PATRICIA TAYLOR
LVN
LAVON,TX
Summary
My military background has taught me the importance of having a strong work ethic with emphasis on setting priorities, working independently, and mentoring others. I am focused and excel when trained appropriately in my assigned work tasks and enjoy the challenges of a non-routine job.
Healthcare professional with substantial experience in utilization review and patient care management. Known for precision in evaluating patient treatment plans and making critical decisions to optimize resource use. Valued team collaborator with focus on achieving impactful results and adapting to dynamic healthcare environments.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Utilization Management Specialist, Licensed Vocational Nurse
Kelsey-Seybold Clinic
Pearland, TX
08.2022 - 08.2025
- Applied CMS/InterQual criteria for Medicare Advantage and commercial referrals.
- Sent requests to MD reviewers for decisions when criteria were not met.
- Contacted providers and patients with HIPAA-compliant determinations regarding adverse decisions.
- Specialized in Durable Medical Equipment referrals.
- Reviewed patient records to ensure compliance with utilization management policies.
Staff LPN Banner Hospital, Licensed Practical Nurse
Progressive Care Unit
Sun City, AZ
12.2021 - 01.2022
- Staff LPN, Banner Hospital, Sun City, Arizona
- Delivered comprehensive patient care to an aging population in a progressive care unit during peak COVID-19 hospitalizations.
Utilization Review Nurse
AIG/HealthDirect
Dallas, TX
05.2020 - 01.2015
- Managed workers' compensation requests, assessing medical necessity using evidence-based criteria.
- Applied criteria for authorization and, if not met, forwarded cases to the medical director for further review.
- Engaged with providers to secure documentation, ensuring clarity of service requests when criteria were unspecified.
Utilization Review Nurse Licensed Vocational Nurse
CorVel Corp
Dallas, TX
09.2013 - 04.2015
- Managed workers' compensation requests, assessing medical necessity using evidence-based criteria.
- Applied criteria for authorization and, if not met, forwarded cases to the medical director for further review.
Preauthorization Nurse, Licensed Vocational Nurse
Injury Management Organization
Plano, TX
10.2013 - 02.2014
- Reviewed medical records and extracted relevant medical information to assess if requests met evidence-based criteria for approval.
- Elevated requests to the medical director for further review and decision-making when authorization cannot be granted at nurse level.
Education
High School Graduate -
Community High School
Nevada, TXVocational School Certificate (DD214) - undefined
Ft. Sam Houston, TXSkills
- InterQual criteria, CMS guidelines, Milliman criteria
- Compliance procedures
- Patient transfers and transitions
- Communication
- Student precepting
- Procedure room preparation
- Attention to detail
- Problem-solving abilities
- Compassionate and caring
- Critical thinking
- Strong clinical judgment
- Direct patient care
- CPR certification
- Patient and family advocacy
- Patient education
- Certified in CPR/AED
- Clinical documentation
- Physical assessment
- Clear patient communication
- Microsoft office
- Task prioritization
- Self motivation
- Delegation and motivation
- Analytical thinking
- Goal setting
- Documentation and reporting
- Utilization review
- Records analysis
- Care of adult population while hospitalized
- IV trained
- Documented in MDR such as Epic and proprietary documentation systems
- InterQual criteria
- Clinical assessment
- Interpersonal and written communication
- Outpatient care
- Prior authorization
- Palliative care
- Physician consultations
- HIPAA compliance
- Discharge planning coordination
- Insurance verification
- Inpatient care
- Healthcare regulations
- Managed care
- Utilization management
- Medical coding
- Needs assessment
- Telephonic nursing
- Medicare
- Milliman guidelines
Certification
- Licensed Vocational Nurse (Compact)
- Basic Life Support (AHA)
- IV Trained
Timeline
Utilization Management Specialist, Licensed Vocational Nurse
Kelsey-Seybold Clinic
08.2022 - 08.2025
Staff LPN Banner Hospital, Licensed Practical Nurse
Progressive Care Unit
12.2021 - 01.2022
Utilization Review Nurse
AIG/HealthDirect
05.2020 - 01.2015
Preauthorization Nurse, Licensed Vocational Nurse
Injury Management Organization
10.2013 - 02.2014
Utilization Review Nurse Licensed Vocational Nurse
CorVel Corp
09.2013 - 04.2015
Vocational School Certificate (DD214) - undefined
High School Graduate -
Community High School