Mackenzie Dowell
Vine Grove,KY
Summary
Detail-oriented Utilization Management Nurse with expertise in assessing medical necessity and compliance with utilization guidelines. Evaluated authorization requests using clinical criteria to ensure prompt coverage decisions. Collaborated with healthcare teams to streamline care pathways and reduce treatment delays, while enhancing patient management through effective use of electronic medical records.
Overview
1
1
Certification
13
13
years of professional experience
Work History
Utilization Review Nurse-Remote
Humana Primary Care Organization
Louisville, Kentucky
08.2024 - Current
- Evaluated concurrent authorization requests to determine alignment with clinical criteria and plan policies.
- Coordinated with physicians, care teams, and members to facilitate informed coverage decisions.
- Reviewed Humana Primary Care Organization cases to ensure compliance with medical necessity and utilization guidelines.
Triage RN-Remote
Norton Healthcare Access Center-OBGYN Department
Louisville, KY
05.2021 - 08.2024
- Triaged patients with critical/emergent OBGYN-related symptoms for all Norton OBGYN offices/providers to ensure that patient received the quickest and most appropriate symptom-based care for maternal/fetal safety.
- Developed skills in chart review, quick and accurate decision making, assessment of patient history and current symptoms within a semi-autonomous work setting
- Exposure to multiple health insurance plans
RN-Infant Stabilization Team
Norton Children’s Hospital
Louisville, KY
04.2017 - 08.2024
- Work in conjunction with in-house neonatologists, OBGYNs, and other medical professionals to attend routine and high-risk births, provide direct care to newborn infants, and use critical thinking and bedside skills to stabilize patients for transition to newborn nursery or NICU setting.
Staff RN
Norton Childrens Hospital Neonatal ICU
Louisville, KY
06.2013 - 05.2021
- Enhanced nursing skills in time management, communication, critical thinking, leadership, and technical areas to improve patient care
- Provided care for patients with a high level of acuity
- Served as preceptor, guiding new nurses in clinical practices and fostering their professional development
RN-Employee Health Covid-19 Hotline
Norton Healthcare
Louisville, KY
11.2020 - 03.2021
- Worked at Employee Health call center to assess and provide assistance to employees who exhibited symptoms or had potential exposure to Covid-19 virus. Directed impacted employees to financial, emotional, and physical health resources through Norton Healthcare.
Education
Bachelor of Science - Nursing (BSN)
Western Kentucky University
Bowling Green, KYSkills
- Utilization review for medical necessity
- Understand authorization requirements for approval or denial based upon 30th edition MCG criteria
- Concurrent/retroactive review
- Clinical documentation
- Telephonic patient management
- Interdisciplinary communication and coordination
- Top 5 overall case review totals in FER department
- Electronic medical records: EPIC, Dragonfly, Tenet, HCA, Xsolis
- Programs: Microsoft Office, Microsoft Excel, Microsoft PowerPoint, Microsoft Teams, Outlook, Zoom, Slack
- Skilled in effective prioritization, organization, delegation, and multitasking
Skills
- Utilization review for medical necessity based upon 30th edition MCG Guidelines
- Concurrent and Retroactive case review
- Clinical documentation
- Telephonic patient management
- Interdisciplinary communication and coordination
- Effective prioritization, communication, delegation, and multitasking
- Electronic Health Records: EPIC, Dragonfly, Tenet, HCA, Xsolis
- Programs: Microsoft Office, Microsoft Excel, Microsoft PowerPoint, Microsoft Teams, Zoom, Slack
Certification
Kentucky Registered Nurse License (Compact State License) # 1137022 Obtained July 2013, Active/in good standing
Nevada Registered Nurse License #882335
Obtained August 2024, Active/In good standing
Timeline
Utilization Review Nurse-Remote
Humana Primary Care Organization
08.2024 - Current
Triage RN-Remote
Norton Healthcare Access Center-OBGYN Department
05.2021 - 08.2024
RN-Employee Health Covid-19 Hotline
Norton Healthcare
11.2020 - 03.2021
RN-Infant Stabilization Team
Norton Children’s Hospital
04.2017 - 08.2024
Staff RN
Norton Childrens Hospital Neonatal ICU
06.2013 - 05.2021
Bachelor of Science - Nursing (BSN)
Western Kentucky University