Kim Kepford
Ringsted,IA
Summary
Experienced Utilization Review Nurse offering continuous assessments and oversight on patient hospitalizations. I have over 42 years experience in the nursing field and experience in clinical review skills. I currently have 10 years' experience as Utilization Review Nurse. Knowledgeable in medical record review and application of the MCG and Interqual software for insurance reviews. I am an experienced nursing professional bringing demonstrated clinical expertise, and technical knowledge to the UM team. I am a Hardworking employee with customer service, multitasking, and time management abilities. I am responsible and motivated to promote positive outcomes. I am detail oriented and I am a team player willing to assist others as needed and complete required duties to promote team efficiency. I am looking forward to possibly working with other team members to promote efficiency and accuracy of the patient care review team. I feel that I get along well with others and work hard to complete my duties with attention to detail and follow up as needed.
Overview
42
42
years of professional experience
1
1
Certification
Work History
Registered Nurse Case Manager
Methodist Jennie Edmundson Hospital
Council Bluffs , IA
05.2014 - Current
- Reviewed denial letters issued by insurance companies and initiated denial process per hospital and insurance policies
- Communicated with MCO's, insurance companies and payors to ensure appropriate records are received for coverage of patient hospital stay under patient plan agreements
- Referred patients to specialized health resources or community agencies to furnish additional assistance.
- Facilitated communication between payers, providers and patients concerning authorization issues or concerns.
- Maintained strict patient data procedures to comply with HIPAA laws and prevent information breaches.
- Served as a resource for staff members seeking guidance on utilization review matters.
- Reviewed patient admissions to determine medical necessity as directed by Interqual and MCG criteria.
- Provided education to providers regarding utilization management processes and protocols.
- Referred cases to secondary review for failure to meet admission criteria.
- Performed discharge planning including referrals for post-acute care services when appropriate.
- Developed case management plans based on individual patient needs and eligibility criteria.
- Kept detailed documentation on all utilization reviews by using MCG and Interqual software
- Coordinated with healthcare team to establish, enact and evaluate patient care plans.
- Managed P2P processes pertaining to denials and potential denials as outlined by insurance carriers.
- Completed day-to-day duties accurately and efficiently.
Nurse Manager Dialysis
Mercy Medical Center North Iowa - East Campus
Mason City , IA
06.1991 - 05.2014
- Introduced new departmental policies and oriented staff to facilitate adoption of changes.
- Oversaw clinical operations staff and procedures while remaining current of federal and state regulations to ensure organization processes were fully compliant with new healthcare law requirements.
- Administered financial operations, budget development, expenditure authorization, accounting, service rate pricing and financial reporting.
- Evaluated quality index scores and key performance indicators to identify opportunities for improvement.
- Assisted in developing quality improvement plans for dialysis services based on data analysis results.
- Monitored inpatient bed use, facilities and staff to provide optimal use of resources.
- Collaborated with physicians to develop individualized treatment plans for each patient's needs.
- Delegated tasks to each member of staff and oversaw task completion, offering assistance to promote success.
- Interviewed applicants and made recommendations for new hires.
- Supervised 32 staff members and provided periodic performance evaluations.
Clinical Supervisor RN
Francis Mahon Deaconess Hospital
Glasgow, MT
03.1988 - 06.1991
- Communicated effectively with physicians regarding patient status updates.
- Assessed patient needs before starting hemodialysis procedure and monitored vital signs and patient condition throughout treatment process.
- Responded to emergency situations with speed, expertise and level-headed approaches to provide optimal care, support and life-saving interventions.
- Initiated and supervised dialysis treatments for patients in the dialysis setting.
- Evaluated patient labs and medications and made adjustments in treatment plan per provider protocols and policies
- Educated patients on their renal failure diagnosis and how to manage their condition.
- Administered prescribed medications during dialysis treatments according to established protocols.
- Completed water testing and completed acute dialysis treatments in the hospital setting.
RN Floor Nurse
Francis Mahon Deaconess Hospital
Wheatland , WY
08.1986 - 03.1988
- Initiated admissions, transitions and discharges by communicating with colleagues as well as patients and family members.
- Promoted continuity of care by accurately communicating patient information during shift change report times.
- Performed wound care, catheter insertion and removal, intravenous therapy, medication administration, and other treatments as ordered by physicians.
- Covered emergency room to triage patients, assist provider in treating and administering prescribed treatments and medications as needed for patient healing and recovery.
- Assisted in care of mothers during labor and with delivery of their infants. Performed post partum cares and cares of the infants immediately following birth until discharge.
- Rounded on nursing home patients daily and reported any concerns with residents and made appropriate referrals to providers as necessary in order to meet patient health needs.
RN
Mercy Medical Sioux City
Sioux City , IA
07.1982 - 07.1986
- Developed individualized plans of care based on assessment data that addressed identified problems or needs.
- Interpreted and evaluated diagnostic tests to identify and assess patient's condition.
- Initiated admissions, transitions and discharges by communicating with colleagues as well as patients and family members.
- Promoted continuity of care by accurately communicating patient information during shift change report times.
- Evaluated patients, recognized and addressed complications and coordinated treatment with other members of critical care team.
- Performed wound care, catheter insertion and removal, intravenous therapy, medication administration, and other treatments as ordered by physicians.
- Managed teams of patients by performing total patient care from medication administration to assisting with ADL's, Vital signs, treatments, wound cares per nursing practice , hospital protocol and documenting according to documentation standards.
Education
Bachelor Degree of Nursing - Nursing
University of Iowa
Iowa City, IA05-2002
Associate Degree in Nursing -
Iowa Central Commmunity College
Fort Dodge, IA07-1982
High School Diploma -
Harlan Community High School
Harlan, IA05-1980
Skills
- Care Coordination
- Quality Improvement
- Patient Needs Assessment
- Patient Evaluation
Certification
- Licensed in the state of Iowa as an RN
- CPR certified
- Current with child and adult abuse reporting and education
- Previously certified dialysis nurse
References
References available upon request.
Timeline
Registered Nurse Case Manager
Methodist Jennie Edmundson Hospital
05.2014 - Current
Nurse Manager Dialysis
Mercy Medical Center North Iowa - East Campus
06.1991 - 05.2014
Clinical Supervisor RN
Francis Mahon Deaconess Hospital
03.1988 - 06.1991
RN Floor Nurse
Francis Mahon Deaconess Hospital
08.1986 - 03.1988
RN
Mercy Medical Sioux City
07.1982 - 07.1986
Bachelor Degree of Nursing - Nursing
University of Iowa
Associate Degree in Nursing -
Iowa Central Commmunity College
High School Diploma -
Harlan Community High School
- Licensed in the state of Iowa as an RN
- CPR certified
- Current with child and adult abuse reporting and education
- Previously certified dialysis nurse
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