Kimberly Edwards
Smyrna,TN
Summary
Experienced nursing professional bringing demonstrated clinical expertise, leadership skills and technical knowledge. Proficient in updating charts, monitoring medications and working with multidisciplinary teams to optimize patient care. Quality-driven and efficient with strong interpersonal abilities. Highly-motivated employee with desire to take on new challenges. Strong work ethic, adaptability, and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
7
7
years of professional experience
1
1
Certification
Work History
Utilization Review Analyst
EviCore Healthcare formerly Care Core National
Franklin, TN
01.2018 - Current
- Displayed strong telephone etiquette, effectively handling difficult calls.
- Performed quality assurance to assess data and validate results.
- Participated in regular meetings with management to assess and address issues and identify and implement improvements.
- Reviewed existing systems and processes for accuracy and compliance with regulations.
- Maintained user confidence and protected operations by keeping information confidential.
- Conducted workplace compliance training to reduce liability risks.
- Set specific goals for projects to measure progress and evaluate end results.
- Worked with cross-functional teams to achieve goals.
- Prioritized and organized tasks to efficiently accomplish service goals.
- Recognized by management for providing exceptional customer service.
- Completed day-to-day duties accurately and efficiently.
- Approached customers and engaged in conversation through use of effective interpersonal and people skills.
- Provided excellent service and attention to customers when face-to-face or through phone conversations.
- Determined medical necessity and cost-effectiveness of services through utilization review processes.
- Maintained up-to-date knowledge of health plan benefits, policies, procedures, regulations, coding guidelines.
- Assessed patient medical records to determine the appropriateness of requested services and procedures.
- Collaborated with providers to obtain required clinical information, supporting prior authorization determinations and individual inquiries.
- Analyzed data from patient surveys, interviews and other sources to assess healthcare service quality.
- Evaluated clinical documentation for accuracy and completeness in order to make decisions about coverage determinations.
- Maintained strict patient data procedures to comply with HIPAA laws and prevent information breaches.
- Participated in provider meetings to discuss cases involving complex medical conditions or difficult authorization decisions.
- Monitored pre-authorization requests to ensure that all necessary information was received prior to approval or denial of services.
- Maintained updated knowledge through continuing education and advanced training.
Licensed Practical Nurse
Maxim Healthcare
Brentwood, TN
08.2016 - 01.2018
- Administered medications and treatments according to established protocols.
- Administered medications and therapies in accordance with physicians orders.
- Administered prescribed medications, noting times and amounts on patient charts.
- Collaborated with multi-disciplinary staff to improve overall patient care and response times.
- Provided patient care in accordance with physicians' orders and nursing standards of practice.
- Communicated concerns regarding patients' status, care and environment to nursing supervisors, clinical care supervisors and case managers.
- Sterilized medical equipment and supplies with germicides, sterilizers and autoclaves.
- Communicated with patients with compassion while keeping medical information private.
- Performed physical assessments, including vital signs and health history documentation.
- Documented patient medical histories, current symptoms and vitals.
- Communicated effectively with patients and loved ones to explain diagnoses, treatment options and procedures.
- Used sterile techniques to prepare patients for procedures.
- Applied interventions to progress patients toward wellness and address maintenance of wellness.
- Assembled and used catheters, tracheotomy tubes or oxygen suppliers.
- Maintained strict patient data procedures to comply with HIPAA laws and prevent information breaches.
- Promoted culture of safety for patients and employees through proper identification, reporting documentation and prevention.
- Guaranteed exceptional care quality by correctly administering medication, inserting and caring for catheters, dressing and changing wounds and assisting with personal hygiene.
- Maintained a safe environment by following infection control policies and procedures.
- Observed strict confidentiality and safeguarded all patient-related information.
- Observed changes in patient's condition and reported any significant changes to the registered nurse or physician.
- Assisted patients with personal hygiene activities such as bathing, dressing, eating, grooming, and toileting needs.
Education
Practical Nurse Diploma - Nursing
Tennessee College of Applied Technology
Murfreesboro, TN08-2014
Some College (No Degree) - LPN To RN Bridge Program
Excelsior University
AlbanySkills
- System Analysis
- Audit Support
- Regulatory Compliance
- Data Integrity Assurance
- Evidence-Based Decision Making
- Data Processing
- Documentation and Reporting
- Home Health Services
- Patient Monitoring
- Medication Administration
- Wound Care
- ICD-10
- Coaching and Mentoring
- Empathetic and Compassionate
- Multi-Tasking and Prioritization
Certification
State of Tennessee Licensed Practical Nurse (compact license)
American Heart Association BLS provider (CPR and AED) Program
Timeline
Utilization Review Analyst
EviCore Healthcare formerly Care Core National
01.2018 - Current
Licensed Practical Nurse
Maxim Healthcare
08.2016 - 01.2018
Practical Nurse Diploma - Nursing
Tennessee College of Applied Technology
Some College (No Degree) - LPN To RN Bridge Program
Excelsior University