SABRINA WARSINSKI
Port Huron,MI
Summary
Analytical and results-driven Utilization Review Nurse with extensive experience interpreting complex medical records, and applying clinical criteria to ensure appropriate patient care. Proven ability to collaborate with healthcare teams, communicate effectively with payers, and implement strategic interventions that prevent denials, now seeking to apply these skills to resolve and win appeals.
Overview
12
12
years of professional experience
Work History
Utilization Review Nurse
McLaren Port Huron
Port Huron, Michigan
10.2024 - Current
- Assessed patient medical records to verify service appropriateness and procedural validity.
- Conducted inpatient utilization reviews for compliance with admission and concurrent review criteria.
- Evaluated clinical data to make informed medical necessity determinations.
- Reviewed denial letters from insurers for accuracy and timeliness.
- Complete education on utilization review best practices, and emerging technologies.
- Referred cases requiring additional audits to secondary review processes.
- Ensured adherence to federal, state, and accreditation standards in utilization management.
- Documented all review activities, findings, and decisions meticulously in patient records.
Critical Care Staff RN
SELECT SPECIALITY HOSPITAL
Grosse Pointe, Michigan
08.2022 - 09.2025
- Completed diagnostic tests and patient assessments to evaluate treatment progress.
- Assisted patients to maintain current understanding of conditions and presentations.
- Utilized critical thinking skills to assess, plan and implement evidence-based patient care.
- Worked with intubated and ventilated patients, monitoring and reporting on conditions to maintain stats within optimal levels.
- Responded rapidly to critical codes to coordinate stabilization treatments and restore vital functions.
- Collaborated with interdisciplinary healthcare team to deliver optimal patient outcomes.
- Performed timely resuscitation and stabilization of acutely ill patients.
- Operated critical care equipment to keep patients stable and promote recovery.
- Managed needs of chronically ill and acute patients with well-coordinated treatment strategies
- Documented work in hospital system and updated patients' charts with orders and observations
- Personalized bedside care and interactions based on cultural backgrounds of different patients.
- Administered medications to treat patients' symptoms and address underlying disease progression.
- Delivered top-notch care exceeding department, hospital and Joint Commission standards.
Hospice RN
Residential Home Health and Hospice
Troy , MI
06.2022 - 08.2022
- Provided emotional support to families facing difficult decisions about a loved one's care.
- Administered prescribed medications and treatments in accordance with approved nursing protocols.
- Assessed patient health and developed individualized care plans accordingly.
- Maintained accurate documentation of patient records in accordance with HIPAA regulations.
- Collaborated with physicians in developing patient-specific treatment plans.
- Advocated for patients by supporting and respecting basic rights, values, and beliefs.
- Conducted intake assessments with patients and relatives to gather case history.
- Counseled patients and caregivers, providing emotional, psychological and spiritual support.
Medical Surgical Staff RN
LAKE HURON MEDICAL CENTER
09.2021 - 06.2022
- Provide nursing care to post-surgical patients, maintaining safe practice utilizing hospital policy and process.
- Evaluate medical chart and communicate as needed with members of health care team for review and change of treatment plan.
- Coordinate plan of care with members of health care team
- Administer medications, treatments and educate patients/families related surgical aftercare and or management of disease process/prevention.
- Ability to respond to changes in condition and implement treatment with direction of physician/specialist.
- Maintain open communication with patient and families providing updates to changes and treatment plan.
RN Case Manager
Marwood Nursing And Rehab
01.2015 - 09.2021
- Specialize in resident assessment coordination that improve quality of care for resident.
- Proficient Knowledge of Medicare, Medicaid reimbursement and benefits
- Act as strong advocate for patients and families while communicating and acting as liaison between patient and interdisciplinary team and medical team.
- Develop and maintain holistic patient centered care plans.
- Work as member of leadership nursing team, ensuring facility is operating in accordance with State/Federal standards, during none administrative hours.
- Advocated for patients by communicating care preferences to practitioners, verifying interventions met treatment goals and identifying insurance coverage limitations.
- Effectively communicated with physicians regarding patient needs, performance, medications and changes.
- Evaluated healthcare needs, goals for treatment, and available resources of each patient and connected to optimal providers and care.
- Participated in patient and family planning process, as well as provided instructions and addressed question and concerns.
- Performed evaluations on consistent basis to address changes in patient needs, conditions and medications, altering care plans when required.
- Coordinated with interdisciplinary professionals to develop plans of care, administer tests and monitor patient status.
- Completed initial assessments of patients and family to determine and address individual home care needs. ·
- Conducted regular re-evaluations to address changes in needs and conditions, introducing revisions to care plans.
- Created individualized care plans based on nursing diagnosis and incorporated appropriate nursing methods to achieve positive outcomes.
Nursing House Supervisor
Marwood Nursing And Rehab
Port Huron, MI
01.2014 - 01.2015
- Managed staff, overseen patient care, ensured that facility policies and procedures where being met with in guidelines.
- Assist and educate staff as needed regarding new policies/processes.
- Acted as liaison between staff and residents/resident families.
- Maintained safe staffing levels to meet resident needs.
- Assisted staff with care of residents as needed.
- Monitored LTC residents for changes in health status and promptly reporting any changes to assigned health care provider.
- Managed prescribed treatments/orders at direction of prescribing physician.
- Maintained documents and documentation per facility policy.
- Supervised and assisted with direct care to ensure quality of care and safety maintained.
Education
BACHELOR OF SCIENCE - Nursing
Chamberlain University
true05-2025
ASSOCIATE OF APPLIED SCIENCE - Nursing
Saint Clair County Community College
Port Huron, MI05.2014
Diploma - LPN
Saint Clair County Community College
Port Huron, MI12.2001
Skills
- Utilization review and InterQual criteria
- Medicare and Medicaid regulations
- Prior authorization processes
- Telehealth systems management
- Case management strategies
- Documentation standards compliance
- Evidence-based care practices
- Critical thinking skills
- Interdisciplinary collaboration techniques
- Effective communication methods
- Time management abilities
- Clinical assessment expertise
Accomplishments
SPECIAL PROJECTS
2020
· QAPI COVID-19 Focus: Assisted Administrative Nursing Team with COVID-19 in identifying, the planning and process requirements of the CDC while meeting the needs of our community, local agencies and hospitals to ensure safety amongst our residents and staff.
2019
· Reduction of Alarms: Assisted with identifying and implementing the process for the (4 P's: potty, position, personal belongings, and pain) in becoming a restraint free facility while improving the quality and safety outcomes of the residents in facility.
2018
· Pain Quality Improvement: Identified a pain tool that assisted the MDS team with improved pain assessment outcomes, directly impacting pain scores and facilities quality measure for pain.
References
References available upon request.
Timeline
Utilization Review Nurse
McLaren Port Huron
10.2024 - Current
Critical Care Staff RN
SELECT SPECIALITY HOSPITAL
08.2022 - 09.2025
Hospice RN
Residential Home Health and Hospice
06.2022 - 08.2022
Medical Surgical Staff RN
LAKE HURON MEDICAL CENTER
09.2021 - 06.2022
RN Case Manager
Marwood Nursing And Rehab
01.2015 - 09.2021
Nursing House Supervisor
Marwood Nursing And Rehab
01.2014 - 01.2015
BACHELOR OF SCIENCE - Nursing
Chamberlain University
ASSOCIATE OF APPLIED SCIENCE - Nursing
Saint Clair County Community College
Diploma - LPN
Saint Clair County Community College