Rhonda Milam
Naoma,WV
Summary
Diligent nursing professional brings a strong foundation of medical knowledge, natural interpersonal strengths, technical abilities, and patient care expertise; honed over 21 years of industry experience. Knowledgeable about utilization management, medical record review, and interdisciplinary collaboration. Quality-focused and efficiency-driven leader. Seasoned nursing professional offering proven clinical knowledge, natural interpersonal strengths, and technical abilities.
Overview
29
29
years of professional experience
1
1
Certification
Work History
Prior Authorization Nurse
Humana
02.2022 - Current
- Educates providers on utilization and medical management processes
- Enters and maintains pertinent clinical information in various medical management systems
- Apply benefit coverage policies, CMS and/or Regulatory medical management criteria guidelines to authorize services, appropriately identify, and refer requests to Medical Director when criteria are not met.
- Meets and/or exceeds monthly metrics.
- Reviews medical records for pertinent information pertaining to inpatient and outpatient surgical requests.
- Cross trained for LTAC, SNF, IRF, and concurrent reviews.
- Review procedure CPT codes against Humana Medical Coverage policies and MCG guidelines.
- Process out-of-network waivers, HMO exceptions, and Letters of Agreement.
- Review certificate of insurance for member coverage for specific benefits.
- Cross-trained in Acute Case Management and SNF/Rehab prior authorizations and continued stay reviews.
- Participated in monthly culture club meetings for education and mentoring for diversity and inclusion.
- Resource for commercial provider offices to inquire about member bariatric coverage, status of cases submitted to Humana, or help to submit prior authorization requests.
- Resource for co-workers for correct CPT codes for surgical procedures performed.
- Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
Off Tour Coordinator
Beckley VA Medical Center
09.2020 - 02.2022
- Directs practice according to established policies, standards of care, and standards of practice, and is responsible to ensure that nursing practice and operations are compliant with all applicable local, VISN, or National Standards, policies, statutes, and regulations.
- Assists Nurse Managers by contributing to performance evaluations, educational development for non-administrative tour employees, and meeting performance measures.
- Collaborates with AOD as needed for decisions related to ongoing patient care and actions taken in emergency situations and disasters.
- Responsible for customer service/patient satisfaction, patient and employee safety, employee relations, standards of care and practice, and work environment.
- Developing and managing collaborative partnerships with physicians and other clinicians.
- Responsible for staffing assigned units on continual basis (24/7), validating daily patient classifications, and working with other Nurse Managers to identify and share resources.
- Provide feedback and recommendations on policies, employee and facility performance standards, and equipment.
- Performed Code Blue debriefings. Reviewed performance of team and patient outcomes, allowing for change in procedures and learning opportunities.
Charge Nurse, Telemetry Floor
Raleigh General Hospital
06.2018 - 09.2021
- Monitored and documented heart rhythms according to physicians' orders.
- Monitored nursing care, patient assessment processes and treatment implementations.
- Trained new nurses in proper techniques, care standards, operational procedures and safety protocols.
- Demonstrated in-depth understanding of telemetry equipment functions.
- Implemented quality patient care techniques to align with safety, health and organizational regulations.
- Administered medications and treatments to patients as ordered by physician, maintaining accountability for accurate narcotic count at end of each shift.
- Documented medications administered, treatments and patient procedures performed in appropriate records according to privacy requirements.
- Followed all protocols to respond to irregular cardiac activity.
- Documented information in patients' electronic medical record, relaying information to clinicians and care providers to facilitate continuity of care.
- Worked with patients diagnosed with chronic obstructive pulmonary disease (COPD), asthma, congestive heart failure (CHF), cerebrovascular accidents (CVA), diabetes or sepsis to asses needs and determine best options for care.
- Triaged incoming phone calls from emergency rooms and inpatient units to determine needs and prioritize care.
- Coordinated nursing care on unit through staff assignments, assisting and rounding with physicians, monitoring patient orders and communicating with ancillary departments.
- Collaborated with various healthcare professionals to determine specific and individualized care plan based on goals and long-term health.
- Directed patient care activities, guided and trained RNs, and LPNs during shift.
- Administered nursing care to cardiac patients undergoing diagnostic, therapeutic or emergency services.
- Managed patients recovering from heart catheterization procedures.
