Latoya Maddox
Registered Nurse
Haines City,Florida
Summary
Smart Utilization Review Nurse considered critical thinker and problem-solver due to dynamic patient care planning and understanding of Medicare guidelines. Known for having great rapport with providers and insurance carriers. Confident Clinical Documentation Specialist and facilitating positive changes to documentation through close collaboration with healthcare providers. Analysis-oriented professional with exemplary interpersonal skills, judgement and critical thinking skills. Consistently finding ways to improve workflows and processes that save time and money.
Overview
26
26
years of professional experience
Work History
Utilization Review Nurse
Blue Cross Blue Shield Arizona
03.2023 - 06.2023
- Performed prior authorization review of services requiring notification.
- Submitted cases for criteria failures and helped facilitate resolutions and approvals.
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Obtained authorizations from multiple insurance carriers for various levels of care.
- Performed admission reviews based for medical necessity based upon Type specification.
- Supervised and maintained all utilization review documentation through Software.
Clinical Documentation Specialist
Orlando Regional Medical Center
11.2021 - Current
- Communicated with physicians, nurses and other caregivers to explain importance of accurate and clear documentation.
- Maintained strong knowledge of medical terminology, diseases and conditions and procedures.
- Managed electronic clinical documentation and uploaded changes or updates using various software.
- Carefully reviewed patient files for clarity on diseases, diagnoses and procedures to determine quality of care.
- Questioned physicians regarding missing or unclear health record documentation and requested further information for clarification.
Clinical Documentation Specialist
Texas Health Resources, Dallas
06.2017 - 03.2019
- Questioned physicians regarding missing or unclear health record documentation and requested further information for clarification purposes.
- Carefully reviewed patient files for clarity on diseases, diagnoses and procedures to determine quality of care.
Utilization Review
Baylor, Scott And White
03.2019 - 10.2021
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Performed admission reviews based for medical necessity based upon patient specification.
- Obtained authorizations from multiple insurance carriers for various levels of care.
- Supervised and maintained all utilization review documentation through various software.
- Communicated with healthcare team members to plan, implement and enhance treatment strategies.
- Served as subject matter resource, providing information related to various situations.
Stroke Coordinator
Texas Health Resources, Dallas
06.2014 - 06.2018
- Trained all staff, providing direct supervision, ongoing staff development and continuing education to employees.
- Developed and updated policies and procedures, maintaining compliance with statutory, regulatory and local, state and federal guidelines relating to HIPAA, benefits administration and general liability.
- Communicated with patients, ensuring that medical information was kept private.
- Direct day-to-day administrative and operational functions for 800 bed facility, providing guidance and leadership to over 500 employees across more than five departments.
Charge Nurse
Texas Health Resources Dallas
01.2007 - 06.2014
- Coordinated nursing care on unit through staff assignments, assisting and rounding with physicians, monitoring patient orders and communicating with ancillary departments.
- Supervised and managed daily scheduling, tasking and administration.
- Trained new nurses in proper techniques, care standards, operational procedures and safety protocols.
- Monitored nursing care, patient assessment processes and treatment implementations.
Registered Nurse
Bahamas Ministry Of Health
01.1998 - 06.2005
- Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing conditions.
- Educated patients, families and caregivers on diagnosis and prognosis, treatment options, disease process and management and lifestyle options.
- Trained new nurses in proper techniques, care standards, operational procedures and safety protocols.
- Provided direct patient care, stabilized patients and determined next course of action.
Charge Nurse
Bergen Regional Medical Center
07.2005 - 12.2007
- Coordinated nursing care on unit through staff assignments, assisting and rounding with physicians, monitoring patient orders and communicating with ancillary departments.
- Supervised and managed daily scheduling, tasking and administration.
Utilization Review Nurse
Blue Cross Blue Shield
03.2023 - Current
- Performed prior authorization review of services requiring notification.
- Submitted cases for criteria failures and helped facilitate resolutions and approvals.
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Obtained authorizations from multiple insurance carriers for various levels of care.
Education
Masters Degree - Christian Education
Dallas Theological Seminary
Dallas, TX06.2017
Bachelor Of Science In Nursing -
University of Texas At Arlington
12.2012
Associate Degree Of Nursing -
College of The Bahamas
Nassau, Bahamas06.1999
Skills
- Treatment Documentation
- Professional Relationships
- Medical History Recording
- Standard Classification Systems
- Disease Determination
Compensation status
Current salary $49.50/hr
Timeline
Utilization Review Nurse
Blue Cross Blue Shield Arizona
03.2023 - 06.2023
Utilization Review Nurse
Blue Cross Blue Shield
03.2023 - Current
Clinical Documentation Specialist
Orlando Regional Medical Center
11.2021 - Current
Utilization Review
Baylor, Scott And White
03.2019 - 10.2021
Clinical Documentation Specialist
Texas Health Resources, Dallas
06.2017 - 03.2019
Stroke Coordinator
Texas Health Resources, Dallas
06.2014 - 06.2018
Charge Nurse
Texas Health Resources Dallas
01.2007 - 06.2014
Charge Nurse
Bergen Regional Medical Center
07.2005 - 12.2007
Registered Nurse
Bahamas Ministry Of Health
01.1998 - 06.2005
Masters Degree - Christian Education
Dallas Theological Seminary
Bachelor Of Science In Nursing -
University of Texas At Arlington
Associate Degree Of Nursing -
College of The Bahamas
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