Kendra Coberley
Sunbury
Summary
Professional nurse with experience in utilization review, med/surg, and mother-baby nursing. Strong focus on team collaboration and achieving results. Reliable and adaptable to changing needs. Skilled in medical record analysis, patient care evaluation, and compliance with healthcare regulations. Strong critical thinking, communication, and problem-solving abilities.
Overview
10
10
years of professional experience
Work History
Registered Nurse, Utilization Review
University Of Cincinnati Medical Center
Cincinnati, OH
08.2024 - Current
- Evaluated patient care plans for medical necessity and compliance with established protocols.
- Collaborated with healthcare teams to optimize resource utilization and improve patient outcomes.
- Documented findings in electronic health record systems, enhancing accuracy of patient data management.
- Assisted in maintaining regulatory compliance by staying up-to-date on Medicare, Medicaid, and commercial insurance requirements for utilization review activities.
- Contributed to cost savings by applying evidence-based guidelines to determine medical necessity and appropriateness of care.
- Collaborated with financial counselors to ensure accurate billing practices based on clinical documentation from utilization reviews.
- Provided accurate documentation of all utilization review findings, ensuring a clear audit trail for future reference or analysis.
- Maintained strict adherence to HIPAA regulations, safeguarding sensitive patient information throughout all aspects of the utilization review process.
- Established strong working relationships with insurance representatives, fostering open communication channels for efficient resolution of coverage issues or disputes related to medical necessity determinations.
- Obtained authorizations from multiple insurance carriers for various levels of care.
- Supervised and maintained all utilization review documentation through Epic.
- Management of utilization review processes for NICU and OB units
Registered Nurse, Medical-Surgical Unit
Ohio Health Marion General Hospital
Marion, OH
09.2023 - 08.2024
- Administered patient care plans, ensuring compliance with established protocols and standards.
- Monitored vital signs and reported changes to healthcare team for timely interventions.
- Collaborated with multidisciplinary teams to optimize patient outcomes and enhance service delivery.
- Educated patients and families on post-discharge care, fostering understanding and adherence to treatment plans.
- Conducted assessments and evaluations to ensure accurate documentation of patient progress.
- Collaborated with interdisciplinary teams for optimal patient care, ensuring seamless communication between healthcare providers.
- Consistently maintained accurate documentation of patient assessments, interventions, and outcomes in accordance with regulatory requirements.
- Skillfully performed venipuncture, IV insertion, and catheterizations, ensuring proper technique and adherence to infection control standards.
- Advocated for and strived to protect health, safety, and rights of patient.
- Administered medications and treatment to patients and monitored responses.
- Educated patients and families on medical-surgical procedures, therapeutic regimens, and pain management techniques.
- Managed complex wound care, including dressing changes, monitoring for signs of infection, and collaborating with wound care specialists as needed.
- Demonstrated flexibility in managing multiple priorities concurrently during high-stress periods while maintaining a calm demeanor.
- Effectively managed acute pain symptoms by administering medications as prescribed while monitoring for potential side effects.
- Managed patients recovering from medical or surgical procedures.
Registered Nurse, Utilization Review
McLaren St. Luke's Hospital
Maumee, OH
10.2016 - 05.2022
- Conducted thorough reviews of treatment requests, ensuring adherence to clinical guidelines.
- Facilitated communication between providers and payers to resolve authorization issues efficiently.
- Identified trends in utilization patterns, recommending adjustments to enhance service delivery.
- Provided education to nursing staff regarding policies and procedures related to utilization review processes.
- Served as a liaison between healthcare providers, insurance companies, and patients for efficient resolution of coverage issues or denials following a utilization review assessment.
- Optimized resource allocation within the healthcare facility by accurately reviewing cases for level-of-care determinations according to established criteria sets.
- Submitted cases for criteria failures and helped facilitate resolutions and approvals.
- Performed admission reviews based for medical necessity based upon criteria specification.
Education
Bachelor of Science - Nursing
Bowling Green State University
Bowling Green, OH05-2008
Skills
- Medication administration
- Documentation and charting
- Patient assessment
- Clinical judgment
- Infection control measures
- Compassion and empathy
- Patient and family advocacy
- Patient assessments
- Professional bedside manner
- EMR systems
- Relationship building
Timeline
Registered Nurse, Utilization Review
University Of Cincinnati Medical Center
08.2024 - Current
Registered Nurse, Medical-Surgical Unit
Ohio Health Marion General Hospital
09.2023 - 08.2024
Registered Nurse, Utilization Review
McLaren St. Luke's Hospital
10.2016 - 05.2022
Bachelor of Science - Nursing
Bowling Green State University