Summary
Overview
Work History
Education
Skills
Work Availability
Quote
Timeline
GeneralManager

Pamela Anderson Jakubowski MSN RN CCM

Garland,TX

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.

Overview

13
13
years of professional experience

Work History

RN Utilization Review Nurse

Ut Southwestern Medical Center
Dallas, TX
02.2022 - Current
  • We evaluated medical guidelines to determine appropriateness of services.
  • Performed emergency room admission review on entry to the facility.
  • Obtained authorizations from multiple insurance carriers for various levels of care.
  • Performed physician advisor referrals for patients that did not meet criteria and documented outcomes.
  • Evaluated patient histories, complaints and current symptoms.
  • Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
  • Documented all responses and interactions in EPIC EMR.

Travel RN Utilization Review Nurse

ADN Healthcare - Travel Nursing
Boynton Beach, FL
09.2021 - 12.2021
  • Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
  • Performed admission reviews based on medical necessity criteria.
  • Prepared and sent all accounts that did not meet criteria to external physician reviewers.
  • Documented all interactions in EPIC EMR.

RN Utilization Review Nurse

Baylor Scott And White Regional Medical Center
Dallas, TX
06.2013 - 04.2021
  • Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
  • Performed admission reviews based on medical necessity based upon criteria specification.
  • Obtained authorizations from multiple insurance carriers for various levels of care.
  • Supported or performed clinical appeals through the company process.
  • Served as subject matter expert in the area of Medicare surgical procedures and admission status appropriateness
  • Collaborated with physician offices on a daily basis on status appropriateness
  • Documented all responses and findings in EPIC EMR
  • Collaborated daily with insurance case managers
  • Collaborated daily with facility case managers to ensure a smooth transition to appropriate levels of care
  • Responsible for reviews for 90 + patients daily
  • Responsible for five Baylor facilities when performing Medicare surgery reviews resulting in large cost savings by averting admit status errors.

RN Case Manager III

Blue Cross Blue Shield Of Texas
Richardson, TX
06.2008 - 06.2013
  • Completed initial assessments of patients and family to determine and address individual home care needs. ·
  • Advocated for patients by communicating care preferences to practitioners, verifying interventions met treatment goals and identifying insurance coverage limitations.
  • Communicated with patients telephonically to establish care plan compliance and updated the care plan accordingly
  • Responded promptly and professionally to patient questions and concerns.
  • Performed utilization review activities to include appeals and denials activities

Education

Associate of Applied Science - Nursing

McLennan Community College
Waco, TX

Bachelor of Science - Nursing

The University of Texas At El Paso
El Paso, TX

Master of Science - Nursing Leadership

The University of Texas Medical Branch
Galveston, TX

Skills

  • Clear Patient Communication
  • Decision Making
  • Patient Care Assessment
  • Compassionate and Caring
  • Utilization review
  • Certified Case Manager

Work Availability

monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Quote

There is a powerful driving force inside every human being that, once unleashed, can make any vision, dream, or desire a reality.
Tony Robbins

Timeline

RN Utilization Review Nurse

Ut Southwestern Medical Center
02.2022 - Current

Travel RN Utilization Review Nurse

ADN Healthcare - Travel Nursing
09.2021 - 12.2021

RN Utilization Review Nurse

Baylor Scott And White Regional Medical Center
06.2013 - 04.2021

RN Case Manager III

Blue Cross Blue Shield Of Texas
06.2008 - 06.2013

Associate of Applied Science - Nursing

McLennan Community College

Bachelor of Science - Nursing

The University of Texas At El Paso

Master of Science - Nursing Leadership

The University of Texas Medical Branch

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Pamela Anderson Jakubowski MSN RN CCM