Olubukola Kehinde
Dacula,GA
Summary
To obtain a position in your establishment that will allow me to use my extensive experience and nursing education. Professional nurse with extensive experience in utilization review. Skilled in analyzing patient care and ensuring compliance with healthcare regulations. Strong focus on team collaboration and achieving optimal patient outcomes. Adaptable and reliable, excelling in dynamic environments requiring precise decision-making and effective communication.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Utilization Review Nurse
North East Georgia Medical Center
11.2016 - Current
- Responsible for evaluating and screening potential admissions to the facility when appropriate
- Knowledgeable of criteria for Medicare, Medicaid, HMO and private insurance coverage
- Communicate daily with admissions personnel regarding admissions and discharges to various units
- Initiate ongoing communication with the resident and resident’s family to assess discharge needs
- Communicate with physicians to ascertain their plans for a timely discharge
- Document discharge planning as an ongoing review
- Cooperate with insurance companies, based on information received
- Ensures that a quality of care is maintained or surpassed by collecting quality indicators and variance data and reporting the data to the appropriate department; reports and identifies data that indicates potential areas for improvement of care and services provided within the system
- Serve as a liaison to the assigned nursing unit to facilitate Utilization management process and to ensure the continuity of care
- Educates physicians and staff regarding appropriate level of care/utilization issues
- Develop and implement methods, policies and procedures to improve the departments’ efficiency and overall effectiveness
- Oversight and evaluation of the discharge planner/ utilization review nurse
- Perform and oversee needs analysis and planning
- Work with executive leadership to ensure targets are met for the annual operating plan/financial management
Prior Authorization Review Nurse/Concurrent review Nurse
Pruitt Health Care Management
07.2013 - 01.2018
- Screen commercial referrals and initiate the admission process by providing direction to admissions directors on appropriateness of patients for admission to a Pruitt facility
- Review clinical documentation and perform InterQual Reviews to ensure that findings fall within established guidelines
- Obtain initial and concurrent authorizations and negotiate reimbursement rates when indicated
- Work closely with the billing department to ensure that AR codes are being used appropriately
- Collaborate with the interdisciplinary team within provider networks and commercial plans electronically and telephonically to coordinate member care
- Conduct discharge planning
- Educate providers on utilization and medical management processes
- Provide clinical knowledge and act as a clinical resource to non-clinical team staff
- Enter and maintain pertinent clinical information in various medical management system
Admission Nurse/ Charge Nurse
Peachford Hospital
08.2012 - 01.2018
- Assess patient through a systematic process interacting with patient and appropriate health care provider
- Administer medication in a safe, accurate and timely manner utilizing the five right of medication
- Collect and analyze data regarding patient physical, psychosocial, environmental, self-care and anticipated discharge planning needs
- Determine patients’ alcohol or drug toxicity and identify signs of withdrawal
- Monitor patients following nursing unit policies and procedures
- Develop a comprehensive outline of care and specific goals and interventions to be included in treatment planning
- Review patient’s records for accuracy and ensure that treatment plan and progress notes clearly reflect progress of patient and family
Registered Nurse
Hillside Hospital
08.2012 - 06.2013
- Conducted admissions in compliance with applicable standards, regulation and hospital protocol
- Supervised and assigned areas of responsibility for LPNs, CAN, MHA and unit secretary during shift
- Administered medication in a safe, accurate and timely manner utilizing the five right of medication
- Collected and analyzed data regarding patient physical, psychosocial, environmental, self-care and anticipated discharge planning needs
- Monitored patients following nursing unit policies and procedures
- Developed a comprehensive outline of care and specific goals and interventions to be included in treatment planning
Education
BSc - Nursing
University of North Georgia
Dahlonega, GAASN - Leadership Concentration (RN)
North Georgia College & State University
Dahlonega, GAAS - Social Work/Psychology
Georgia Perimeter College
BSC - Economic Management
University of Ibadan
Computer Science
Federal College of Education
Skills
- Nursing Informatics
- Health Policy
- EPIC user
- Evidenced Based Practice
- Health Assessment
- Transformation to Professional Nursing
- Clinical Reasoning
- Decision Making
- Complaints Handling
- Interpersonal Skills
- Communication Skills
- Time Management
- Team Leadership
- InterQual Criteria
- Documentation And Reporting
- Utilization review
- Records analysis
- Clinical assessment
- Physician consultations
- Patient Care Plans
Certification
- Basic Cardiac Life Support – American Heart Association
- ASN/Leadership Concentration, RN, BSN
- Certified Case Manager (CCM)
Accomplishments
- Collaborated with team of 6 UR nurses in the development of standard work
- Supervised team of 10 staff members.
- Achieved team work through effectively helping with collaboration with other team members
Languages
English
Professional Working
Timeline
Utilization Review Nurse
North East Georgia Medical Center
11.2016 - Current
Prior Authorization Review Nurse/Concurrent review Nurse
Pruitt Health Care Management
07.2013 - 01.2018
Admission Nurse/ Charge Nurse
Peachford Hospital
08.2012 - 01.2018
Registered Nurse
Hillside Hospital
08.2012 - 06.2013
ASN - Leadership Concentration (RN)
North Georgia College & State University
AS - Social Work/Psychology
Georgia Perimeter College
BSC - Economic Management
University of Ibadan
Computer Science
Federal College of Education
BSc - Nursing
University of North Georgia
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