Travel Registered Nurse
American Mobile Nursing Network
11.2017 - 06.2018
- Travel RN assigned to various hospitals for 13-week contracts on Medical/Surgical/Telemetry floors.
- Able to float to ICU, CCU, and Step-Down Units.
- Able to integrate quickly to new units and facilities, with minimal orientation.
- Delivered outstanding care to patients with various diagnoses and managed care from treatment initiation through to completion.
- Trained new nurses in proper techniques, care standards, operational procedures and safety protocols.
- Updated patient charts with data such as medications to keep records current and support accurate treatments.
- Documented all elements of care and updated patient charts and confidential files to reflect changes in care plans, interventions applied and observations.
Staff Registered Nurse
Beckley Veteran Affairs Medical Center
01.2014 - 10.2017
- Serves as a mentor/teacher to junior nurses on a daily basis., assigned to a 25-bed medical/surgical/telemetry inpatient unit.
- Applies the nursing process to the care of veteran patients.
- Assures appropriate documentation reflects assessment of patient needs, interdisciplinary treatment plans, clinical interventions, and evaluation of patients' responses to treatments.
- Delivers fundamental, knowledge-based care to adult and geriatric patients with technical competence in accordance with the Nurse Practice Act and VA standards of practice.
- Provides direct nursing care to individual and groups of patients under the guidance and direction of the Nurse Manager with a team nursing model.
- Documents observations, assessments, and changes in patient's condition; collaborate with health team members to facilitate positive patient care outcomes; provide full range of nursing care to patients with a variety of physical and/or behavior problems.
- Serves as a part time unit Charge Nurse making patient assignments, coordinating between unit staff and providers to facilitate efficient care of our veterans, and managing daily activities on the unit.
Travel Registered Nurse
WV Nursing Network
08.2013 - 01.2014
- Provided Registered Nurse staffing to area healthcare facilities experiencing a shortage in their registered nursing staffing.
- Able to function as independent team member on staff with minimal training.
- Administered medications and treatment to patients and monitored responses while working with healthcare teams to adjust care plans.
- Delivered outstanding care to patients with various diagnoses and managed care from treatment initiation through to completion.
- Trained new nurses in proper techniques, care standards, operational procedures and safety protocols.
- Updated patient charts with data such as medications to keep records current and support accurate treatments.
Unit Manager
Genesis Hilltop Center
04.2013 - 08.2013
- Unit Manager for Units 3&4 in a 120 bed nursing and rehabilitation center.
- Managed day to day nursing care for residents by assessing ADL’s and updating the plan of care accordingly.
- Assess new residents for nursing and rehabilitation needs.
- Provided on-call RN Supervisor coverage for the facility.
- Covered other units when the unit manager position was in a transition period.
- Provided training to recent LPN graduates and students.
- Assessed critical patient’s and coordinated with physician for the most appropriate treatment.
- Coordinated nursing with other services to promote continuity of total regimen of care.
- Maintained adequate stock of medications, supplies and equipment to meet patient needs.
- Oversaw RNs, LPNs, nursing aides, medical clerks and support staff and performed staffing scheduling duties.
Registered Nurse
Loved Ones In Home Care
09.2012 - 04.2013
- Responsible for evaluating Medicaid recipients for personal care services in their home for 99 clients in Wyoming and Fayette County.
- Supervised and assisted homemakers in following the Plan of Care as set forth by the registered nurse.
- Performed spot checks and evaluated homemaker performance and client satisfaction with homemaker services.
- Performed semi-annual RN physical assessments to make sure the client meets the guidelines for personal care services.
- Reviewed weekly homemaker logs to ensure compliance with the Plan of Care and Medicaid guidelines.
- Audited charts and reviewed clinical documents to verify accuracy.
- Determined and addresses individual home care needs by completing detailed assessments and reviewing documentation.
- Introduced changes to patient care plans based on regular evaluations and patient changes.
- Responded to patient requests with appropriate clinical and personal assistance.
- Created customized care plans, working with homemakers and families to assess and meet individual needs.
Registered Nurse, Medical-Surgical-Telemetry Unit
Raleigh General Hospital
06.2012 - 02.2013
- PRN Staff RN on a medical/surgical/telemetry inpatient ward.
