Summary
Overview
Work History
Education
Skills
Certification
References
Timeline
Generic

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, TN
12-2015

Associate of Science - Registered Nurse

Roane State Community College
Harriman, TN
05-2013

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

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Shana Duncan