Shana Duncan
Oneida,TN
Summary
Energetic individual offering 7 years' experience in reviewing compliance standards and auditing charts. Astute Utilization Review Nurse knowledgeable in medical data gathering, analysis and authorization obtainment.
Overview
11
11
years of professional experience
1
1
Certification
Work History
RN Staff Nurse
Lake Cumberland Medical Center
Somerset, KY
02.2024 - Current
- Provided direct patient care, including administering medications and treatments according to physician orders.
- Maintained accurate records of patient health information and treatment plans in electronic health record systems.
- Participated in quality improvement initiatives to improve outcomes in the healthcare facility.
Utilization Review Nurse
Humana
Lexington, KY
01.2020 - 04.2024
- Conducted reviews of inpatient utilization for compliance with admission criteria and concurrent review requirements.
- Collaborated with multidisciplinary teams on developing strategies for improving care quality and controlling costs.
- Monitored pre-authorization requests to ensure that all necessary information was received prior to approval or denial of services.
Utilization Review Nurse
Big South Fork Medical Center
Oneida, TN
08.2017 - 01.2020
- Assessed patient medical records to determine the appropriateness of requested services and procedures.
- Provided education to providers regarding utilization management processes and protocols.
- Evaluated clinical documentation for accuracy and completeness in order to make decisions about coverage determinations.
- Generated reports related to utilization management activities such as length of stay trends, denials rates.
RN Staff Nurse
Parkwest Medical Center
Knoxville, TN
10.2014 - 08.2017
- Provided direct patient care, including administering medications and treatments according to physician orders.
- Instructed new nurses on proper techniques for providing patient care.
- Supervised licensed practical nurses, certified nurse assistants and other staff members.
RN Staff Nurse
Turkey Creek Medical Center
Knoxville, TN
06.2013 - 10.2014
- Provided direct patient care, including administering medications and treatments according to physician orders.
- Collaborated with health groups to plan or implement programs designed to improve overall health of communities.
- Achieved departmental goals and objectives by instituting new processes and standards for in-patient care.
Education
Bachelor of Science - Registered Nurse
King University
Bristol, TN12-2015
Associate of Science - Registered Nurse
Roane State Community College
Harriman, TN05-2013
Skills
- Quality Improvement
- Case Management
- Direct Patient Care
- Team training and development
- Excellent Communication
- Healthcare Personnel Supervision
- InterQual Criteria
- Utilization Management
- Insurance Verification
- Medicaid knowledge
- Managed Care
- Prior Authorization
- Discharge Planning
- HIPAA Compliance
Certification
- RN LICENSURE OBTAINED JUNE 2013
References
References available upon request.
Timeline
RN Staff Nurse
Lake Cumberland Medical Center
02.2024 - Current
Utilization Review Nurse
Humana
01.2020 - 04.2024
Utilization Review Nurse
Big South Fork Medical Center
08.2017 - 01.2020
RN Staff Nurse
Parkwest Medical Center
10.2014 - 08.2017
RN Staff Nurse
Turkey Creek Medical Center
06.2013 - 10.2014
Bachelor of Science - Registered Nurse
King University
Associate of Science - Registered Nurse
Roane State Community College
- RN LICENSURE OBTAINED JUNE 2013
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