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
OH/KY, Midlands
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
Middleburg Heights OH
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
Middleburg Heights OH
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