Kyla Buffington
Fayetteville,AR
Summary
Dynamic Utilization Management Nurse with a proven track record at Aetna, a CVS Health, excelling in care coordination and quality improvement. Demonstrated adaptability and problem-solving abilities, enhancing team success and patient outcomes. Skilled in Microsoft Office with a commitment to interdisciplinary collaboration and continuous learning. Known for having great rapport with providers and colleagues. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Overview
21
21
years of professional experience
Work History
Utilization Management Nurse
Aetna, CVS Health
07.2017 - 06.2024
- Contributed to team success by consistently meeting or exceeding productivity goals.
- Consistently meeting or exceeding 90% individual quality scores while maintaining high-quality standards in job performance.
- Ensured compliance with regulatory guidelines by staying current on industry standards and participating in ongoing education opportunities.
- Maintained up-to-date knowledge of payer-specific guidelines to ensure accurate authorizations for medically necessary services.
- 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.
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Increased efficiency in case management documentation by maintaining organized records and utilizing electronic medical record systems.
Critical Care Registered Nurse
Southwest General Health Center
11.2009 - 07.2017
- Assessed and managed various patient treatments for numerous patient diagnoses from sepsis to acute respiratory distress and cardiac care.
- Monitored hemodynamic parameters and analyzed complex data sets, making appropriate adjustments to treatment plans based on patient response.
- Demonstrated a high level of adaptability in adjusting to ever-changing patient acuity levels within the critical care unit, ensuring consistent delivery of safe and effective nursing care often seeing 1 up to 4 critically ill patients per shift.
- Actively participated in continuing education opportunities to remain current with best practices in the rapidly evolving field of critical care nursing receiving certification in critical care nursing.
- Managed multiple priorities simultaneously while maintaining focus on providing exceptional patient-centered care within a fast-paced critical care environment.
- Collaborated with interdisciplinary teams during daily rounds to develop individualized treatment plans based on specific patient needs and goals.
- Coordinated with healthcare staff from various disciplines to devise, carry out, and manage personalized care plans to benefit patient health and recovery.
Licensed Practical Nurse
Southwest General Health Center
07.2003 - 11.2009
- Improved patient outcomes by administering medications, monitoring vital signs, and documenting relevant information.
- Assisted with admissions, appointments, transfers, and discharges, often caring for 15 to 25 patients per shift.
- Collaborated with interdisciplinary healthcare teams to ensure continuous quality improvement in patient care delivery.
- Facilitated efficient communication between patients, families, and healthcare providers to promote continuity of care across settings.
- Collaborated with interdisciplinary team of healthcare and social service providers to address patients' needs through effective intervention and care planning.
- Promoted a culture of teamwork through active participation in unit meetings, performance improvement initiatives, and collaborative problem-solving efforts.
Education
Associate of Applied Science - Nursing
RETS College of Nursing
Cuyahoga Falls, OH2008
Licensed Practical Nursing - Nursing
Twin Lakes Vocational Technical School
Harrison AR 1990
Skills
- Care Coordination
- Quality Improvement
- Interdisciplinary Collaboration
- Medical Necessity Evaluation
- Discharge planning coordination
- Utilization Management
- Time Management
- Problem-solving abilities
- Excellent Communication
- Adaptability and Flexibility
- Microsoft Office
- HIPAA Compliance
Timeline
Utilization Management Nurse
Aetna, CVS Health
07.2017 - 06.2024
Critical Care Registered Nurse
Southwest General Health Center
11.2009 - 07.2017
Licensed Practical Nurse
Southwest General Health Center
07.2003 - 11.2009
Associate of Applied Science - Nursing
RETS College of Nursing
Licensed Practical Nursing - Nursing
Twin Lakes Vocational Technical School
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