Lexis Clement Nwaefulu
Sachse,TX
Summary
Dynamic Utilization Review Nurse with expertise in MCG and Medicare criteria at UHG Wellmed. Proven ability to enhance patient outcomes through effective multidisciplinary care coordination and utilization review. Skilled in EMR systems and fostering teamwork, ensuring compliance and appropriateness of services.
Overview
8
8
years of professional experience
1
1
Certification
Work History
Utilization Review Nurse
UHG Wellmed
, TX
09.2024 - Current
- Conducted comprehensive utilization reviews for medical necessity and appropriateness.
- Utilized electronic health record systems for data retrieval and documentation.
- Provided training and support to new utilization review nurses on best practices.
- Assessed patient medical records to determine the appropriateness of requested services and procedures.
- Conducted reviews of inpatient utilization for compliance with admission criteria and concurrent review requirements.
Care Coordinator/Case Manager
Children's Medical Center Of Dallas
01.2022 - 07.2024
- Utilizes a complete and systematic methodology/process to assess, plan, implement, evaluate and provide patient care coordination from pre-hospital through post-hospital care.
- Coordinated discharge planning, ensuring a smooth transition from hospital to home or other facilities.
- Assessed patient needs and connected them with appropriate resources to ensure optimal health outcomes.
- Managed patient caseloads effectively, ensuring timely follow-up and appropriate interventions.
- The Care Manager works collaboratively with all healthcare disciplines to assure appropriate and timely services.
L&D Travel RN
Cedars Sinai LA
09.2021 - 12.2021
- Assist physician during delivery, treatment, examination, and surgical procedures
- Providing care for normal and problematic pregnancies
- Coaching women, assisting with any complications, and administering medications during birth
- Provided patient and family education on labor, pain and newborn care
Staff RN Labor and Delivery
Parkland Health & Hospital System
07.2018 - 09.2021
- Assist physician during delivery, treatment, examination, and surgical procedures
- Providing care for normal and problematic pregnancies
- Coaching women, assisting with any complications, and administering medications during birth
- Provided patient and family education on labor, pain and newborn care
Education
Bachelor of Science Nursing -
Baylor University
Waco, Texas05.2018
Bachelor of Science - Biology
Prairie View Agricultural and Mechanical University
Prairie View, Texas12.2016
Skills
- MCG and Medicare criteria
- EMR Systems (EPIC & CERNER)
- Utilization review
- Teamwork and Collaboration
- Multidisciplinary Care Coordination
- Microsoft Office
Certification
- Texas Compact & CA RN licenses
- ACLS, BLS, NRP, AWHONN Intermediate Fetal Monitoring certifications
Timeline
Utilization Review Nurse
UHG Wellmed
09.2024 - Current
Care Coordinator/Case Manager
Children's Medical Center Of Dallas
01.2022 - 07.2024
L&D Travel RN
Cedars Sinai LA
09.2021 - 12.2021
Staff RN Labor and Delivery
Parkland Health & Hospital System
07.2018 - 09.2021
Bachelor of Science Nursing -
Baylor University
Bachelor of Science - Biology
Prairie View Agricultural and Mechanical University