- Competent in RN admission assessments, blood product administration, IV medication administration, establishing patient Plan of Care, supervising unlicensed personnel and LPN's.
- Competent in using nursing judgment in delegating tasks and assessing patients by acuity and needs.
- Provided direct patient care, stabilized patients and determined next course of action.
- Managed care from admission to discharge.
- Administered medications and treatment to patients and monitored responses while working with healthcare teams to adjust care plans.
- Advocated for patients by communicating care preferences to practitioners, verifying interventions met treatment goals and identifying insurance coverage limitations.
Licensed Practical Nurse
Princeton Community Hospital
04.2011 - 05.2012
- Served as LPN on a 28-bed Progressive Care Unit.
- Effectively managed care of 6-8 medical/surgical patients during my shift.
- Ensured that doctor’ orders were effectively carried out, including testing, medical procedures, medication administration, consultations and stat orders.
- Monitored, tracked and conveyed important patient information to healthcare staff to help optimize treatment planning and care delivery.
- Supported physicians during examinations and scans to assist with diagnostic procedures.
- Educated patients and caregivers on medical diagnoses, treatment options, chronic disease self-management and wound management.
- Comforted and counseled patients and families throughout care process.
- Performed functional assessments for admission and discharge.
Health Care Representative
Chamberlin Edmonds
01.2010 - 07.2011
- Screening uninsured patients for state and federal programs that provide for reimbursement for health care associated costs.
- Worked closely with hospital financial personnel in obtaining reimbursement from self pay patients by facilitating their applications for Medicaid, Supplemental Security Income (SSI), and Retirement, Disability, and Survivors Income (RSDI).
- Obtained patient information to properly record and document demographics and medical histories.
- Managed 20-30 incoming phone calls per day to resolve patient inquiries and refer calls to appropriate departments.
- Followed up with doctors and nurses to obtain necessary information to complete patients' records.
- Followed document protocols to safeguard confidentiality of patient records.
Travel LPN
United Talent Staffing
11.2009 - 08.2010
- Provided LPN coverage to medical facilities around Charleston, WV.
- Places Assigned include CAMC Hospital-Memorial Division, Genesis Valley Center, and Select Specialty Hospital.
- Administered medications and treatment to patients and monitored responses while working with healthcare teams to adjust care plans.
- Delivered outstanding care to patients with various diagnoses and managed care from treatment initiation through to completion.
- Reviewed post-operative orders and continuously monitored patients' post-operative vitals, and set up fluids and oriented patients to unit.
- Updated patient charts with data such as medications to keep records current and support accurate treatments.
- Documented all elements of care and updated patient charts and confidential files to reflect changes in care plans, interventions applied and observations.
Staff LPN
Heartland of Beckley
11.2008 - 12.2009
- Worked as the float LPN Supervisor in a long term care facility.
- Managed care of 23-32 long term care residents during any given shift.
- Duties included medication administration, providing wound care treatment, supervision of certified nursing assistants and their daily work assignments.
- Collaborated with interdisciplinary team of healthcare and social service providers to address patients' needs through effective intervention and care planning.
LPN
BJC Medical Center
01.2007 - 10.2008
- In the Utilization Review/Case Management Department as a pre-authorization nurse for insurance reimbursement.
- Worked closely with hospital staff, area physicians, and insurance companies to obtain authorization for inpatient and outpatient services.
- Completed monthly hospital blood bank reviews to ensure quality assurance of patients receiving blood products using standards set by Joint Commission Guidelines.
- Participated in morning patient care conferences to ensure compliance with patient care plans.
Staff LPN
BJC Medical Center
08.2006 - 10.2008
- Worked on the 36-bed inpatient medical/surgical unit.
- Provided nursing care to patients ranging from birth to geriatric.
- As a versatile employee, floated to various departments in the hospital to work. These departments included: Emergency Department, Intensive Care Unit, and the adjacent long term care nursing facility owned by the hospital.
- Monitored, tracked and conveyed important patient information to healthcare staff to help optimize treatment planning and care delivery.
- Managed patient care through closely monitoring respiration, blood pressure and blood glucose levels.
- Cared for wounds, provided treatments and assisted with procedures.
- Supported physicians during examinations and scans to assist with diagnostic procedures.
