Nicholas Amick
Rockledge,FL
Summary
Dynamic Prior Authorization Nurse Analyst with meticulous attention to accuracy and expertise in regulatory compliance. Proven track record of optimizing case processing times and mentoring new hires. Skilled in analytical problem solving, ensuring medical necessity evaluations align with guidelines while enhancing patient care outcomes.
Overview
9
9
years of professional experience
Work History
Prior Authorization Nurse Analyst
Evicore
03.2019 - Current
- Referred cases to medical director for further review when request did not meet medical necessity guidelines or initiate peer review to establish if request is appropriate for members needs.
- Responsible for reviewing prior authorization requests for medical procedures by using clinical documentation from various providers to evaluate for medical necessity based upon Medicare guidelines, and nursing knowledge.
- Communicated by phone with providers and members when additional information was needed to process requests or to give notification of decision regarding request.
- Working independently and in collaboration with colleagues to develop and implement procedures to increase case processing times.
- Consistently met or exceeded metric requirements for case processing via phone and fax prior authorization requests.
- Promoted a culture of continuous improvement within the Prior Authorization department by regularly reviewing processes and making recommendations for optimization.
- Mentored new hires within the team, sharing expertise in navigating complex insurance guidelines and best practices for managing workflow efficiently.
- Proactively identified potential barriers to approval, implementing strategies to address these challenges before they impacted patient care.
- Maintained detailed records and documentation related to prior authorization requests, ensuring accurate tracking and reporting for both internal and external stakeholders.
- Assisted in maintaining compliance with changing regulations and policies by staying up-to-date on industry trends and best practices.
- Demonstrated commitment to professional development by participating in ongoing training opportunities related to the field of Prior Authorization nursing.
Registered Nurse - PICU
Nemours Children's Hospital
02.2018 - 03.2019
- Managed care from admission to discharge.
- Provided direct patient care, stabilized patients and determined next course of action.
- Administered medications and treatment to patients and monitored responses while working with healthcare teams to adjust care plans.
- Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing conditions.
- Implemented medication and IV administration, catheter insertion and airway management.
- Collected blood, tissue and other laboratory specimens and prepared for lab testing.
- Provided exceptional care to high-acute patients needing complex care such as ventilator management, extensive wound care and rehabilitation.
- Improved patient outcomes with continuous assessment, early identification of potential complications, and prompt intervention when needed.
- Effectively managed multiple priorities during high-stress situations by remaining calm, organized, and focused on delivering optimal patient care.
Registered Nurse, MICU
Health First Palm Bay Hospital
08.2017 - 02.2018
- Provided direct patient care, stabilized patients and determined next course of action.
- Coordinated and analyzed sustainable person-centered care plans involving formal and informal supports.
- Facilitated assessment of individual physiological, psychological, financial, cultural and family situation and coordinated social services to address individual and family needs.
- Assessed healthcare needs and monitored effectiveness and progress plans to achieve desired outcomes.
- Administered medications and treatment to patients and monitored responses while working with healthcare teams to adjust care plans.
- Performed emergency medical procedures such as BLS, ACLS and other condition stabilizing interventions.
Registered Nurse - Vascular Care Unit
Florida Hospital South
09.2016 - 08.2017
- Monitored surgical patients and delivered quality level of care before, during and after operations to promote positive outcomes.
- Coordinated and consulted with healthcare teams to plan, implement, assess and evaluate patient care plans.
- Assessed team members' workloads and pitched in to help in areas where need was most evident.
- Prevented the spread of infections by consistently adhering to strict infection control protocols and educating patients on proper hygiene practices.
- Updated patient charts with data such as medications to keep records current and support accurate treatments.
- Collected, labeled and transported specimens and delivered to lab for testing.
- Participated in evidence-based practice project implementation, nursing competency development and nursing simulation activities.
- Utilized critical thinking skills to prioritize nursing interventions based on patients'' acuity levels and individual needs.
Education
Associate of Science - Nursing
Keiser University
Orlando, FL08.2016
Skills
- Meticulous attention to accuracy
- Analytical problem solving
- Collaborative communication skills
- Employee mentoring
- Task assignment and encouragement
- Expertise in Microsoft Office applications
- Knowledge of pathophysiology
- Thorough documentation practices
- Diagnostic Test Evaluations
- Regulatory compliance
- HIPAA regulations adherence
Timeline
Prior Authorization Nurse Analyst
Evicore
03.2019 - Current
Registered Nurse - PICU
Nemours Children's Hospital
02.2018 - 03.2019
Registered Nurse, MICU
Health First Palm Bay Hospital
08.2017 - 02.2018
Registered Nurse - Vascular Care Unit
Florida Hospital South
09.2016 - 08.2017
Associate of Science - Nursing
Keiser University
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