Shannon Congdon
Flushing,MI
Summary
Dynamic Utilization Review Registered Nurse with extensive experience at Blue Cross and Blue Shield, skilled in critical care and clinical assessment. Proven track record in enhancing patient outcomes through effective communication and quality improvement initiatives. Committed to continuous education and compliance with healthcare regulations, ensuring optimal care delivery and patient satisfaction.
Overview
5
5
years of professional experience
Work History
Utilization Review Registered Nurse
Blue Cross and Blue Shield
05.2018 - 07.2018
- Utilized critical thinking skills to prioritize nursing interventions based on patients'' acuity levels and individual needs.
- Assisted in the training and mentorship of new nursing staff members, contributing to a positive work environment and high-quality patient care
- Assisted in maintaining regulatory compliance by staying up-to-date on Medicare, Medicaid, and commercial insurance requirements for utilization review activities.
- Increased staff knowledge and competency with continuous professional development opportunities related to evolving industry standards and trends in the field of medical necessity evaluations.
- Participated in performance improvement projects aimed at streamlining processes related to utilization review and case management activities.
- Established strong working relationships with insurance representatives, fostering open communication channels for efficient resolution of coverage issues or disputes related to medical necessity determinations.
- Served as a liaison between healthcare providers, insurance companies, and patients for efficient resolution of coverage issues or denials following a utilization review assessment.
Registered Nurse Intensive Care Float
Genesys
08.2017 - 05.2018
- Utilized critical thinking skills to prioritize nursing interventions based on patients'' acuity levels and individual needs.
- Conducted thorough patient assessments to identify changes in condition, promptly notifying physicians and initiating appropriate interventions when necessary.
- Administered medications safely according to established guidelines while closely monitoring for side effects or adverse reactions requiring intervention.
- Enhanced patient satisfaction by providing compassionate, holistic nursing care that addressed physical, emotional, and spiritual needs.
PACU Registered Nurse
Hurley Medical Center
10.2015 - 08.2017
- Enhanced patient safety by diligently monitoring vital signs and administering medications postsurgery.
- Reduced recovery times through effective pain management and close collaboration with the surgical team.
- Maintained accurate records of medication administration, vital signs monitoring, and other critical data points for proper evaluation of patients'' progress during recovery.
- Mentored new PACU nurses, sharing best practices for efficient patient turnover and discharge processes.
- Supported successful implementation of newly adopted protocols within the PACU department through active involvement in training sessions and policy updates.
- Assisted in maintaining a clean and organized work environment, adhering to infection control standards for optimal patient health.
- Participated in continuing education opportunities to stay current with advancements in nursing practices and trends within the PACU specialty area.
- Increased patient comfort during recovery by addressing anxiety and concerns about surgery results.
- Provided emotional support to patients during their postoperative experience, creating a positive atmosphere that facilitated smooth recoveries.
- Managed challenging cases effectively by utilizing clinical judgment, problem-solving skills, and prioritization techniques in dynamic situations.
- Collaborated with interdisciplinary teams to develop individualized care plans, optimizing patient outcomes.
- Evaluated patients' pain levels, implementing correct dosage of medication to alleviate discomfort.
- Documented treatments delivered, medications and IVs administered, discharge instructions, and follow-up care.
- Monitored patient reactions after administering medications and IV therapies.
- Managed patients recovering from medical or surgical procedures.
- Provided skilled, timely and level-headed emergency response to critically-ill patients.
- Communicated with healthcare team members to plan, implement and enhance treatment strategies.
- Performed frequent checks on life support equipment and made necessary adjustments to preserve optimal patient conditions.
Registered Nurse, Medical-Surgical Unit
Hurley Medical Center
04.2014 - 10.2015
- Collaborated with interdisciplinary teams for optimal patient care, ensuring seamless communication between healthcare providers.
- Consistently maintained accurate documentation of patient assessments, interventions, and outcomes in accordance with regulatory requirements.
- Skillfully performed venipuncture, IV insertion, and catheterizations, ensuring proper technique and adherence to infection control standards.
- Developed strong rapport with patients and families through active listening, empathy, and clear communication during challenging situations.
- Provided health education to patients and families regarding discharge instructions and plans of care.
- Managed complex wound care, including dressing changes, monitoring for signs of infection, and collaborating with wound care specialists as needed.
- Demonstrated flexibility in managing multiple priorities concurrently during high-stress periods while maintaining a calm demeanor.
- Implemented fall prevention strategies to minimize patient injuries and promote a safe environment within the medical-surgical unit.
- Started intravenous fluids, administered medications, and documented patient charts by recording food and fluid output and intake.
- Mentored new staff members and nursing students, fostering a supportive learning environment within the unit.
- Performed emergency medical procedures such as BLS, ACLS and other condition stabilizing interventions.
- Monitored patient vital signs to perform thorough condition assessments.
Home Health Registered Nurse
First Health
08.2013 - 04.2014
- Educated patients and families on disease management, prevention strategies, and self-care techniques.
- Assessed patient conditions regularly, promptly reporting changes in status to healthcare providers for timely intervention.
- Provided physical assessments, medication, and chronic disease management to home health patients.
- Coordinated with physicians, therapists, social workers, and other healthcare professionals to ensure seamless continuity of care for patients.
- Spinal cord Injury and traumatic brain injury patients.
Education
Associate of Applied Science - Registered Nurse
Charles Stewart Mott Community College
Flint, MI05-2013
Skills
- Patient confidentiality
- Medical documentation
- Clinical assessment
- Quality improvement
- Healthcare regulations
- Policy compliance
- Continuing education
- HIPAA compliance
- Resource utilization
- Discharge planning coordination
- Documentation and reporting
- Records analysis
- Inpatient care
- Interpersonal and written communication
- Insurance verification
- Critical care experience
- Hemodynamic monitoring
- Central line management
- Chest tube management
- Patient assessments
- Direct patient care
- Medication administration
- Medication and IV administration
Timeline
Utilization Review Registered Nurse
Blue Cross and Blue Shield
05.2018 - 07.2018
Registered Nurse Intensive Care Float
Genesys
08.2017 - 05.2018
PACU Registered Nurse
Hurley Medical Center
10.2015 - 08.2017
Registered Nurse, Medical-Surgical Unit
Hurley Medical Center
04.2014 - 10.2015
Home Health Registered Nurse
First Health
08.2013 - 04.2014
Associate of Applied Science - Registered Nurse
Charles Stewart Mott Community College
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