KIMBERLEY DHABALT
Indianola ,IA
Summary
Qualified Registered Nurse with 24+ years of experience in fast-paced Utilization Management and call center environments supporting insurance company needs. Personable and professional under pressure.
Overview
34
34
years of professional experience
Work History
Prior Authorization RN, Work from Home
Anthem Blue Cross and Blue Shield Healthcare Solutions
05.2017 - Current
- Review clinical information for prior authorization requests for medical necessity for durable medical equipment, pain management procedures, orthotics, out of network requests, etc
- When unable to approve pend and route to the medical director for final determination
- Complete denial letters and notify provider of the denial and or approval
- Work within a multi-disciplinary team setting
- Utilizing Citrix along with Facets and Macess as well as Interqual software
- Knowledgeable of state Medicaid guidelines as well as CMS guidelines
- This is a telecommute / work from home position
- Effective liaison between customers and internal departments
- Maintained up-to-date knowledge of product and service changes
Utilization Management Nurse
Wellmark Blue Cross and Blue Shield
04.2014 - 05.2017
Registered Nurse
Mary Greeley Medical Center
10.2012 - 02.2014
- Staff nurse on medical/surgical floor
- Monitored and recorded patient condition, vital signs, recovery progress and medication side effects
- Educated patients and families on treatment strategies and at-home care
- Coordinated care with physicians and other clinical staff to prepare for treatment, carry out interventions and enhance continuum of care to deliver comprehensive services
- Developed and adapted individualized treatment plans according to patient recovery goals
- Administered oral, intramuscular and IV medications to patients and monitored responses
- Administered medications, tracked dosages and documented patient conditions
- Treated patients suffering from chronic and acute medical concerns, including asthma, seizure disorders and pneumonia
- Administered scheduled medications and therapies intravenously, rectally, orally, subcutaneously and via intramuscular injections while overseeing pain management plans
- Used facility EMR system to update patient records, transmit prescriptions and transfer files
Registered Nurse
Wolfe Surgery Center
08.2011 - 02.2012
Registered Nurse
Mary Greeley Medical Center
06.1991 - 06.2007
- Managed care for pre and post-operative patients through discharge in an outpatient setting
- Self-directed with astute judgment skills
- High level of personal accountability
- Sound, ethical and independent decision-making ability consistent with medical protocols
- Communicated with primary care physicians or emergency care providers to relay patient needs
- Delivered high-quality and compassionate treatment to all patients
- Collaborated with doctors to plan post-treatment home care and prevent return hospitalization due to complications
- Answered patient questions and provided take-home materials for further information
- Updated physicians on patient test results and assisted in developing care plans
- Consistently assessed and evaluated patients' health needs by coordinating across medical disciplines to create, implement and modify personalized care plans
- Educated patients and families on treatment strategies and at-home care
Education
Associate Degree Nursing - Nursing
Iowa Central Community College
Webster City, IA1991
Skills
- Pain Management
- Customer Contact
- Customer Complaint Resolution
- Product and Service Information
- Team Leadership
- Problem-Solving Skills
- Work prioritization
- Prioritizing workflow's
- Workload prioritization
- Working with shifting priorities
- Obtaining authorizations
- Work order administration
- Request prioritization
- Delegating work assignments
- Workflow processes
Additional Information
- Registered Nurse in the State of Iowa (Multi-state License)
- Registered Nurse in the State of Nevada
Timeline
Prior Authorization RN, Work from Home
Anthem Blue Cross and Blue Shield Healthcare Solutions
05.2017 - Current
Utilization Management Nurse
Wellmark Blue Cross and Blue Shield
04.2014 - 05.2017
Registered Nurse
Mary Greeley Medical Center
10.2012 - 02.2014
Registered Nurse
Wolfe Surgery Center
08.2011 - 02.2012
Registered Nurse
Mary Greeley Medical Center
06.1991 - 06.2007
Associate Degree Nursing - Nursing
Iowa Central Community College
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