Michelle Keeter
Gustine
Summary
Highly adaptable Nurse dedicated to providing exceptional skills in the adolescent and adult health environment. Caring and motivated with developed interpersonal and time management skills. Seeking challenging role in setting devoted to quality patient care. With 34 years’ experience, I aim to leverage my abilities to successfully fill the school nursing role at your High School.
Knowledgeable in Nursing with robust background in administering medications and monitoring patient responses. Proven ability to manage patient care efficiently and ensure adherence to healthcare protocols. Demonstrated skills in patient communication and accurate medication documentation.
Overview
34
34
years of professional experience
1
1
Certification
Work History
Commercial Specialty Medication Nurse
CVS Caremark
11.2025 - Current
- Work independently to research and approve specialty medications.
- Communicate with pharmacists and MDO to obtain clinicals needed to process authorization of medications.
- Maintained accurate documentation of all calls and clinical obtained.
- Assures the proper processing, review and maintenance of all PA paperwork
- Remote
Utilization Review Specialist
Billing Solutions/ Medusind
Phoenix, AZ
09.2023 - 07.2025
- Adhered to all federal and state compliance requirements related to utilization review process.
- Communicated effectively with internal departments, external vendors, providers, members and patients, payers and other stakeholders regarding utilization management issues.
- Assessed provider requests for authorization of services utilizing clinical judgement and evidence based guidelines.
- Performed utilization review activities, including pre-authorization and concurrent reviews of services to ensure that medical necessity criteria were met.
- Applied review criteria to compile accurate accounts of patients' clinical circumstances.
- Navigated multiple EMR's to obtain data
- Submitted clinical reviews via Live reviews, voicemail, portal and fax.
Utilization Review Nurse
Summer Sky Inc.
Stephenville, TX
01.2009 - 12.2022
- Determined medical necessity and cost-effectiveness of services through utilization review processes.
- Collaborated with providers to obtain required clinical information, supporting prior authorization determinations and individual inquiries.
- Collaborated with administrative staff in group meetings to identify issues and find cost-effective solutions.
- Reviewed patient admissions to determine medical necessity as directed by ASAM criteria.
- Advocated for patient needs with interdisciplinary team and implemented outlined treatment plans.
- Applied medical criteria and clinical judgement to researched cases to evaluate and establish determinations.
- Contacted insurance carriers to obtain authorizations for services delivered to patients.
- Obtained authorization for initial and concurrent reviews in a timely manner.
LVN Charge Nurse
Summer Sky Inc.
Stephenville, TX
01.1992 - 01.2009
- Compassionate and Caring.
- Accurate Documentation.
- Patient Care Assessment.
- Worked with both Adolescent and Adult patients
- Worked as part of healthcare team to assess patient needs, plan and modify care and implement interventions.
- Charted changes in patient conditions and discussed concerns with supervising healthcare provider.
- Documented patient medical histories, current symptoms and vitals.
- Met with administrator to discuss patient care status, issues and information.
- Maintained strict patient data procedures to comply with HIPAA laws and prevent information breaches.
- Built and maintained strong working relationships between nursing department and other disciplines.
- Complied with OSHA programs, maintaining safe and clean working environment.
- Directed implementation of improved patient care and documentation methods and procedures to achieve quality objectives.
- Audited patient charts in real-time, verifying accuracy and completion of information.
- Communicated effectively with patients and loved ones to explain diagnoses, treatment options and procedures.
- Counseled clients, patients and families and provided emotional and psychosocial support.
Education
Licensed Vocational Nurse - Nursing
Ranger College
TXSkills
- Utilization Review
- Ability to multitask, prioritize and meet deadlines
- Clear Communication
- Experienced in Adolescent and Adult health
- Work well as a team member
- Accurate Documentation
- Self-Motivated
- Medical necessity criteria
- Both Inpatient/Outpatient Behavioral Health
Certification
LVN
Timeline
Commercial Specialty Medication Nurse
CVS Caremark
11.2025 - Current
Utilization Review Specialist
Billing Solutions/ Medusind
09.2023 - 07.2025
Utilization Review Nurse
Summer Sky Inc.
01.2009 - 12.2022
LVN Charge Nurse
Summer Sky Inc.
01.1992 - 01.2009
Licensed Vocational Nurse - Nursing
Ranger College