Summary
Overview
Work History
Education
Skills
Certification
References
Affiliations
Accomplishments
References
Timeline
Megan Willey

Megan Willey

Lancaster,OH

Summary

Experienced ER registered nurse with expertise in high-pressure emergency environments. Proficient in patient triage, acute care management, and effective collaboration with medical teams. Recognized for critical thinking and rapid decision-making skills that enhance patient care quality. Accomplished Utilization Management Nurse with a strong focus on productivity and thorough task completion, specializing in patient care coordination and healthcare policy compliance.

Overview

24
24
years of professional experience
1
1
Certification

Work History

Nurse Reviewer Specialist

Gainwell Technologies
Madison, USA
03.2024 - Current
  • Collaborated with physicians and support staff to determine optimal care levels for improved clinical outcomes.
  • Reviewed requests for authorization promptly, adhering to established guidelines and maintaining team turnaround time.
  • Analyzed patient data to evaluate necessity of hospitalizations and services requiring pre-certification.
  • Utilized InterQual and MCG criteria to assess medical information for authorization decisions.
  • Maintained current knowledge of Medicare and Medicaid regulations related to concurrent review processes.
  • Demonstrated expertise in utilization management techniques, including concurrent and retrospective review, appeals, pre-certification, and pre-authorization.
  • Successfully managed daily operations workflow using practical critical thinking skills.
  • Provided verbal or written notifications regarding authorization decisions based on clinical criteria.

Concurrent Review Nurse II

Centene Corporation
St Louis, USA
11.2018 - 12.2023
  • Collaborated with physicians and support staff to determine optimal care levels for best clinical outcomes.
  • Analyzed patient data to evaluate necessity of hospitalizations and services requiring pre-certification.
  • Reviewed authorization requests on time, adhering to established standards and maintaining team turnaround time.
  • Utilized InterQual and MCG criteria to assess medical information for authorization decisions.
  • Maintained current knowledge of Medicare and Medicaid policies related to concurrent review processes.
  • Expertise in utilization management techniques, including concurrent and retrospective reviews, appeals, pre-certification, and pre-authorization.
  • Provided verbal or written notifications regarding authorization decisions based on clinical criteria.
  • Successfully managed daily operations workflow using practical critical thinking skills.

Sexual Assault Nurse Examiner (SANE)

Various Emergency Departments
, OH
09.2002 - 01.2015
  • Delivered compassionate care to increase comfort and psychological, social, and spiritual well-being.
  • Oversaw patient admission and discharge processes to coordinate related paperwork.
  • Delivered information regarding care and medications to patients and caregivers in comprehensible terminology.
  • Performed physical assessments to identify any changes in the patient's condition or needs.
  • Coordinated discharge planning to ensure continuity of care post-hospitalization.
  • Administered medications and treatments, monitoring patients for reactions and side effects.
  • Referred patients to specialized health resources or community agencies to furnish additional assistance.
  • Acted as patient advocate and implemented total patient care through team nursing process.
  • Maintained thorough, accurate and confidential documentation in electronic medical records.

ED Staff Registered Nurse

Fairfield Medical Center
Lancaster, OH
01.2010 - 06.2012
  • Assessed patient conditions, monitored behaviors and updated supervising physicians with observations and concerns.
  • Helped patients and families feel comfortable during challenging and stressful situations, promoting recovery and reducing compliance issues.
  • Participated in quality improvement initiatives to enhance patient care and department efficiency.
  • Responded promptly to medical emergencies within the department, initiating resuscitation measures when necessary.
  • Provided direct patient care, including assessments and treatments, to acutely ill patients.
  • Maintained accurate records of patient care services rendered according to established standards and procedures.

Staff Rn Emergency Department

O'BLENESS Memorial Hospital
Athens, OH
01.2009 - 01.2010
  • Participated in staff training sessions, acquiring new skills and knowledge.
  • Built and maintained working relationships with peers and upper management.
  • Administered medications, treatments, and vaccines as prescribed, adhering to strict safety protocols.
  • Coordinated care with physicians and other clinical staff to prepare for treatment, carry out interventions and enhance continuum of care.
  • Conducted patient assessments and diagnostic tests to provide physician with important patient health information.
  • Responded quickly to life threatening situations using advanced cardiac life support protocols.
  • Utilized advanced cardiac life support (ACLS) and basic life support (BLS) techniques during critical situations.
  • Helped patients and families feel comfortable during challenging and stressful situations, promoting recovery and reducing compliance issues.
  • Cared for patients experiencing acute traumas, including cardiac arrests, strokes and gunshot wounds.

Emergency Room Staff Nurse

Greene Memorial Hospital
Xenia, OH
07.2001 - 09.2008
  • Managed patient triage, prioritizing care based on severity of condition and available resources.
  • Administered oral, IV and intra-muscular medications and monitored patient reactions.
  • Cared for patients experiencing acute traumas, including cardiac arrests, strokes and gunshot wounds.
  • Participated in continuing education opportunities to stay abreast of new developments in nursing practice.
  • Provided emotional support to patients and their families during difficult times.
  • Responded to emergency situations with speed, expertise and level-headed approaches to provide optimal care, support and life-saving interventions.
  • Monitored patient vital signs and symptoms, responding rapidly to changes in condition and initiating appropriate interventions.
  • Advocated for patient rights and ethical treatment, ensuring respect and dignity in patient care.

Education

Some College (No Degree) - Applied Behavioral Sciences

University of Arizona Global Campus, Arizona
07-2026

Associate’s degree - nursing

Hocking College, Nelsonville, OH
08.2000

Skills

  • Utilization management
  • Problem solving
  • Healthcare regulations
  • Medical record review
  • Quality improvement
  • Patient assessment
  • Clinical documentation
  • Critical thinking
  • Collaboration skills
  • Patient advocacy
  • EKG interpretation
  • Advanced cardiac life support
  • Clinical judgment
  • Intravenous therapy
  • Trauma nursing
  • Emergency triage
  • Charting and clinical documentation
  • Patient assessments
  • Training staff
  • Professionalism
  • Update electronic charts
  • Accurate documentation
  • Strong clinical judgment
  • Regulatory compliance
  • Patient education
  • Effective communication
  • Team collaboration
  • InterQual/MCG
  • Attention to detail
  • Multitasking
  • CPR/AED
  • Organizational skills
  • Patient condition monitoring
  • Teamwork and collaboration
  • Written communication

Certification

Registered Nurse

References

Professional and personal references are available upon request.

Affiliations

  • Avid reader of all types of literature
  • Crafting handmade books and journals

Accomplishments

  • Recognized by the Greene County Prosecutor's Office for excellence in SANE nursing

References

References available upon request.

Timeline

Nurse Reviewer Specialist - Gainwell Technologies
03.2024 - Current
Concurrent Review Nurse II - Centene Corporation
11.2018 - 12.2023
ED Staff Registered Nurse - Fairfield Medical Center
01.2010 - 06.2012
Staff Rn Emergency Department - O'BLENESS Memorial Hospital
01.2009 - 01.2010
Sexual Assault Nurse Examiner (SANE) - Various Emergency Departments
09.2002 - 01.2015
Emergency Room Staff Nurse - Greene Memorial Hospital
07.2001 - 09.2008
University of Arizona Global Campus - Some College (No Degree), Applied Behavioral Sciences
Hocking College - Associate’s degree, nursing

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Megan Willey