Michael Morris
Oxnard
Summary
Detail-oriented Utilization Review Nurse with diverse healthcare experience. Ensures patient care services meet medical necessity and adherence to protocols. Demonstrates strong clinical judgment and critical thinking, leveraging medical software for data analysis. Drives team success by implementing best practices in patient care management.
Overview
6
6
years of professional experience
2
2
years of post-secondary education
Work History
Utilization Review Nurse
Optum
Oxnard
04.2024 - Current
- Conducted clinical reviews of authorization requests, ensuring adherence to established criteria.
- Documented rationale for approval of requests, maintaining accuracy and completeness.
- Evaluated patient medical records to determine medical necessity and ensure compliance with payer policies and evidence-based criteria.
- Utilized InterQual or MCG criteria to support authorization and utilization review decisions.
- Reviewed prior authorization requests for medical procedures, imaging, medications, and specialty services to determine medical necessity.
- Applied clinical guidelines, payer policies, and evidence-based criteria to support authorization decisions.
Medical Surgical
St. John’s Regional Medical Center
Oxnard
06.2023 - 04.2024
- Evaluated medical information and provided direct bedside nursing care to pre and post-surgery patients
- Assessing, planning, implementing, and evaluating patient care plans in consultation with healthcare professionals
- Preparing, administering, and recording prescribed medications
- Changed dressings for patients to promote healing and prevent infection.
- Monitored patients’ vitals and reported adverse reactions to medications promptly to facilitate swift medical interventions
- Adjust specialized medical equipment as needed, as well as interpret and record measurements
- Collaborate on discharge planning with the healthcare team
- Answer questions and educate patients and their families on surgical procedures and post-surgery care
RN Event Operations Administrator
Medix Staffing Solutions
01.2022 - 05.2023
- Coordinated arrival times for all staff members to ensure timely attendance at events.
- Briefed staff on new protocols and practices before the event started.
- Oversaw compliance with personal protective equipment (PPE) and testing protocols among staff.
- Ensure the special arrangements of the event meet all social distancing requirements, and health and safety standards
- Implemented new test to treat program
- Assess patients, vital signs taken, documentation in electronic medical record
- Conducted screenings for COVID-positive patients to determine eligibility for test-to-treat program and arranged telehealth consultations.
Admitting Supervisor
Vista Del Mar Hospital
11.2021 - 01.2022
- Processed and received admissions and discharges, ensuring accurate patient information and timely transitions
- Coordinated with Case Management to address follow-up needs and facilitate safe discharges for all patients
- Reviewed discharge medication list and prescriptions, prepared discharge packet, and discussed it with patient/family to ensure understanding of care plan
- Initial triage assessment of patient and report off to unit charge nurse on reason for patient’s visit
Psychiatric Charge Nurse
Vista Del Mar Hospital
01.2021 - 11.2021
- Provide psychiatric nursing services under the direction of the Psychiatrist and Director of Nursing
- Assessing, planning, implementing, evaluating, and documenting all aspects of patient care
- Collaborated with physicians on patient progress towards outcomes and assisted during treatment/examinations and order processing
- Coordinated with healthcare providers to ensure efficient and quality patient care
- Evaluate patient’s signs and symptoms and record and report results
- Communicate effectively and maintain therapeutic relationships with patients, families, physicians, and staff
- Oversaw patients and staff on the unit, delegating care of patients to behavioral health technicians.
- Managed patient medications and meals while communicating 5150 status and advisement to patients
- Administered psychiatric nursing services according to the guidance of the Psychiatrist and Director of Nursing
Dialysis nurse
Fresenius Kidney Care
06.2020 - 01.2021
- Verify treatment orders relevant to the dialysis treatment for each individual patient
- Oversee dialysis treatment and cannulation access
- Coordinated discharge planning with health care team to ensure comprehensive patient transition
- Administer medications to patients per physician orders
- Educated patients and significant others on illness management, including post-treatment home care and self-administration of medication
- Record patients' medical information and vital signs
- Coordinate discharge planning needs for discharge with other members of the health care team
- Monitored patients' specialized dialysis equipment and interpreted and recorded information.
Education
Bachelor of Science -
National University
La Jolla, CA 08.2016 - 01.2019
Skills
- Authorization review
- Utilization management
- Necessity review
- Documentation review
- InterQual Criteria
- MCG Guidelines
- CMS compliance
- Humana Clinical Guidelines
- Evidence-based practice
- Insurance verification
- Medicare knowledge
- EZ-CAP Authorization System
- Electronic records
- Excel
- Quality assurance
- Workflow Optimization
- Policy interpretation
- HIPAA Compliance
- Patient Advocacy
- Provider Communication
- PubMed Research
- Merck Manual Clinical Reference
Accomplishments
- Member of Pinnacle Honor Society
- Member of National University Honor Society
- Achieved The Academic Excellence Award
Professional References
- Alfred Yu, MD, FACEP, Medical Director for AEP at Simi Valley Hospital, Adventist Heath Simi Valley Hospital, 818-577-9707
- Ira Tilles, MD, FACEP, Assistant Medical Director for AEP at Adventist Health Simi Valley Hospital, 805-587-1241
- Jennie Hoffman, RN, BSN, MSN, MBA, CEN, Emergency Services Director at Baylor Scott & White Lake Pointe, 805-444-6510
- Kristen Shorts, RN, BSN, CEN, MICN, CSRN, Pre Hospital Care Coordinator at Adventist Heath Simi Valley Hospital, 805-341-2394
Skills Certifications
- BLS
- Competent in Microsoft Word, Excel, Powerpoint, Outlook
- Excellent computer and people skills
- Able to work well in a group setting, or individually
Timeline
Utilization Review Nurse
Optum
04.2024 - Current
Medical Surgical
St. John’s Regional Medical Center
06.2023 - 04.2024
RN Event Operations Administrator
Medix Staffing Solutions
01.2022 - 05.2023
Admitting Supervisor
Vista Del Mar Hospital
11.2021 - 01.2022
Psychiatric Charge Nurse
Vista Del Mar Hospital
01.2021 - 11.2021
Dialysis nurse
Fresenius Kidney Care
06.2020 - 01.2021
Bachelor of Science -
National University
08.2016 - 01.2019