Shannon Phillip
Lizella,GA
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. Self-motivated professional promoting attention to detail and the drive to resolve issues effectively. Calm and poised in the most stressful environments. Seeking the opportunity to join new organization in the role of Utilization Review Nurse. Energetic individual offering several years' experience in reviewing compliance standards and auditing charts. Astute utilization review nurse knowledgeable in medical data gathering, analysis and authorization obtainment. Highly adaptable Utilization Review Nurse dedicated to providing exceptional skills in the hospital case environment. Smart and bilingual with developed interpersonal and time management skills. Seeking challenging role in setting devoted to quality patient care. Experienced nursing professional bringing demonstrated clinical expertise, leadership skills and technical knowledge. Proficient in updating charts, monitoring medications and working with multidisciplinary teams to optimize patient care. Quality-driven and efficient with strong interpersonal abilities. Dedicated and well-qualified RN offering proven skills in patient care, medication administration and treatment implementation. Detail-oriented, responsive, and proficient in routine care and emergency response. Brings multi-year record in field.
Overview
33
33
years of professional experience
1
1
Certification
Work History
Senior Utilization Review Nurse
Centene
Atlanta, GA
11.2013 - Current
- 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.
- Analyzed data from patient surveys, interviews and other sources to assess healthcare service quality.
- Provided education to providers regarding utilization management processes and protocols.
- Collaborated with multidisciplinary teams on developing strategies for improving care quality and controlling costs.
- Evaluated clinical documentation for accuracy and completeness in order to make decisions about coverage determinations.
Lead Registered Nurse, Case Manager, L&D Nurse
Atrium Healthcare
Macon, GA
04.1992 - 11.2013
- Provided direct patient care and assessment, developed individualized plans of care, and coordinated with multidisciplinary team members.
- Monitored staff productivity and quality of care; identified opportunities for improvement and implemented corrective action when necessary.
- Maintained accurate documentation of patient's medical records according to established standards.
- Coordinated communication between physicians, other healthcare providers, patients and families regarding diagnosis, treatment plans and prognosis.
- Delegated tasks to appropriate personnel based on their experience level and competency requirements.
- Collaborated with other departments within the facility on various projects related to improving services provided to patients.
- Assessed and monitored patient health conditions, including vital signs such as temperature, pulse rate and blood pressure.
- Provided nursing care for patients with various medical diagnoses and treatments.
- Administered medications and treatments in accordance with physician orders.
- Collaborated with other healthcare professionals to develop individualized plans of care for each patient.
- Educated patients on their medical condition, treatment plans, and self-care management techniques.
- Ensured that all documentation was accurate and up-to-date according to established guidelines.
- Performed physical assessments to identify any changes in the patient's condition or needs.
- Supported families during times of illness or injury by providing emotional support and assistance with decision making processes.
- 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.
- Participated in quality improvement initiatives in order to improve patient outcomes.
- Provided guidance to new employees regarding policies and procedures within the organization.
- Facilitated communication between members of the healthcare team by attending interdisciplinary meetings.
Education
Bachelor of Science - Nursing
Georgia College And State University
Milledgeville, GA05-1998
Associate of Science - Nursing
Georgia Southwestern State University
Americus, GA05-1995
Bachelor of Science - Psychology
Georgia Southwestern State University
Americus, GA05-1994
Skills
- Patient Care Plans
- Compliance procedures
- Outpatient Care
- Communication
- Medicare knowledge
- Needs Assessment
- Discharge Planning
- Utilization Management
- Performing assessments
- Documentation And Reporting
- Healthcare regulations
- Interpersonal and written communication
- Discharge planning coordination
- Medicaid knowledge
Certification
- Certified Case Manager
Accomplishments
- Maintain TAT at 100
- Exceeds productivity-( complete 15-20 reviews per day)
- Promoted to Senior Review Nurse
- Trainer of new staff
Timeline
Senior Utilization Review Nurse
Centene
11.2013 - Current
Lead Registered Nurse, Case Manager, L&D Nurse
Atrium Healthcare
04.1992 - 11.2013
- Certified Case Manager
Bachelor of Science - Nursing
Georgia College And State University
Associate of Science - Nursing
Georgia Southwestern State University
Bachelor of Science - Psychology
Georgia Southwestern State University
Similar Profiles
Delisa HendersonDelisa Henderson
Customer Support Specialist at CenteneCustomer Support Specialist at Centene
Feminique SimmonsFeminique Simmons
Care Coordinator at CenteneCare Coordinator at Centene
Regine NemorinRegine Nemorin
Referral Specialist III at CenteneReferral Specialist III at Centene