Shanika Darvin
Lebanon,TN
Summary
Skilled utilization review nurse offering talents in continuous assessments and clinical records oversight. Pleasant individual with several years in the nursing field. Ready to join new company that appreciates attention to detail and exemplary clinical review skills.
Overview
9
9
years of professional experience
1
1
Certification
Work History
Hemodialysis Nurse
Fresenius Medical Care NA
Smyrna, TN
04.2024 - Current
- Assisted with setting up dialysis machines, preparing solutions for hemodialysis treatments and ensuring proper functioning of equipment.
- Provided direct patient care in the dialysis unit, including pre and post-treatment evaluation of patients.
- Performed assessments of patients prior to initiating dialysis treatments, monitoring vital signs during treatment and providing necessary interventions to maintain patient safety.
- Administered medications as ordered by the physician according to hospital policy and procedure guidelines.
- Monitored fluid balance of patients during hemodialysis treatments to ensure safe removal or replacement of fluids as prescribed by physician orders.
- Assessed patient conditions, monitored behaviors and updated supervising physicians with observations and concerns.
- Evaluated effectiveness of treatments given throughout each session using established criteria.
- Reported any abnormal findings or changes in condition immediately to attending physicians or charge nurses.
- Collaborated with physicians, nurses and other healthcare professionals to develop individualized plans of care for each patient.
- Educated patients on their disease process, diet restrictions and lifestyle changes needed to manage chronic kidney disease.
- Maintained accurate records of all treatments provided including medications administered, laboratory values obtained and any adverse reactions experienced by the patient.
- Conducted weekly quality assurance checks on dialysis machines and other equipment used in the dialysis unit.
- Ensured compliance with all applicable laws, regulations and standards related to hemodialysis nursing practice.
UR Review Nurse (Contract)
Green Key Resources
Cary, NC
04.2023 - 07.2024
- Assessed patient medical records to determine the appropriateness of requested services and procedures.
- Conducted reviews of inpatient utilization for compliance with admission criteria and concurrent review requirements.
- 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.
- Monitored pre-authorization requests to ensure that all necessary information was received prior to approval or denial of services.
- Participated in provider meetings to discuss cases involving complex medical conditions or difficult authorization decisions.
- Determined medical necessity and cost-effectiveness of services through utilization review processes.
- Referred cases to secondary review for failure to meet criteria.
Psychiatric Registered Nurse (Contract)
TrustPoint Hospital
Murfreesboro, TN
08.2023 - 02.2024
- Provided comprehensive care to patients suffering from mental health issues.
- Performed physical and mental assessments of psychiatric patients.
- Monitored patient progress and adjusted treatments as needed.
- Educated families on the diagnosis, management, and prevention of mental illness.
- Administered medications according to physician orders.
- Conducted psychosocial assessments to determine appropriate interventions.
- Assisted with crisis intervention when needed.
- Assessed patient conditions, monitored behaviors and updated supervising physicians with observations and concerns.
- Advised family members on available community resources that can help them manage their loved one's condition.
- Coached clients on healthy coping skills such as relaxation techniques or stress management strategies.
Senior Nurse Case Management Analyst
Cigna Medicare
Nashville, TN
07.2019 - 05.2023
- Responsible for the effective and sufficient support of all Utilization Management activities, including the review of inpatient and outpatient medical services for medical necessity and appropriateness of setting, according to established policies and compliance guidelines.
- Uses an established set of criteria to evaluate and authorize the medical necessity of services.
- Collaborated with physicians, case managers and other healthcare providers to ensure quality patient outcomes.
- Provide notification of decisions in accordance with compliance guidelines.
- Coordinate with Medical Directors when services do not meet criteria or require additional review.
- Evaluated the effectiveness of treatments and interventions, making modifications as needed.
- Maintained accurate records of patient assessments, treatments and interventions in electronic health record system.
- Facilitated effective communication between interdisciplinary team members by attending regular meetings.
- Collaborated with doctors to plan post-treatment home care and prevent return hospitalization.
