Hi, I’m
Nancy Boykin
Sunrise,FL
Summary
Smart Utilization Review Nurse considered critical thinker and problem-solver due to dynamic patient care planning and understanding of Medicare guidelines. Known for having great rapport with providers and insurance carriers.
Motivated and empathetic Utilization review nurse committed to providing patients and their families with comprehensive care and education. Specialized in efficiently allocating medical resources and ensuring the fair treatment of each patient. Seeking a position where I can use my case management and interpersonal skills to perform all utilization management review process.
Overview
21
years of professional experience
Work History
Centers Plan for Healthy Living/ Elevance Health
Registered Nurse (Utilization, Case Management)
08.2021 - Current
Job overview
- Offer early intervention and regular treatment to a caseload of up to 150 patients
- Educated family members and caregivers on patient care instructions.
- Facilitated patient transitions between different levels of care, ensuring continuity of services and minimizing disruptions in treatment plans.
- Communicate, consult and collaborate with outside medical specialists to develop individualized treatment plans and coordinate care
- Improved patient outcomes by implementing evidence-based nursing interventions and individualized care plans.
- Assisted in maintaining regulatory compliance by staying up-to-date on Medicare, Medicaid, and commercial insurance requirements for utilization review activities.
- Participated in performance improvement projects aimed at streamlining processes related to utilization review and case management activities.
- Serve as a liaison between healthcare providers, insurance companies, and patients for efficient resolution of coverage issues or denials following a utilization review assessment.
SnapNurse
Registered Nurse
01.2021 - 08.2021
Job overview
- Administered medications safely according to established guidelines while closely monitoring for side effects or adverse reactions requiring intervention.
- Assisted in the training and mentorship of new nursing staff members, contributing to a positive work environment and high-quality patient care.
- Prevented the spread of infections by consistently adhering to strict infection control protocols and educating patients on proper hygiene practices.
- Administered vaccines per manufacturer instructions and educated patients and caregivers about age specific immunizations, precautions/contraindications and possible adverse reactions
Legacy Healing Center
Charge Registered Nurse
02.2020 - 01.2021
Job overview
- Led shift handover meetings effectively communicating critical information about each patient''s status ensuring continuity of care.
- Trained new nurses in proper techniques, care standards, operational procedures, and safety protocols.
- Coordinated nursing care on unit through staff assignments, assisting and rounding with physicians, monitoring patient orders, and communicating with ancillary departments.
- Managed medication administration safely and accurately while maintaining meticulous documentation in electronic health records systems.
- Documented information in patients' electronic medical record, relaying information to clinicians and care providers to facilitate continuity of care.
University Hospital
Registered Nurse, Medical-Surgical Unit
01.2019 - 03.2020
Job overview
- Collaborated with interdisciplinary teams for optimal patient care, ensuring seamless communication between healthcare providers.
- Consistently maintained accurate documentation of patient assessments, interventions, and outcomes in accordance with regulatory requirements.
- Skillfully performed venipuncture, IV insertion, and catheterizations, ensuring proper technique and adherence to infection control standards.
- Provided health education to patients and families regarding discharge instructions and plans of care.
- Started intravenous fluids, administered medications, and documented patient charts by recording food and fluid output and intake.
- Improved patient outcomes by providing comprehensive assessments and developing individualized care plans.
- Educated patients and family members on disease processes, treatment options, and self-care techniques.
- Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
Wellpath
Registered Nurse
11.2004 - 12.2018
Job overview
- Administered medications safely according to established guidelines while closely monitoring for side effects or adverse reactions requiring intervention.
- Monitored patient reactions after administering medications and IV therapies.
- Lead and trained newly staff registered nurses on unit routine facility protocol, and direct patient care, and duties within the unit.
- Accurately transcribed medical orders and ensured appropriate procedures were followed for transcription and verification of medical orders.
- Established intra and interdisciplinary collaborative relationships with all members of the health care team.
- CIWA and COWS scales, EMR Charting
- Performed Intake screenings and release discharges
Life Care Center of Inverrary
Licensed Practical Nurse, Home Care
12.2003 - 11.2004
Job overview
- Ensured patients safety by consistently monitoring vital signs and administering medications as prescribed.
- Coordinated seamless transitions from hospital to home setting by collaborating with discharge planners, physicians, therapists, and social workers.
- Facilitated effective communication among team members during shift handoffs to ensure continuity of care for all patients.
- Participated in ongoing professional development opportunities to stay current with best practices, regulatory requirements, and advancements within the field of home care nursing.
- Administered injections, catheter care, and other skilled nursing procedures with precision and attention to patient comfort.
- Administered different therapies and medications in line with physician orders and treatment plan.
Education
Mercy Hospital College , Miami, FL
Associate of Science from Nursing
08.2019
Sheridan Technical College , Hollywood, FL
Nursing Diploma from Practical Nursing
08.2003
Skills
- Patient evaluation
- Charting and clinical documentation
- Patient education and counseling
- Patient Monitoring
- Patient Management
- Care Plan Development
- Strong communication
- Medical Documentation
- Clinical assessment
- Medicare knowledge
- Medicaid knowledge
- Utilization review
Timeline
Registered Nurse (Utilization, Case Management)
Centers Plan for Healthy Living/ Elevance Health
08.2021 - Current
Registered Nurse
SnapNurse
01.2021 - 08.2021
Charge Registered Nurse
Legacy Healing Center
02.2020 - 01.2021
Registered Nurse, Medical-Surgical Unit
University Hospital
01.2019 - 03.2020
Registered Nurse
Wellpath
11.2004 - 12.2018
Licensed Practical Nurse, Home Care
Life Care Center of Inverrary
12.2003 - 11.2004
Mercy Hospital College
Associate of Science from Nursing
Sheridan Technical College
Nursing Diploma from Practical Nursing
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