Summary
Overview
Work History
Education
Skills
References
Timeline
RegisteredNurse
Kendra Torres

Kendra Torres

LPN
Richmond Hill,GA

Summary

Seasoned nurse offering proven clinical knowledge in prior-authorizations, case management, and claims review. Organized and dependable candidate with willingness to take on added responsibilities to meet team goals.

Overview

8
8
years of professional experience

Work History

Prior Authorization Specialist

Centene
07.2024 - Current
  • Inpatient & Outpatient status review
  • Apply evidence based criteria to determine authorization outcomes
  • Appeals & Peer-to Peer Coordination
  • Collaborated with physicians to obtain necessary clinical information for prior authorization submissions.
  • Surgical, Diagnostic, Medication, and DME authorization review
  • Clear documentation and rationale writing
  • Conflict resolution
  • Policy interpretation

Prior Authorization Nurse

CommunityCare
01.2020 - 06.2024
  • Review of Medical/Surgical/DME/Medications/ and Imaging request for medical necessity per evidence based criteria guidelines InterQual/Medicare Administrative Contractor (MAC)
  • Maintain productivity and quality benchmarks in a high-volume review environment
  • Escalate complex or non criteria meeting cases to the Medical Director for further review
  • Ensure compliance with federal state and payer regulations

Licensed Practical Nurse Case Manager

Global Health Holdings
03.2018 - 01.2020
  • Streamlined case management processes to improve efficiency and optimize resource utilization in healthcare setting.
  • Reduced hospital readmission rates through closely monitoring patient progress, adjusting treatment plans as needed.
  • Collaborated with multidisciplinary teams to develop comprehensive care plans tailored to patients'' specific needs.
  • Educated patients and caregivers on disease processes, medications, self-care techniques, and lifestyle modifications to promote optimal health outcomes.

Education

High School Diploma -

Mcloud High School
Mcloud, OK
05.2001 -

License Practical Nurse - Nursing

DeMarge College
OKC, OK
05.2001 -

Skills

Prior Authorization/Utilization Review

Microsoft Office applications

Electronic Health Records/ UM Software

InterQual, CMS, and Commercial Guidelines Application

Data Entry & Documentation Accuracy

References

- Renea Creekpaum 918-901-3393

- Barbara LaBass 918-906-4363

- Trecia McCampbell 405-549-6241

Timeline

Prior Authorization Specialist

Centene
07.2024 - Current

Prior Authorization Nurse

CommunityCare
01.2020 - 06.2024

Licensed Practical Nurse Case Manager

Global Health Holdings
03.2018 - 01.2020

High School Diploma -

Mcloud High School
05.2001 -

License Practical Nurse - Nursing

DeMarge College
05.2001 -
Kendra TorresLPN