- Collaborated with health groups to plan or implement programs designed to improve overall health of communities.
- Meet or exceed department Turn Around time, daily established productivity goals, and service levels.
- Proficient knowledge of policies and procedures, Medicare, HIPAA, and NCQA standards.
Adolescent Nurse
TriStar Skyline Behavioral Health
Nashville, TN
01.2018 - 07.2019
- Provide direct patient care as prescribed by physician and treatment team, ensuring environmental safety and crisis management for the patient population.
- Assessed and monitored patient health conditions, including vital signs such as temperature, pulse rate and blood pressure.
- Administered medications and treatments in accordance with physician orders.
- Collaborated with other healthcare professionals to develop individualized plans of care for each patient.
- Ensured that all documentation was accurate and up-to-date according to established guidelines.
- Maintained a safe environment for both staff and patients through adherence to safety protocols.
- Managed multiple tasks simultaneously while prioritizing urgent requests from physicians or nurses.
Lentz School Health Nurse
Metro Public Health Department
Nashville, TN
09.2016 - 12.2017
- Assess students for illness, develop Individual Health Plans, and provide skilled nursing services as ordered by medical providers.
- Evaluates the health needs in assigned schools and provides effective skilled nursing services.
- Provided health assessments, screenings and referrals for students.
- Assessed student health needs and identified areas of concern.
- Provided individual counseling to students regarding physical or mental health issues.
- Collaborated with other school staff members to promote a healthy environment for learning.
- Conducted classroom health education lessons on topics such as nutrition, hygiene, substance abuse prevention, growth and development.
- Educated parents on the importance of vaccination schedules and provided resources for obtaining vaccinations.
- Provided direct health care services to students involving triage, evaluation, and first aid care for illness and injury.
Med/Surg Unit Nurse
Nashville General Hospital at Meharry
Nashville, TN
08.2015 - 10.2016
- Assessing, implementing, and evaluating care for various patients within the facility.
- Performed assessments and developed individualized care plans for patients.
- Provided direct patient care in accordance with the established standards of practice, policies, procedures and protocols.
- Administered medications and treatments as prescribed by physician orders.
- Educated patients and families on disease processes, treatment plans, self-care techniques and discharge planning needs.
- Maintained accurate documentation in electronic medical records system according to agency guidelines.
- Evaluated effectiveness of nursing interventions through ongoing assessment of patient responses.
- Collaborated with multidisciplinary team members to ensure quality patient outcomes.
- Coordinated care with physicians and other clinical staff to prepare for treatment, carry out interventions and enhance continuum of care.
- Developed and implemented discharge plans for patients returning home or transitioning to a different level of care facility.
Education
Bachelor of Science in Nursing -
Austin Peay State University School of Nursing
Clarksville, TN05.2015
High School Diploma -
Stratford High School
Nashville, TN05-2002
Skills
- Patient transfers and transitions
- Case Management
- Chronic Disease Management
- Nutritional counseling
- Care Coordination
- Direct Patient Care
- Patient Care Plans
- Records analysis
- Discharge Planning
- Inpatient Care
- Outpatient Care
- Utilization review
- Insurance Verification
- HIPAA Compliance
- Utilization Management
Personal Information
Title: RN, BSN
Certification
CPR/BLS
References
References available upon request.
Timeline
Hemodialysis Nurse
Fresenius Medical Care NA
04.2024 - Current
Psychiatric Registered Nurse (Contract)
TrustPoint Hospital
08.2023 - 02.2024
UR Review Nurse (Contract)
Green Key Resources
04.2023 - 07.2024
Senior Nurse Case Management Analyst
Cigna Medicare
07.2019 - 05.2023
Adolescent Nurse
TriStar Skyline Behavioral Health
01.2018 - 07.2019
Lentz School Health Nurse
Metro Public Health Department
09.2016 - 12.2017
Med/Surg Unit Nurse
Nashville General Hospital at Meharry
08.2015 - 10.2016
Bachelor of Science in Nursing -
Austin Peay State University School of Nursing
High School Diploma -
Stratford High School