Shannon Clark
McKinney,TX
Summary
Highly-motivated employee with desire to take on new challenges. Strong work ethic, adaptability, and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills. Looking for a position that offers career growth and opportunities for advancement. Committed to continuous learning and staying current with industry trends to contribute to organizational success.
Overview
14
14
years of professional experience
1
1
Certification
Work History
Medical Reviewer
Mitchell Martin Agency/HCSC
09.2024 - Current
- Assessed medical information to identify the appropriateness of services rendered and determine if claims were medically necessary.
- Performed retrospective reviews of medical records, insurance policies, and other relevant documentation.
- Evaluated clinical documentation for accuracy and completeness in order to make decisions about coverage determinations.
- Referred cases to secondary review for failure to meet criteria.
- Reviewed and updated utilization review criteria and guidelines to reflect current standards of practice.
Case Manager/UM Review Nurse
90 Degree Benefits
Katy, TX
07.2023 - 10.2024
- Assessed clients' needs, developed service plans and monitored progress towards goals.
- Facilitated communication between clients, families, caregivers, social services and other agencies to ensure client needs were met.
- Maintained accurate case records and documentation according to agency guidelines.
- Counseled clients on available resources within the community that could help meet their needs.
- Monitored client progress through regular follow-up contacts.
- Monitored pre-authorization requests to ensure that all necessary information was received prior to approval or denial of services.
Benefit Review Nurse
Imagine360/GPA
Dallas, TX
07.2019 - 10.2023
- Evaluated clinical documentation for accuracy and completeness in order to make decisions about coverage determinations.
- Applied medical criteria and clinical judgement to researched cases to evaluate and establish determinations.
- Performed pre-certification, concurrent, and retrospective reviews of inpatient and outpatient services, along with high-dollar medication reviews.
- Utilized evidence-based guidelines to support utilization review decisions and recommendations.
- Collaborated with other healthcare professionals to develop individualized plans of care for each patient.
Radiation Oncology Nurse
Texas Oncology Cancer Center
McKinney, TX
02.2011 - 10.2019
- Assisted Radiation Oncologist with patient care, including assessments and treatments.
- Provided emotional support to patients and families throughout the radiation oncology process.
- Educated patients regarding their treatment plans and side effects of therapy.
- Evaluated effectiveness of interventions used for symptom management.
- Coordinated with healthcare team to establish, enact and evaluate patient care plans.
Registered Nurse
Texas Health Presbyterian Hospital
Plano, TX
05.2017 - 06.2019
- Assessed, planned, implemented and evaluated nursing care for assigned patients.
- Administered medications and treatments according to physician orders.
- Collaborated with physicians, nurses, therapists, social workers and other healthcare professionals to develop individualized treatment plans for each patient.
- Utilized critical thinking skills to assess clinical situations quickly and accurately.
- Maintained thorough, accurate and confidential documentation in electronic medical records.
Education
Bachelor of Science - Clinical Laboratory Science
University of Louisiana At Monroe
Monroe, LA12-2011
Bachelor of Science - Nursing
Grambling State University
Grambling, LA05-2008
Skills
- Verbal and written communication
- Problem-solving abilities
- Charting and clinical documentation
- Attention to detail
- Maintain patient confidentiality
- Organizational skills
- Analytical skills
- Team collaboration
Certification
- Texas Registered Nurse Compact License
- California Registered Nurse License
Timeline
Medical Reviewer
Mitchell Martin Agency/HCSC
09.2024 - Current
Case Manager/UM Review Nurse
90 Degree Benefits
07.2023 - 10.2024
Benefit Review Nurse
Imagine360/GPA
07.2019 - 10.2023
Registered Nurse
Texas Health Presbyterian Hospital
05.2017 - 06.2019
Radiation Oncology Nurse
Texas Oncology Cancer Center
02.2011 - 10.2019
- Texas Registered Nurse Compact License
- California Registered Nurse License
Bachelor of Science - Clinical Laboratory Science
University of Louisiana At Monroe
Bachelor of Science - Nursing
Grambling State University
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