Kimberly Andrews
Naples
Summary
Dynamic Utilization Management Nurse at Humana with expertise in medical necessity reviews and patient care coordination. Proven track record in enhancing patient outcomes through strategic case management and multidisciplinary collaboration. Adept at mentoring staff and applying critical thinking to optimize resource utilization while maintaining high-quality standards.
Overview
26
26
years of professional experience
Work History
Utilization Management Nurse
Humana
03.2018 - Current
- Conducted comprehensive reviews of medical necessity for healthcare services to ensure compliance with clinical guidelines.
- Collaborated with multidisciplinary teams to coordinate patient care and optimize resource utilization.
- Analyzed utilization trends and identified opportunities for cost reduction while maintaining quality of care.
- Developed and implemented strategies to improve patient outcomes through effective case management interventions.
- Mentored junior staff, fostering a culture of continuous improvement and professional development within the team.
- Led initiatives aimed at enhancing operational efficiency in claims processing and service delivery workflows.
- Applied critical thinking skills to assess complex medical cases and determine appropriate levels of care in accordance with industry benchmarks.
- Promoted a positive work environment by mentoring new nurses and serving as a resource for clinical questions and concerns.
- Contributed to team success by consistently meeting productivity goals while maintaining high-quality standards in job performance.
Case Manager
Titus Regional Medical Center
05.2016 - 03.2018
- Coordinated patient care plans to enhance treatment outcomes and ensure continuity of services.
- Conducted comprehensive assessments to identify patient needs and recommend appropriate interventions.
- Developed and maintained strong relationships with multidisciplinary teams for effective case resolution.
- Facilitated communication between patients, families, and healthcare providers to optimize care delivery.
- Monitored patient progress and adjusted care plans based on evolving health conditions and feedback.
Charge Nurse
Good Shepard Medical Center
06.2007 - 04.2016
- Supervised nursing staff to ensure compliance with care standards and protocols.
- Coordinated patient care plans in collaboration with healthcare teams and specialists.
- Mentored junior nurses, fostering professional development and improving clinical skills.
- Implemented quality improvement initiatives to enhance patient safety and satisfaction.
- Supervised daily operations of ICU, ensuring adherence to protocols and standards.
- Collaberated patient care plans with multidisciplinary teams for optimal outcomes.
- Enhanced patient care by implementing evidence-based nursing practices and protocols in the ICU.
Nursing House Supervisor
Good Sheppard Medical Center
03.2000 - 05.2002
- Supervised nursing staff to ensure adherence to best practices and quality care standards.
- Coordinated patient admissions, discharges, and transfers to optimize workflow efficiency.
- Developed and implemented training programs for new nursing personnel to enhance skill sets.
- Monitored patient care activities to maintain compliance with regulatory requirements and safety protocols.
Education
Bachelor of Science - Nursing
University of Texas
Arlington, Tx05-2015
Associate of Science - Nursing
Northeast Texas Community College
Mount Pleasant, Texas, TX05-2000
Skills
- Utilization management
- Patient care coordination
- Medical necessity reviews
- Case management strategies
- Multidisciplinary collaboration
- Staff mentorship
- Team leadership skills
- Critical thinking application
Timeline
Utilization Management Nurse
Humana
03.2018 - Current
Case Manager
Titus Regional Medical Center
05.2016 - 03.2018
Charge Nurse
Good Shepard Medical Center
06.2007 - 04.2016
Nursing House Supervisor
Good Sheppard Medical Center
03.2000 - 05.2002
Bachelor of Science - Nursing
University of Texas
Associate of Science - Nursing
Northeast Texas Community College