Ra'Shima Pierson
10531 Firefly Court Grand Prairie,Texas
Summary
Seeking a professional role in healthcare where I can apply my skills effectively and contribute to organizational success, with opportunities for growth and development.
Overview
19
19
years of professional experience
Work History
Utilization Management Coordinator
Blue Cross Blue Shield
08.2019 - Current
- Review in-patient, concurrent, and retroactive information to assess medical necessity for service authorization based on MCG and medical guidelines
- Coordinate with healthcare providers to support discharge planning, ensuring it is efficient, cost-effective, and timely, aligned with patients' medical needs
- Gather clinical information and verify eligibility for surgeries, home health, skilled nursing facilities (SNF), LTAC, and rehabilitation services, ensuring compliance with patient contractual guidelines.
Utilization Review Coordinator/Case-Manager/Discharge Planner
Union Health Service
04.2009 - 03.2019
- Collect and review initial, and concurrent clinical information for both in-network and out-of-network patients, following department guidelines
- Collaborate with physicians, social workers, and registered nurses to manage care for over 40,000 union patients, facilitating transfers to higher levels of care as needed
- Assess and coordinate patient discharge plans to outpatient services, including physical therapy (PT), occupational therapy (OT), speech therapy, skilled nursing facilities (SNF), ITAC, or hospice, in line with patient benefits
- Engage with multidisciplinary teams to ensure appropriate hospital care and to verify patient goals and objectives are being met
- Manage referrals and provide HCPCS and CPT codes for authorizations related to home health, durable medical equipment (DME), ambulance services, hospice care, and hospital services.
Registered Nurse
Union Health Service
07.2007 - 04.2009
- Worked with various physicians, including Oncologists, Gastroenterologists, Endocrinologists, Gynecologists, Internal medicine specialists, and Surgeons, to evaluate and develop patient care plans and outcomes
- Responsible for patient triage, education, and maintaining customer relations
- Served as Charge Nurse as needed based on clinic requirements
- Oversaw daily clinic operations and ensured efficient patient care
- Administered dressing changes, immunizations, injections, IVs, and foley catheter insertions
- Performed clinical duties in accordance with standard nursing practices.
Labor and Delivery
St. James Hospital
08.2006 - 07.2007
- Provide direct care to patients and infants on a 20-bed Labor and Delivery unit
- Obtain relevant admission histories, assess patients for medication administration, and manage treatments related to pregnancy diagnoses
- Monitor patient labor, including uterine contractions, cervical dilation, and effacement
- Assist with delivery of infants and perform postpartum care for both mothers and newborns
- Collaborate closely with physicians and anesthesiologists during surgeries and monitor patient status in recovery
- Ensure precise management of sterile equipment during surgical procedures
- Document and chart patient responses to care and treatment accurately
- Adhere to hospital standards and policies while performing clinical tasks.
Medical Surgical Nurse
St. James Hospital
02.2006 - 08.2006
- Delivered bedside care, treatment, and medication administration for patients on a 36-bed Medical-Surgical unit.
- Managed patient admissions, discharges, and transfers.
- Maintained sterile fields during dressing changes, suctioning, and insertion of catheters and IVs.
- Provided patient education on health issues such as smoking cessation, diabetes management, and recovery.
- Administered blood transfusions, assessed patient status, and reported any clinical changes to physicians.
- Ensured accurate charting and documentation of treatment and patient progress.
Education
BSN -
Governors State University
University Park, Illinois05.2023
Associate Degree in Nursing (ADN) -
Olive Harvey College
Chicago, Illinois01.2005
Military Service
1989, 1993, United States Army, Honorable Discharge
References
Available upon request
Timeline
Utilization Management Coordinator
Blue Cross Blue Shield
08.2019 - Current
Utilization Review Coordinator/Case-Manager/Discharge Planner
Union Health Service
04.2009 - 03.2019
Registered Nurse
Union Health Service
07.2007 - 04.2009
Labor and Delivery
St. James Hospital
08.2006 - 07.2007
Medical Surgical Nurse
St. James Hospital
02.2006 - 08.2006
BSN -
Governors State University
Associate Degree in Nursing (ADN) -
Olive Harvey College
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