Rachael Collins
Amarillo
Summary
Compassionate and detail-oriented Registered Nurse with a strong clinical background and a passion for promoting student health and well-being. Experienced in patient assessment, care coordination, and health education, with the ability to respond calmly and effectively in urgent situations. Adept at building trusting relationships with children, families, and staff, and committed to creating a safe and supportive school environment. Organized, dependable, and skilled in managing multiple priorities.
Overview
15
15
years of professional experience
Work History
Utilization Review Nurse
Enhabit Home Health & Hospice
Amarillo
08.2012 - 02.2025
- Conduct comprehensive utilization reviews to ensure services meet medical necessity, payer guidelines, and CMS regulations.
- Perform detailed clinical documentation audits, identifying deficiencies and providing corrective guidance to improve compliance and reimbursement accuracy.
- Review and validate OASIS assessments (SOC, Recertification, Discharge) to ensure accuracy, consistency, and regulatory compliance.
- Apply ICD-10-CM coding principles to support appropriate case mix, risk adjustment, and reimbursement.
- Collaborate with clinicians, case managers, and leadership to resolve documentation issues and reduce claim denials.
- Support quality improvement initiatives by analyzing audit trends and implementing corrective action plans.
- Ensure adherence to Medicare Conditions of Participation (CoPs) and payer-specific requirements.
- Participate in survey readiness and regulatory reviews, contributing to successful outcomes.
- Provide education and feedback to field clinicians to strengthen documentation quality and utilization efficiency.
- CORE COMPETENCIES
- Utilization Review & Medical Necessity
- Clinical & Documentation Audits
- OASIS (Start of Care, Recert, Discharge)
- Home Health Coding (ICD-10-CM)
- Medicare & CMS Compliance
- Denials Prevention & Appeals Support
- Quality Assurance & Performance Improvement (QAPI)
- Regulatory Readiness & Surveys
- Risk Adjustment & Case Mix Optimization
- EMR/EHR Documentation Review
- Interdisciplinary Collaboration
Case Manager
Children's Home Healthcare
Amarillo
01.2010 - 09.2010
- Provided specialized and skilled nursing care to children in their homes, focusing on their unique needs and medical conditions.
- Worked with medically fragile children, including newborns, infants, toddlers, and adolescents; adapting care plans to individual circumstances and family support.
- Administered medication's treatments and therapies as prescribed.
- Performed procedures related to G-tube's, tracheostomies, and oxygen therapies.
- Collaborated with other healthcare professionals and agencies involved in the child's care.
- Advocate for the child's needs and well-being.
- Educate families about child's condition, procedures, and medication management.
- Conduct comprehensive health assessments and monitor patient conditions, ensuring timely identification of changes and appropriate interventions.
- Provide medication management, education, and monitoring for patients with acute and chronic conditions.
- Develop and maintain individualized care plans, coordinating services with physicians, therapists, families, and community resources.
- Maintain accurate, confidential health documentation in compliance with regulatory and organizational standards.
- Educate patients and caregivers on disease management, safety, and health promotion.
- Demonstrate strong independent decision-making, time management, and prioritization skills.
- Respond to urgent and emergent situations with calm clinical judgment and appropriate escalation of care.
- CORE COMPETENCIES
- Chronic Condition Management (Asthma, Diabetes, Seizures, Allergies)
- Medication Administration & Monitoring
- Emergency Response & First Aid
- Care Plans & Individualized Health Plans (IHPs)
- Health Screenings & Documentation
Education
BSN -
West Texas A&M University
Canyon, TXSkills
- Chronic and acute condition management
- Diabetes, education
- Asthma management
- Oasis
- Customer service
- OASIS-E Documentation
- Home Health EMRs
- Medicare & Commercial Payer Guidelines
- Clinical Quality Reporting
- ICD-10
- Medication administration
- ADLS
- Care plans
- Childcare
- CPR/BLS Certification
- Utilization review
- Medical necessity
- Clinical documentation
- ICD-10-CM coding
License
Texas Board of Nursing license, 780378
Timeline
Utilization Review Nurse
Enhabit Home Health & Hospice
08.2012 - 02.2025
Case Manager
Children's Home Healthcare
01.2010 - 09.2010
BSN -
West Texas A&M University