Richard Crawford
Spokane,WA
Summary
Proven Utilization Review Nurse with a track record of reducing healthcare costs and enhancing patient care quality. Knowledgeable in InterQual and MCG Criteria and adept at fostering teamwork and collaboration. Achieved significant improvements in compliance and efficiency through critical thinking and effective case management. Reliable individual bringing 25 years of experience in healthcare environments. Maintains positive relationships with case managers and providers. Remains polished and calm under extreme stress.
Overview
23
23
years of professional experience
Work History
Utilization Review Nurse
Physican of Southwest Washington
03.2023 - Current
- Reduced healthcare costs through efficient utilization of resources and identification of unnecessary treatments or procedures.
- Ensured compliance with regulations and accreditation standards by maintaining accurate documentation of all utilization review activities.
- Maintained professional competence by staying current on industry trends, best practices, and regulatory requirements specific to utilization review nursing.
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Performed prior authorization review of services requiring notification.
- Contributed to organizational success by providing expert advice on medical necessity criteria and evidence-based practices in utilization review nursing.
- Submitted cases for criteria failures and helped facilitate resolutions and approvals.
Utilization Review Nurse
Community Health Care of Washington
02.2018 - 03.2022
- Reduced healthcare costs through efficient utilization of resources and identification of unnecessary treatments or procedures.
- Ensured compliance with regulations and accreditation standards by maintaining accurate documentation of all utilization review activities.
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Performed prior authorization review of services requiring notification.
- Contributed to organizational success by providing expert advice on medical necessity criteria and evidence-based practices in utilization review nursing.
- Submitted cases for criteria failures and helped facilitate resolutions and approvals.
Utilization Review Nurse
Premera Blue Cross Of Washington
02.2015 - 01.2018
- Reduced healthcare costs through efficient utilization of resources and identification of unnecessary treatments or procedures.
- Ensured compliance with regulations and accreditation standards by maintaining accurate documentation of all utilization review activities.
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Performed prior authorization review of services requiring notification.
- Submitted cases for criteria failures and helped facilitate resolutions and approvals.
Staff Nurse
RN Network
11.2013 - 12.2014
- Administered medications via oral, IV, and intramuscular injections and monitored responses.
- Performed various nursing interventions such as wound dressing, vital sign monitoring, and specimen collection.
- Assessed physical, psychological, physiologic, and cognitive status of patients.
- Monitored patients' conditions and reported changes in physical presentation, appearance, and behavior to discuss treatment with physicians.
- Updated patient charts with data such as medications to keep records current and support accurate treatments.
- Developed strong rapport with patients and families, fostering trust and open communication during challenging times.
- Collaborated with physicians, pharmacists and therapists to deliver quality, evidence-based care.
- Educated patients, families and caregivers on diagnosis and prognosis, treatment options, disease process, and management and lifestyle options.
- Demonstrated excellent time management skills while juggling multiple priorities in a fast-paced environment.
- Acted as a patient advocate, ensuring their needs were met and their rights protected throughout their healthcare journey.
- Directed patient care by initiating and following through with plan of care, continuing care, and discharge instructions.
- Reduced medication errors through meticulous charting and double-checking dosages.
- Improved patient satisfaction scores by providing empathetic, compassionate care to diverse populations.
Staff Nurse, Case Manager, Unit Manager
St Lukes Rehabilitation Institute
11.2001 - 10.2013
- Administered medications via oral, IV, and intramuscular injections and monitored responses.
- Performed various nursing interventions such as wound dressing, vital sign monitoring, and specimen collection.
- Assessed physical, psychological, physiologic, and cognitive status of patients.
- Monitored patients' conditions and reported changes in physical presentation, appearance, and behavior to discuss treatment with physicians.
- Maintained accurate documentation on all cases, ensuring compliance with regulations and confidentiality requirements.
- Conducted thorough assessments of clients'' situations, identifying issues, goals, and necessary interventions.
- Monitored ongoing cases closely, adjusting case management strategies as needed based on evolving circumstances or new information.
- Enhanced communication between clients and providers through consistent follow-ups and progress updates.
- Evaluated employee performance regularly for professional growth opportunities, accountability measures, and feedback-driven improvement strategies.
- Ensured compliance with regulations and standards through regular audits, staff education, and policy updates.
- Resolved conflicts among team members quickly to maintain a positive working environment conducive for continued excellence in patient care.
- Oversaw RNs, LPNs, nursing aides, medical clerks and support staff and performed staffing scheduling duties.
- Managed budgetary constraints through careful resource allocation, cost control measures, and fiscal responsibility practices.
- Addressed clinical issues promptly to reduce risks associated with patient care or operational inefficiencies in the unit.
- Assisted in development and implementation of policies, procedures, and regulations for unit operations.
- Developed strong working relationships with physicians, nurses, therapists, and ancillary staff for cohesive unit functioning.
- Met with nursing staff and support personnel to plan services, programs and activities.
- Optimized staffing levels by monitoring unit needs and making data-driven adjustments to scheduling as necessary.
- Increased staff retention rates with supportive leadership techniques, mentoring programs, and positive work environment initiatives.
- Promoted a culture of safety within the unit by enforcing strict adherence to protocols, guidelines, and infection control measures.
- Handled complaints from patients and families and immediately took steps for quick resolution and to prevent reoccurrence.
- Implemented evidence-based practices within the unit to enhance overall quality of care provided to patients.
- Participated actively in committee meetings to contribute insights from a Unit Manager perspective, influencing hospital-wide decisions and policies.
- Improved patient satisfaction with timely and accurate communication between patients, families, and medical professionals.
- Contributed to hospital-wide quality improvement initiatives by identifying areas of opportunity within the unit and implementing best practices.
Education
Associate of Science - Nursing
Spokane Community College
Spokane, WA06.2000
High School Diploma -
Thompson Falls High School
Thompson Falls, MT06.1983
Skills
- InterQual Criteria
- Documentation And Reporting
- Utilization review
- Records analysis
- Clinical assessment
- Prior Authorization
- HIPAA Compliance
- Quality Improvement
- Inpatient Care
- Discharge Planning
- Utilization Management
- Milliman Guidelines
- Case Management
- Student Precepting
- Blood Draw and Sample Collection
- Teamwork and Collaboration
- Problem-Solving
- Medication and IV administration
- Time Management
- Attention to Detail
- Problem-solving abilities
- Multitasking
- Compassionate and Caring
- Multitasking Abilities
- Reliability
- Critical Thinking
- Strong Clinical Judgment
- Direct Patient Care
- Team Collaboration
- Active Listening
- Patient Education
- Monitoring Vital Signs
- Vitals monitoring
- Clear Patient Communication
- Wound Care
- Microsoft Office
- Intravenous therapy
- Team building
- Delegation and Motivation
- Task Prioritization
- Self Motivation
- Medication Administration
- Infection Control
- Patient Condition Monitoring
- Accurate Documentation
- Interpersonal Skills
- Documentation
- Professionalism
- Adaptability
Timeline
Utilization Review Nurse
Physican of Southwest Washington
03.2023 - Current
Utilization Review Nurse
Community Health Care of Washington
02.2018 - 03.2022
Utilization Review Nurse
Premera Blue Cross Of Washington
02.2015 - 01.2018
Staff Nurse
RN Network
11.2013 - 12.2014
Staff Nurse, Case Manager, Unit Manager
St Lukes Rehabilitation Institute
11.2001 - 10.2013
Associate of Science - Nursing
Spokane Community College
High School Diploma -
Thompson Falls High School
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