Hospital Corpsman
United States Navy, USN
01.1999 - 07.2005
- Maintained medical records for all active duty, veterans, and their dependents for three months.
- Transferred to the Family Practice Clinic and served as the assistant Leading Petty Officer in charge of four junior personnel for one year.
- Move to the Acute Care Clinic where I served as an EMT-B and worked as a technician in the clinic.
- Performed various duties to include: IV administration and therapy, dressing changes, wound debridement, venipuncture, primary closure of various wounds and lacerations, and provided emergency medical care and conducted physical exams and interviews to gain medical history and relevant health data.
- Administered medical care for range of conditions and basic health concerns.
- Filled prescriptions and maintained pharmacy stock.
- Provided leadership, delegation and exceptional medical service in high-pressure situations.
- Coordinated and executed transport of sick and injured patients.
- Learned new techniques to better serve patients' needs.
- Prioritized medical procedures based on severity of concern and available resources.
- Provided leadership, delegation and exceptional medical service in high-pressure situations.
- Transported sick and injured and conducted preliminary physical examinations.
- Leading Petty Officer in charge of 11 LPNs and 25 Hospital Corpsman.
- Managed scheduling, government civilian employee payroll, and enlisted disciplinary issues.
Torpedoman's Mate
Naval Shipyard and Intermediate Maintenance Facility
01.1995 - 01.1999
- Assembled and maintained MK 48 Warshot and MK 48 ADCAP Torpedoes.
- Provided weapons maintenance and delivery of countermeasure weapons systems to naval submarines.
- Learned to operate new technology systems and procedures through instruction, simulators and models.
- Loaded cargo according to ship capacity and appropriate weight load distribution.
- Held a secret security clearance.
Education
Certificate - CEHRS
MedCerts
Online09.2023
Associate of Applied Science - Nursing ASN
Bluefield State College
Bluefield, WV07.2012
LPN Diploma - Practical Nursing
Lanier Technical College
Oakwood, GA06.2006
Associate of Arts - Arts-General Studies
University of Phoenix
Tempe, AZ06.2005
Skills
- Prior Authorization
- Verbal and Written Communication
- Nursing Care Coordination
- Interdisciplinary Collaboration
- Concurrent Reviews
- Acute Case Management
- Data Input
- Electronic Medical Records Management
- Medical Records Requests
- Patient Data Abstracts
Certification
Multi-state WV RN License, Additionally licensed in California, Nevada, Oregon, Michigan, Minnesota, Connecticut, Massachusetts, Illinois, Pennsylvania, and New York
MCG certified
CCM Certified
Timeline
Prior Authorization Nurse
Humana
02.2022 - Current
Off Tour Coordinator
Beckley VA Medical Center
09.2020 - 02.2022
Charge Nurse, Telemetry Floor
Raleigh General Hospital
06.2018 - 09.2021
Travel Registered Nurse
American Mobile Nursing Network
11.2017 - 06.2018
Staff Registered Nurse
Beckley Veteran Affairs Medical Center
01.2014 - 10.2017
Travel Registered Nurse
WV Nursing Network
08.2013 - 01.2014
Unit Manager
Genesis Hilltop Center
04.2013 - 08.2013
Registered Nurse
Loved Ones In Home Care
09.2012 - 04.2013
Registered Nurse, Medical-Surgical-Telemetry Unit
Raleigh General Hospital
06.2012 - 02.2013
Licensed Practical Nurse
Princeton Community Hospital
04.2011 - 05.2012
Health Care Representative
Chamberlin Edmonds
01.2010 - 07.2011
Travel LPN
United Talent Staffing
11.2009 - 08.2010
Staff LPN
Heartland of Beckley
11.2008 - 12.2009
LPN
BJC Medical Center
01.2007 - 10.2008
Staff LPN
BJC Medical Center
08.2006 - 10.2008
Hospital Corpsman
United States Navy, USN
01.1999 - 07.2005
Torpedoman's Mate
Naval Shipyard and Intermediate Maintenance Facility
01.1995 - 01.1999
Certificate - CEHRS
MedCerts
Associate of Applied Science - Nursing ASN
Bluefield State College
LPN Diploma - Practical Nursing
Lanier Technical College
Associate of Arts - Arts-General Studies
University of Phoenix
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