-making and effective communication.

Overview

9
9
years of professional experience
1
1
Certification

Work History

Prior Authorization Nurse

United Healthcare- WellMed
11.2022 - Current
  • Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings. Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to prior authorization requests.
  • Worked closely with case managers to facilitate appropriate utilization of healthcare resources through the prior authorization process.
  • Assisted in maintaining compliance with changing regulations and policies by staying up-to-date on industry trends and best practices.

Prior Authorization Nurse

Centene Corporation
07.2021 - 11.2022
  • Streamlined the prior authorization process, reducing wait times and improving overall efficiency.
  • Maintained detailed records and documentation related to prior authorization requests, ensuring accurate tracking and reporting for both internal and external stakeholders.
  • Expedited urgent requests for prior authorization, ensuring timely access to critical medical treatments.
  • Tracked performance metrics within the department, identifying areas for improvement and implementing targeted interventions as needed.

Registered Nurse/Patient Service Representative

Northwestern Medicine
02.2016 - 07.2021
  • Mohs Micrographic Surgery. Experience outpatient surgical setting over twelve years. Assisting with Mohs surgery, biopsies and excisions. Communicated with various managed care insurance companies completing prior authorizations and scheduled and removed sutures. Initiated referrals, answer In-Basket patient calls and refilled prescriptions.
  • Collaborated with interdisciplinary teams to develop comprehensive treatment plans for complex patients with multiple comorbidities.
  • Promoted a culture of safety within the healthcare facility by participating in quality improvement initiatives, identifying potential hazards, and advocating for best practices in nursing care delivery.

Education

ADN -

Indiana University Northwest

RN-BSN -

Grand Canyon University

Skills

  • HIPAA compliance
  • Clinical documentation
  • Training and mentoring
  • Clinical assessment
  • Utilization review
  • Quality improvement

Certification

  • Illinois RN license
  • Wisconsin RN license

Timeline

Prior Authorization Nurse

United Healthcare- WellMed
11.2022 - Current

Prior Authorization Nurse

Centene Corporation
07.2021 - 11.2022

Registered Nurse/Patient Service Representative

Northwestern Medicine
02.2016 - 07.2021

ADN -

Indiana University Northwest

RN-BSN -

Grand Canyon University

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