MARY AKINYEMI
Richmond,TX
Summary
Effective at improving revenue, team productivity and policies to keep the facility operating at a sustainable and profitable level. Detail-oriented Medical and Health Services Manager passionate about facilitating excellent patient care. Adept at designing and implementing policies and procedures. Motivated team builder and supervisor focused on driving team collaboration. Authorized to work in the US for any employer Skilled Utilization Review Nurse offering talents in continuous assessments and clinical records oversight. Pleasant individual with over 14 years in the nursing field. Ready to join new company that appreciates attention to detail and exemplary clinical review skills.
Overview
14
14
years of professional experience
1
1
Certification
Work History
Utilization Management Nurse
Brazos Healthcare Center
Houston, TX
11.2020 - 04.2024
- Proactively involved in all aspects of Utilization Management including precertification, concurrent review, discharge planning, and clinical case appeal
- Ensure patient admissions are in compliance with Medicare by using Milliman Care Guidelines
- Review electronic and paper charts to provide documentation for admission/stay criteria
- Confer with internal and external physicians to assess the appropriateness of the level of care
- Analyze appropriate data to identify trends/problems relating to delays in the delivery of care and patient placement
- Initiate timely communication with insurance companies to obtain authorization for hospitalizations and advanced imaging to achieve the maximum allowable reimbursement
- Notify third-party payors, including various state Medicaid programs, via online websites.
- Assessed patient eligibility for services and benefits according to insurance policies and guidelines.
- Conducted utilization reviews, concurrent reviews, authorization requests and discharge planning.
- Identified opportunities for improved quality of care through review of clinical documentation.
QA Nurse
Focus care at Beechnut.
Richmond, TX
01.2017 - 11.2020
- Monitor staff, process and policies to ensure the highest quality care of residents
- Review facility systems such as falls, infection prevention and control, admissions and discharges, weight loss, pressure ulcers
- Educate facility leadership and nursing department team members
- Oversee employee management and staffing.
- Provided nursing care for patients with various medical diagnoses and treatments.
- Administered medications and treatments in accordance with physician orders.
- Assessed and monitored patient health conditions, including vital signs such as temperature, pulse rate and blood pressure.
Night Shift RN Supervisor
Texas Rehabilitation Hospital
Arlington, TX
02.2016 - 12.2016
- Coordinates and assists the interdisciplinary team in the development and implementation of patient care policies
- Supervises day-to-day patient care activities and is available to field staff for assistance with problems or concerns
- Reviews patient medical files on a regular basis and addresses any discrepancies noted
- Review and ensure proper resident charting and procedure documentation
- Develop and implement resident care plans in coordination with physician, medical director, nursing staff, and outside consultants (i.e., therapists
- Ability to complete necessary assessments; have a good knowledge of infection control procedures.
LVN Charge Nurse/RN Supervisor
Remarkable Healthcare
Plano, TX
10.2014 - 12.2016
- Addressed patient care needs, collected vitals, dressed wounds and managed catheters
- Answered patient calls, identified issues and determined how best to provide assistance within parameters established by facility and supervisor.
Home Health LVN/ Office Manager
Yetkin Advanced Health care
07.2011 - 07.2015
- Directed implementation of improved patient care and documentation methods and procedures to achieve quality objectives
- Evaluated patient care procedural changes for effectiveness and made necessary adjustments
- Case Management
- Charted changes in patient conditions and discussed concerns with supervising healthcare provider
- Verify insurance from insurance companies
- Submit authorization to insurance companies.
- Educated patients on their medical condition, treatment plans, and self-care management techniques.
- Prepared detailed reports on patient progress which were presented at weekly staff meetings.
- Administered medications, tracked dosages and documented patient conditions.
LVN Floor Nurse
San Remo nursing home
Richardson, TX
08.2010 - 07.2011
- Monitored infection control procedures to verify facility-wide health and safety
- Answered patient calls, identified issues and determined how best to aid within parameters established by facility and supervisor
- Observed strict confidentiality and safeguarded all patient-related information
- Directed implementation of improved patient care and documentation methods and procedures to achieve quality objectives
- Provided behavioral and emotional support and closely supervised patients suffering from dementia and Alzheimer's
- Performed triage to maximum team productivity and effectiveness
- Communicated effectively with patients and loved ones to explain diagnoses, treatment options and procedures
- Assisted patients with daily tasks, such as dressing, hygiene upkeep and movement throughout facility.
Education
Bachelor of Science in Nursing - Nursing
The University of Texas At Arlington
12-2024
Associate of Applied Science in Nursing RN -
Lamar Community College
12.2013
Diploma in LVN -
Kilgore College
12.2009
Skills
- ICD-10
- Conflict management
- Hospital experience
- Clinical documentation improvement
- NCQA standards
- Team management
- Risk management
- Interviewing
- Document management
- SharePoint
- Microsoft Access
- Regulatory reporting
- Supervising experience
- Quality assurance
- Contracts
- Home health
- Typing
- Quality control
- Windows
- Motivational interviewing
- Utilization review
- Microsoft Office
- Documentation review
- Customer service
- Quality Improvement
- Policy Adherence
- Discharge Planning
- Documentation And Reporting
- Home Health Care
- Performing assessments
- Insurance Verification
- Utilization Management
- Medicaid knowledge
- Insurance knowledge
- Interdisciplinary Collaboration
Certification
- RN License
- LVN
- Certified Case Manager
- Compact State Nurse License
- ACLS Certification
- BLS Certification
Timeline
Utilization Management Nurse
Brazos Healthcare Center
11.2020 - 04.2024
QA Nurse
Focus care at Beechnut.
01.2017 - 11.2020
Night Shift RN Supervisor
Texas Rehabilitation Hospital
02.2016 - 12.2016
LVN Charge Nurse/RN Supervisor
Remarkable Healthcare
10.2014 - 12.2016
Home Health LVN/ Office Manager
Yetkin Advanced Health care
07.2011 - 07.2015
LVN Floor Nurse
San Remo nursing home
08.2010 - 07.2011
Bachelor of Science in Nursing - Nursing
The University of Texas At Arlington
Associate of Applied Science in Nursing RN -
Lamar Community College
Diploma in LVN -
Kilgore College
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