Shantrel Ward
Slidell,Louisiana
Summary
Professional nurse with experience in utilization review. Strong focus on team collaboration and achieving results. Reliable and adaptable to changing needs. Skilled in medical record analysis, patient care evaluation, and compliance with healthcare regulations. Known for critical thinking, communication, and problem-solving abilities.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Utilization Review Registered Nurse
United Healthcare – Optum
07.2022 - Current
- Perform initial and ongoing reviews pertaining to primary role (PA, ICM, DCM, PACM), appropriately applying clinical criteria (InterQual, policies, National and Local Coverage Determinations) for approval and sending to Medical Directors if review is necessary for determining an adverse determination.
- Collaborate with Medical Directors, clinical peers, and Health Plan partners on performing appropriate clinical decision making and/or referrals.
- Apply clinical expertise when discussing case with internal and external Case Managers and Physicians
- Follow all Standard Operating Procedures in end-to-end management of cases.
- Participate in team meetings, education discussions and related activities.
- Maintain compliance with Federal, State and accreditation organizations.
Registered Nurse- Administrator and Telehealth Case Management
JMS Caring Services- New Orleans, LA
02.2021 - 08.2024
- Performing and interpreting assessment findings and diagnostic data to ensure quality, individualized care of residents.
- Leading the team in the management of day-to-day operations.
- Promoting a positive and productive work environment.
- Ensuring quality services are provided to each client through person-centered admissions and discharge planning.
- Ensuring evaluation, orientation, and training of all residential care staff.
- Conducting patient assessment education, crisis intervention, counseling, and triage.
- Utilizing care protocols, standards, and guidelines in arriving at decisions.
- Fielding patient questions on topics like medical conditions, medications, and side effects.
- Assessing patient conditions to determine the next steps in evaluation process.
- Conducting patient follow-ups and monitoring patient’s vital signs and any changes in health conditions.
- Partnering with interdisciplinary teams to deliver evidence-based care to all patients.
- Assist patients with scheduling appointments and referring patients to healthcare specialists when applicable.
- Discussing diagnosis with physicians and other health care providers, including providing recommendations for treatments when applicable.
Registered Nurse-Nurse Manager
Ochsner Rehabilitation Hospital- New Orleans, LA
07.2021 - 05.2024
- Directing assigned nursing personnel and serving as a resource.
- Providing and overseeing nursing care, implementing hospital and departmental philosophy and objectives.
- Maintaining approved standards of patient care and collaborating with appropriate interdisciplinary team members to ensure continuity of care.
- Assisting with staff shortages by working additional shifts and accepting patient caseloads.
- Promoting continuous quality improvement. Conducted audits of patients’ charts to ensure compliance.
- Engaged in QAPI meetings to ensure quality services and outcomes were achieved.
- Educating and supervising healthcare personnel to ensure.
- Evaluated patients for post-acute and secondary levels of care.
- Coordinated educational needs, health maintenance, and preventive care visits.
Licensed Practical Nurse- Charge Nurse
Act’s Home Health- Gretna, LA
11.2016 - 03.2020
- Provided care for patients with various diagnoses and co-morbidities.
- Implemented age-specific individualized care and assisted with formulating care plans.
- Participated in continuing education to stay abreast of modern technology and treatment modalities.
- Provided holistic care and support to help patients and families manage disease processes.
- Communicated with the interdisciplinary team to ensure continuity of care.
Licensed Practical Nurse- Medication Nurse
Beacon Behavior Health- Lacombe, LA
09.2017 - 05.2019
- Participated in planning, coordinating, and documenting total patient care.
- Conducted audits of patients’ charts to ensure compliance.
- Engaged in QAPI meetings to ensure quality services and outcomes were achieved.
- Educating and supervising healthcare personnel to ensure.
- Evaluated patients for post-acute and secondary levels of care.
- Coordinated educational needs, health maintenance, and preventive care visits.
Licensed Practical Nurse- Utilization Manager/Case Management & Floor Nurse
Belle Maison- Harahan, LA
09.2016 - 01.2018
- Provided care for patients with various diagnoses and co-morbidities.
- Implemented age-specific individualized care and assisted with formulating care plans.
- Participated in continuing education to stay abreast of modern technology and treatment modalities.
- Provided holistic care and support to help patients and families manage disease processes.
- Performed assessments and monitored patients for significant changes.
Licensed Practical Nurse- Charge Nurse
Guest House- New Orleans, LA
07.2015 - 08.2016
- Audited medical records to determine benefit coverages and appropriate levels of care for home health services.
- Utilized the Home Health Outcome and Assessment Information Set to collect time-sensitive patient information.
- Participated in medical necessity reviews for clinical judgments and determinations of an adequate level of care.
- Collaborated with the interdisciplinary team to coordinate patient-specific care and develop individualized care plans.
- Coordinated daily administrative duties and assignments for clinical and non-clinical team members.
- Maintained quality improvement systems per CMS, JCAHO, and OSHA guidelines.
Education
Master of Science in Nursing - Leadership & Administration
Capella University
Minneapolis, MN08.2023
Bachelor of Science in Nursing - undefined
Herzing University
Metairie, LA04.2022
Associate of Science in Nursing - undefined
Herzing University
Metairie, LA12.2020
Diploma of Practical Nurse - undefined
Nunez Community College
Chalmette, LA12.2007
Skills
- Versatile and adaptable registered nurse with 18 years of managerial and clinical nursing experience, case management experience in various fast-paced healthcare settings and telehealth Proven history of effectively implementing nursing procedures and training to promote safe, patient-centered care while adhering to facility philosophies and objectives
- Clinical assessment
- Quality improvement
- Medical documentation
- Patient confidentiality
- Healthcare regulations
- Policy compliance
- Resource utilization
- HIPAA compliance
- Discharge planning coordination
Certification
- Registered Nurse Expiration- January 2026
- Advanced Cardiovascular Life Support Certification Expiration- December 2026
- Basic Life Support Certification Expiration- November 2026
- Crisis Prevention Institute Certification Expiration – February 2026
Timeline
Utilization Review Registered Nurse
United Healthcare – Optum
07.2022 - Current
Registered Nurse-Nurse Manager
Ochsner Rehabilitation Hospital- New Orleans, LA
07.2021 - 05.2024
Registered Nurse- Administrator and Telehealth Case Management
JMS Caring Services- New Orleans, LA
02.2021 - 08.2024
Licensed Practical Nurse- Medication Nurse
Beacon Behavior Health- Lacombe, LA
09.2017 - 05.2019
Licensed Practical Nurse- Charge Nurse
Act’s Home Health- Gretna, LA
11.2016 - 03.2020
Licensed Practical Nurse- Utilization Manager/Case Management & Floor Nurse
Belle Maison- Harahan, LA
09.2016 - 01.2018
Licensed Practical Nurse- Charge Nurse
Guest House- New Orleans, LA
07.2015 - 08.2016
Master of Science in Nursing - Leadership & Administration
Capella University
Bachelor of Science in Nursing - undefined
Herzing University
Associate of Science in Nursing - undefined
Herzing University
Diploma of Practical Nurse - undefined
Nunez Community College