Lisa Griffin
St Johns ,FL
Summary
Experienced nurse with over eight years of patient management, specializing in hospice and quality care assurance. Proven ability in advocacy, documentation, and interdisciplinary collaboration. Seeking to leverage nursing admissions and nursing care expertise into a role with utilization review remote position.
Overview
9
9
years of professional experience
1
1
Certification
Work History
Utilization Review Nurse
Liberty Medicare Advantage
08.2025 - Current
- Conducted comprehensive reviews of patient care plans to ensure compliance with Medicare guidelines.
- Collaborated with healthcare providers to assess medical necessity for treatments.
- Streamlined workflows, reducing turnaround times for authorization requests through process improvements.
- Ensured compliance with regulations and accreditation standards by maintaining accurate documentation of all utilization review activities.
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Performed prior authorization review of services requiring notification.
Registered Nurse, Inpatient Hospice
Community Hospice of Northeast Florida
02.2022 - 08.2025
- Led initiatives to enhance patient care through comprehensive assessment and individualized care plans.
- Maintained accurate documentation of patient records in accordance with HIPAA regulations.
- Collaborated with IDG team to ensure adherence to care standards and improve patient outcome.
- Provided emotional support to families facing difficult decisions about a loved one's care.
- Adhered to infection control procedures to facilitate safe, clean patient environment.
- Updated charts throughout shifts with current, accurate information to maintain strict recordkeeping standards.
Utilization Review - Remote Fl
Ally Align
02.2021 - 02.2022
- Collaborated with providers to obtain required clinical information, supporting prior authorization determinations and individual inquiries.
- Determined medical necessity and cost-effectiveness of services through utilization review processes.
- Applied medical criteria and clinical judgement to researched cases to evaluate and establish determinations.
- Reviewed patient admissions to determine medical necessity as directed by interqual criteria.
- Collaborated with plan management, Medical director, nurse practitioners, in group meetings to identify issues and find cost-effective solutions.
- Maintained strict patient data procedures to comply with HIPAA laws and prevent information breaches.
- Advocated for patient needs with interdisciplinary team and implemented outlined treatment plans.
Registered Nurse
Community Hospice
03.2019 - 06.2021
- Educated patients and families on treatment strategies and at-home care.
- Advocated for patients by identifying insurance coverage, communicating care preferences to practitioners and verifying interventions met patients' treatment goals.
- Developed and adapted individualized treatment plans according to patient goals.
- Counseled patients using pharmacological and non-pharmacological treatment modalities to address various disorders, diseases and injuries.
- Improved patient outcomes and quality of care by determining and suggesting changes to processes.
- Delivered high-quality and compassionate care to indigent and low-income patient communities.
- Communicated with hospital physicians or emergency care providers to relay patient needs.
- Answered patient questions and provided take-home materials for further information.
- Oversaw patient admission processes to coordinate efficient movements and related paperwork.
- Provided behavioral and emotional support and closely supervised patients suffering from dementia and Alzheimer's.
- Collaborated with doctors to plan comfort care and prevent return hospitalization due to complications.
- Monitored and recorded patient condition, vital signs, disease process and medication side effects.
- Monitor scheduled medications and therapies intravenously, rectally, orally, subcutaneously and via intramuscular injections while overseeing pain management plans.
- Discussed hospice care and philosophies ranging from assessment to development and implementation of care plans.
- Delivered direct patient care, including stabilizing patients and identifying comfort care options.
- Boosted patient outcomes by prioritizing nursing tasks and assignments and accurately reporting on each patient's status.
- Conducted patient assessments and reviewed diagnostic tests to provide physician with important patient health information used to create focused care plans.
- Delivered quality care and comfort to patients with heart failure, pulmonary hypertension, pulmonary embolisms and end-stage renal disease.
- Developed appropriate care plans for at-risk individuals and high-risk families.
- Reviewed effectiveness of comfort care needs for individual and family situations.
- Collaborated with various healthcare providers to facilitate delivery of services.
- Determined and coordinated appropriate level of care to meet individual patient needs.
Registered Nurse
UF Health Jacksonville
11.2017 - 06.2019
- Providing continued assessments throughout my shift. Monitor and document progress of patient care. Provide specific needs of patient; cardiac monitoring, respiratory monitoring, tracheotomy care/suctioning, peritoneal dialysis, colostomy care, IV infusions, heparin drips, blood administration, admissions & discharges, CIWA, additional physician orders, and prepare for procedures.
- Maintain vitals WNL and treatment of care per protocol.
- Accurate documentation and charting.
- Time management and coordinating patient care.
- Educate patient and family for optimal health.
- Provide treatments, blood collection, additional labs, and wound care.
- Recognized for knowledge and achievements in areas including clinical & communication skills, medical team collaboration, HIPPA standards, Joint Commission standards providing safe quality care.
- Initiated care plans during admission.
- Boosted patient outcomes by prioritizing nursing tasks and assignments and accurately reporting on each patient's status.
- Administered scheduled medications and therapies intravenously, rectally, orally, subcutaneously and via intramuscular injections while overseeing pain management plans.
- Coordinated care with physicians and other clinical staff to prepare for treatment, carry out interventions and enhance continuum of care to deliver comprehensive services.
- Counseled patients and caregivers, providing emotional, psychological and spiritual support.
Education
Bachelor of Science - Nursing
Chamberlain School of Nursing
Jacksonville, Fl06.2017
Skills
Regulatory compliance
Documentation expertise
Patient advocacy
Clinical assessment
Quality assurance
Multidisciplinary collaboration
Adaptability
Organized
Detailed-oriented
EMR
InterQual criteria
Utilization review
Prior authorization
HIPAA compliance
Discharge planning coordination
Teamwork and collaboration
Time management
Certification
- Basic Life Support (BLS) Certification & AED
- State of Florida License RN9471609
- Compact Nursing License
- Valid drivers license
Additional Information
COVID vaccinated 1/20/21 & 2/11/21
References
References available upon request.
Education and Training
other
Timeline
Utilization Review Nurse
Liberty Medicare Advantage
08.2025 - Current
Registered Nurse, Inpatient Hospice
Community Hospice of Northeast Florida
02.2022 - 08.2025
Utilization Review - Remote Fl
Ally Align
02.2021 - 02.2022
Registered Nurse
Community Hospice
03.2019 - 06.2021
Registered Nurse
UF Health Jacksonville
11.2017 - 06.2019
Bachelor of Science - Nursing
Chamberlain School of Nursing