Caring and detail-oriented Registered Nurse with a demonstrated clinical background, excellent communication skills, attention to detail and recently obtained utilization review experience with Remote Learning Services. I pride myself on having a solid knowledge base, high-level critical thinking skills, and ability to apply evidence-based guidelines during the determination process. My clinical background in Medical/Surgical nursing has given me the foundation that is needed in utilization review by using my knowledge through experiences in acute and chronic care environments.
● Identified high risk patients for targeted disease management to prevent complications.
● Managed and treated health problems, ranging from common to serious, chronic and complex for adults and the elderly by continuously fostering improvement.
● Adapted to different structural changes with staffing and work hours to meet facility needs.
● Evaluated workflow, established priorities for time sensitive assignments to ensure quality.
● Formulating and individualizing patient’s plan of care based on ongoing assessments.
● Fostered interdisciplinary teamwork, seamlessly integrating into various departments to ensure continuity of care and optimal patient experiences.
● Medication and Health management for over 700 students for school district.
● Utilized excellent communication and organization skills.
● Reviewed charts and interpreted health records while submitting data as ordered.
● Provide excellent customer service and comply with HIPAA confidentiality.
● Assessed and planned care for multiple patients with promptness and efficiency.
● Responsible for admissions and discharge planning duties with DME ordering at discharge.
● Developed a quality relationship with an interdisciplinary team to provide patient centered care.
● Utilization Review
● Emergency Department
● Medical/Surgical-Tele
● Rehabilitation/Geriatrics
● Care Coordination
● Admissions/Intakes
● Appeals/Denials
● Community Health
● Medicare/Medicaid
● Knowledge/ICD-10
● Concurrent Review
● Retrospective Review
● Preauthorization
● Attention to Detail
● Quality Assurance
● EMR-Various Systems
● Time Management
● Mentor/Leadership
● MS Office, Excel
● Flexibility/Adaptable