Katrina M. Holford
Summary
Innovative and goal-oriented Registered Nurse with over 20 years of extensive experience, committed to professional development and expert leadership in all aspects of the work environment.
Insightful in specific diagnostic approaches, treatment strategies and techniques to overcome hurdles in patient care.
Work great with individuals from different backgrounds and cultures to achieve healthcare objectives.
Attention to details and dedication to improving patient outcomes, while focusing on continuous professional development is the utmost importance.
Handle stress well and quickly flex with changing demands.
Demonstrate excellence of therapeutic communication while promoting patient safety.
Strive to stay abreast of latest research, treatments and techniques for all areas of nursing.
Overview
20
20
years of professional experience
Work History
Care Coordinator/Utilization Review Nurse
WellSpan Chambersburg Hospital
Chambersburg, PA
01.2011 - Current
- Evaluate medical guidelines and benefit coverage to determine appropriateness of services.
- Attend workgroup meetings with multidisciplinary team to find effective solutions to issues.
- Supervise and maintain all utilization review documentation through Epic.
- Submit cases to physician for criteria failures and helped facilitate resolutions and approvals.
- Perform continued stay reviews based upon medical necessity - using primarily Interqual criteria.
- Serve as a subject matter resource nurse, providing needed information related to individual situations.
- Devise or identify solutions for irregular requests and issues.
- Obtain authorizations from multiple insurance carriers (commercial, Medicare and Medicaid), for various levels of care.
- Support clinical appeals through collecting needed info from the medical record.
- Perform prior authorization needed for admission.
- Participate in evidence-based implementation and nursing competency development.
- Apply nursing expertise to meet needs of patients and co-workers in challenging work environment.
- Assessed and evaluated mental health needs, working with multidisciplinary team to initiate, manage and modify individualized care plans.
- Conveyed treatment options, diagnosis information and home care techniques to patients and caregivers to continue care consistency.
Appeals Coordinator
Select Medical Corporation
Mechanicsburg, PA
12.2009 - 12.2010
- Acted as departmental resource on appeals matters.
- Coordinated with staff and expertly reviewed medical record to compose appeal responses.
- Created, composed and maintained appeal response templates.
- Acted as appeals expert, answering internal and external questions and inquiries.
- Communicated effectively with staff members of operations, finance and clinical departments.
- Coordinated with contracting department to resolve payer issues.
- Reviewed outstanding requests and redirected workloads to complete projects on time.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Maintained confidentiality of patient finances, records and health statuses.
- Overturned 3+ million dollars worth of claims thru written appeals.
Registered Nurse, Dual Diagnosis Unit
Roxbury Treatment Center
Shippensburg, PA
10.2008 - 12.2009
- Provided direct patient care, stabilized patients and determined next course of action.
- Managed care from admission to discharge.
- Administered medications via oral, IV and intramuscular injections and monitored responses.
- Advocated for patients by communicating care preferences to practitioners, verifying interventions met treatment goals and identifying insurance coverage limitations.
- Educated patients, families and caregivers on diagnosis and prognosis, treatment options, disease process and management and lifestyle options.
- Secured controlled narcotics and distributed medication on schedule to meet patient needs and minimize misuse opportunities.
- Audited charts and reviewed clinical documents to verify accuracy.
- Evaluated healthcare needs, goals for treatment and available resources of each patient and connected to optimal providers and care.
- Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing conditions.
- Conferred with physicians to discuss diagnoses and devise well-coordinated treatment approaches.
- Monitored patient reactions to drugs and carefully documented findings.
- Contributed substantially to successful department JCAHO accreditation by consistently operating to highest standards of care.
Maternal Care Coordinator
Keystone Women's Care
Chambersburg, PA
10.2006 - 10.2008
- Determined need for special assessment activities for complex cases, while effectively handling care plans.
- Supported patient care excellence via planning and interpretation of Healthy Beginnings Program.
- Completed in-office patient histories and physical assessments in accordance with current regulations and guidelines.
- Built strong relationships with clients to deliver professional emotional support during their pregnancy.
- Conducted home visits to assess mothers and infants - ensuring healthy recovery from birthing process.
- Extensive discussion with mothers and devised care plans related to mother-baby assessment and home visit.
- Facilitated nurse triage line and determined appropriate care needed.
- Ensured appropriate care of all patients via direct orders and discussion with providers.
- Conducted NST's in the nurse triage office and followed physician's orders regarding results.
- Facilitated documents and care objectives with the staff on the Family Birthing Unit at the affiliated hospital.
Register Nurse, Family Birthing Unit
Chambersburg Hospital
Chambersburg, PA
06.2004 - 10.2006
- Managed care from admission to discharge.
- Provided direct patient care, stabilized patients and determined next course of action.
- Administered medications and treatment to patients and monitored responses while working with healthcare teams to adjust care plans.
- Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing conditions.
- Assisted physician with implementation of epidural protocol and followed guidelines of successful care of such.
- Secured controlled narcotics and distributed medication on schedule to meet patient needs and minimize misuse opportunities.
- Trained new nurses in proper techniques, care standards, operational procedures and safety protocols.
- Contributed substantially to successful department JCAHO accreditation by consistently operating to highest standards of care.
- Oversaw delivery of care for laboring and post-partum patients, providing direct care and following directs orders from physicians.
- Conferred with physicians to discuss diagnoses and devise well-coordinated treatment approaches.
- Educated patients, families and caregivers on diagnosis and treatment protocols.
- Facilitated the care of mother and baby during cesarean sections performed in the operating room.
Education
Associate of Science - Nursing
Penn State University
Mont Alto, PA06.2004
Bachelor of Arts - Social Work
Shippensburg University of Pennsylvania
Shippensburg, PA12.2001
High School Diploma -
Chambersburg Area Senior High School
Chambersburg, PA06.1996
Skills
- Procedure/Operating Room Assistance
- Creative Problem Solving
- Utilization Review
- Patient Care Assessment
- Care Coordination
- Treatment Plan Modification
- Direct Patient Care
- Knowledge of Epic
Timeline
Care Coordinator/Utilization Review Nurse
WellSpan Chambersburg Hospital
01.2011 - Current
Appeals Coordinator
Select Medical Corporation
12.2009 - 12.2010
Registered Nurse, Dual Diagnosis Unit
Roxbury Treatment Center
10.2008 - 12.2009
Maternal Care Coordinator
Keystone Women's Care
10.2006 - 10.2008
Register Nurse, Family Birthing Unit
Chambersburg Hospital
06.2004 - 10.2006
Associate of Science - Nursing
Penn State University
Bachelor of Arts - Social Work
Shippensburg University of Pennsylvania
High School Diploma -
Chambersburg Area Senior High School