Kristin Peeples
Mulberry,Florida
Summary
Registered Nurse with a strong foundation in clinical resource coordination, adept at performing medical necessity reviews and supporting appeals processes. Proficient in evaluating documentation for payer compliance and actively engaging with providers to ensure optimal patient care and efficient resource utilization.
Overview
2
2
Certifications
24
24
years of professional experience
Work History
Clinical Resource Coordinator/Registered Nurse
Winter Haven Hospital
Winter Haven, FL
05.2008 - Current
- Facilitate communication among clinical staff, physicians, case management, and revenue cycle departments to address patient status and utilization review requirements
- Complete InterQual reviews for all Medicare and Medicaid plans
- Complete detailed clinical reviews for commercial, Medicare, and Medicaid payers utilizing InterQual criteria
- Facilitate peer-to-peer reviews and submit expedited appeals to support authorization approvals and overturn potential denials.
- Documented and reported avoidable delays for inpatient behavioral health patients, identifying barriers to discharge and facilitating timely resolution with interdisciplinary teams.
Registered Nurse, Inpatient Psychiatry / 23-Hour Observation Unit
Lakeland Regional Medical Center
Lakeland, FL
01.2007 - 05.2008
- Assisted in opening and implementing the hospital's 23-Hour Adult Psychiatric Observation Unit.
- Provided nursing care for adult and adolescent psychiatric patients in acute and observation settings.
- Assisted with Electroconvulsive Therapy (ECT) procedures, patient preparation, monitoring, and post-treatment care.
- Conducted assessments and monitored patients for behavioral health and medical needs.
- Evaluated patients for appropriate levels of care and treatment placement.
- Coordinated staff assignments and patient flow across specialty units, optimizing clinical operations and resource allocation.
- Supervised staff during shifts across multiple psychiatric units, maintaining operational continuity and staff performance.
- Assisted with denial management and insurance appeal processes.
- 23-Hour Psychiatric Observation Unit
Registered Nurse, Medical/Surgical Unit
Lakeland Regional Medical Center
Lakeland, Florida
01.2005 - 01.2007
- Provided comprehensive nursing care for medical and surgical patients in an acute care environment.
- Administered medications and treatments to ensure effective therapeutic interventions for patient recovery.
- Performed patient assessments and monitored changes in condition.
- Collaborated with physicians and interdisciplinary teams to develop and implement tailored care plans, enhancing patient outcomes.
- Educated patients and families on diagnoses and medications, facilitating informed discharge planning and improved self-management.
- Maintained accurate clinical documentation and regulatory compliance.
Nurse Intern
Lakeland Regional Medical Center
Lakeland, FL
01.2003 - 01.2005
- Assisted nursing staff in delivering high-quality patient care within acute care hospital setting, enhancing overall patient experience.
- Monitored patient conditions and effectively communicated concerns to nursing staff, contributing to timely interventions.
- Supported patient assessments and documentation, ensuring accurate records of activities of daily living for effective care planning.
- Developed strong clinical and communication skills while supporting patient safety and quality care initiatives.
Education
Associate Degree - Nursing (ADN)
Hillsborough Community College
Plant City, FL01-2005
Skills
- Clinical Resource Coordination
- Utilization Management
- Case Management
- Medical Necessity Review
- Denial management
- Appeals Support
- Documentation review
- InterQual Criteria
- Resource Management
- Interdisciplinary Collaboration
- EMR management
Certification
Basic Life Support (BLS)
Accomplishments
- Over 18 years of experience coordinating patient placement, utilization management, and clinical resource allocation in an acute care hospital.
- Extensive experience evaluating appropriate levels of care and supporting medical necessity determinations.
- Strong background collaborating with case management, utilization review, physicians, and payers to facilitate appropriate patient care and reimbursement.
- Recognized for critical thinking, ability to manage complex patient flow, and resource utilization challenges.
Timeline
Clinical Resource Coordinator/Registered Nurse
Winter Haven Hospital
05.2008 - Current
Registered Nurse, Inpatient Psychiatry / 23-Hour Observation Unit
Lakeland Regional Medical Center
01.2007 - 05.2008
Registered Nurse, Medical/Surgical Unit
Lakeland Regional Medical Center
01.2005 - 01.2007
Nurse Intern
Lakeland Regional Medical Center
01.2003 - 01.2005
Associate Degree - Nursing (ADN)
Hillsborough Community College