Shannon Maxwell
Olney,MD
Summary
Experienced and dedicated RN with a strong background in case management, pediatrics, triage, med/surg, orthopedics, neurosurgery, utilization management, and home hospice care. Excellent critical thinking and communication skills. Compassionate and driven professional providing exceptional care to a diverse patient population.
Overview
20
20
years of professional experience
1
1
Certification
Work History
Case Manager/Utilization Review RN
MedStar Montgomery Medical Center
05.2025 - Current
- Performs concurrent, and retrospective medical record reviews based on approved screening criteria, knowledge of insurance coverage, and communication with the third-party payers.
- Ensures medical necessity determinations, service authorization and concurrent denials are managed effectively and financially responsibly.
- Evaluates concurrent and retrospective denials for appeal opportunities. May generate appeal letters based on knowledge of clinical severity and intensity.
- Identifies insurance information, obtains authorization, communicates with financial counseling and assigns appropriate length of stay for admission.
- Implements strategies to avoid denials including potential denial notification to attending physician. Issues letter of non-coverage for Medicare or third party payers according to policies and procedures. Communicates utilization plans to case management team.
- Performs admission reviews and subsequent concurrent reviews to determine the necessity for acute care by application of accepted criteria based on age specific needs. Interacts with and assists third party payer reviewers to facilitate appropriate care and ensure payment for services.
- Coordinates services for discharge planning to include home needs, rehab, or long term care.
- Participates in longer length of stay meetings, presenting on patients, and identifying barriers to discharge.
- Identifies possible discharge needs while inpatient to facilitate a safe and timely discharge.
UTILIZATION Review RN
CARESOURCE
05.2021 - 04.2025
- Provided prospective, retrospective and concurrent review of inpatient admissions.
- Coordinated care and facilitated discharge to an appropriate level of care in a timely and cost-effective manner.
- Identified and referred quality issues to Quality Improvement.
- Documented, identified, and communicated with Health Partners, Care Managers and Discharge Planners to establish safe discharge planning needs and coordination of care.
- Provided guidance to non-clinical medical management staff.
- Oriented new hires to the UR team.
- Participated in longer length of stay meetings and collaborated on discharge barrier reductions.
- Managed care from admission to discharge.
Triage/Pediatric Registered Nurse
Montgomery Hospice
09.2012 - 03.2021
- Provided symptom management and emotional support to patients and families.
- Documented patient information, nursing actions performed, and patient response to care in a timely and appropriate manner.
- Responsible for formulating and implementing nursing plan of care consistent with standards of practice.
- Specialized in Pediatric and Adult end of life care.
- Provided assessments as well as educational and evaluative services to meet the needs of terminally ill patients and their families and caregivers.
- Responded to telephone requests for assistance by addressing the request over the telephone or by scheduling an in-home visit.
- Managed team of in-home visit nurses.
- Utilized Suncoast and Wellsky documentation systems.
- Strong leader for nursing personnel assigned to the shift.
- Provided on-call care at all times of day and night.
Registered Staff Nurse, Medical-Surgical
MD General Hospital
12.2009 - 04.2010
- Performed documentation of patient information, nursing actions performed, and patient response to care in a timely and appropriate manner.
- Delegated tasks appropriately.
- Prepared patients for surgical and radiological procedures and provided post-op care.
- Administered medication; assisted during examinations and procedures.
- Specialized in Telemetry.
- Utilized Meditech documentation system.
- Admitted patients to unit.
- Participated in daily discharge planning meetings.
- Developed patient care plans, including assessments, evaluations and nursing diagnoses.
- Assessed need for, ordered, obtained and interpreted appropriate lab tests.
- Strong leader for nursing personnel assigned to the unit/shift.
- Pharmacological and non-pharmacological management and treatment of various disorders and diseases.
- Effective counseling in health maintenance and disease management.
Registered Staff Nurse, Medical-Surgical
Calvert Memorial Hospital
01.2009 - 12.2009
- Implemented total patient care through a team nursing process covering 5-6 high acuity patients per shift.
- Initiated and carried out nursing care plan.
- Acted as patient advocate; assessed patient status and notified physician of clinical changes in a timely manner.
- Provided assistance to, delegated to, and educated CNA's.
- Specialized in the care of Orthopedic and Neurological surgical patients as well as Pediatric patients.
- Performed total patient assessments.
- Initiated and maintained IV therapy.
- Utilized Meditech documentation system.
- Chronic patient care in med-surg unit, adeptly handling all aspects of treatment from medication to wound care.
- Participated in unit-based Quality Assurance Program.
LPN then registered nurse
Bayside care center
09.2007 - 11.2009
- Responsible for the care of 40+ geriatric or debilitated patients to include dispensing of medications, monitoring of vital signs, IV therapy, O2 therapy, wound care, tracheostomy care, nasopharyngeal and oral suctioning, insertion and care of indwelling urethral catheters, and gastrointestinal tubes.
- Documented patient information, nursing actions performed, and patient response to care in a timely and appropriate manner.
- Assessed patients and reported clinical changes to physician.
- Supervised team of GNA's and delegated tasks in accordance with their job description and scope of practice.
- Educated patients and family members on ADL's, end of life care, medication, etc.
- Performed paper charting.
CNA
Calvert Memorial Hospital
09.2005 - 09.2007
- Performed direct patient care to include, but not limited to: assisting with ADL's, phlebotomy, urethral catheterization, basic dressing changes and wound care, etc.
- Reported any changes of condition to RN in a timely appropriate manner.
- Documented pertinent information accurately and in a timely manner.
Education
Associate of Science - Nursing
College of Southern Md
01.2008
Master of Science - education specialty
Walden University
Minneapolis, MN02.2020
Skills
- Strategic decision-making
- Patient and family advocacy
- Precepting
- Strong clinical judgment
- Self-directed with astute judgment skills
- Community health
- Health promotion
- Culturally-sensitive care
- Nursing staff leadership
- At-risk patient care
- Coordinating referrals
- Case management
- Strong medical ethic
- Utilization review
Certification
- RN, R184967, 2025-08-01
- CHPN
- MCG Certified
Activities
- ELNEC Pediatric Train the Trainer Course
- Children’s ministry leader
- Elementary and Middle school volunteer
- PTA President
Timeline
Case Manager/Utilization Review RN
MedStar Montgomery Medical Center
05.2025 - Current
UTILIZATION Review RN
CARESOURCE
05.2021 - 04.2025
Triage/Pediatric Registered Nurse
Montgomery Hospice
09.2012 - 03.2021
Registered Staff Nurse, Medical-Surgical
MD General Hospital
12.2009 - 04.2010
Registered Staff Nurse, Medical-Surgical
Calvert Memorial Hospital
01.2009 - 12.2009
LPN then registered nurse
Bayside care center
09.2007 - 11.2009
CNA
Calvert Memorial Hospital
09.2005 - 09.2007
Associate of Science - Nursing
College of Southern Md
Master of Science - education specialty
Walden University
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