Summary
Overview
Work History
Education
Skills
Timeline
Generic

KIMBERLY CONVERSE

CUMMING

Summary

Utilization Review Nurse with 21 years of experience at Aetna, specializing in patient assessments, care coordination, and clinical documentation. Demonstrates exceptional team leadership, patient advocacy, and healthcare compliance skills, collaborating effectively with medical directors to optimize treatment outcomes and resource utilization. Committed to enhancing patient care and ensuring high standards of healthcare delivery.

Overview

24
24
years of professional experience

Work History

Utilization Review Nurse

Aetna
Atlanta
10.2003 - Current
  • Evaluate patient cases for medical necessity, ensuring compliance with insurance guidelines.
  • Conduct patient assessments with MCG guidelines, to determine care levels, ensuring optimal outcomes
  • Knowledge of Medicare rules and guidelines for better member outcomes
  • Experience with the commerical side of UM and experience with NICU cases, spent time on NICU team.
  • Experience with team lead responsibilities , assignments, precepting, resource for coworkers
  • Participates in med director rounds, discussing cases with difficult authorization decisions, long length of stays.

Registered Nurse

Children's Healthcare of Atlanta
Atlanta
12.2001 - 10.2003
  • Delivered compassionate care to pediatric patients, ensuring comfort and recovery.
  • Collaborated with multidisciplinary teams to implement treatment plans.

Education

Diploma -

Sewickley Valley School of Nursing
Sewickley, PA
01-1991

Skills

  • Patient Advocacy
  • Utilization review
  • Healthcare Compliance
  • Clinical Documentation
  • Care Coordination
  • Time Management

Timeline

Utilization Review Nurse

Aetna
10.2003 - Current

Registered Nurse

Children's Healthcare of Atlanta
12.2001 - 10.2003

Diploma -

Sewickley Valley School of Nursing

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