Summary
Overview
Work History
Education
Skills
Affiliations
Certification
Timeline
Generic

Shea Colwell

Smithville,Tennessee

Summary

Dedicated healthcare professional with expertise in nursing and appeals management. Skilled in fostering interdisciplinary collaboration and ensuring accurate documentation. Committed to improving patient care quality through effective communication and attention to detail.

Overview

7
7
years of professional experience
1
1
Certification

Work History

Appeals Analyst

Cigna Healthcare
Nashville, TN
11.2024 - Current
  • Analyzed and evaluated appeals for compliance with relevant laws and regulations.
  • Reviewed documents for accuracy before processing appeals.
  • Managed denials by coordinating follow-ups with relevant parties.
  • Reviewed provider dispute appeals and collaborated with Medical Director for final decisions.

Registered Nurse, Same Day Surgery

Ascension Saint Thomas Riverpark Hospital
McMinnville, Tennessee
08.2023 - 11.2024
  • Performed pre-operative, intra-operative, and post-operative assessments for all surgical cases.
  • Administered medications prescribed by physicians in accordance with established policies and procedures.
  • Documented medication administration accurately per policy and procedure guidelines.
  • Provided direct nursing care to same day surgery patients according to established standards of practice.
  • Evaluated patient responses to treatments and interventions; identified adverse reactions and outcomes promptly.
  • Coordinated discharge planning activities to ensure safe transition of care from hospital to home environment.
  • Communicated effectively with staff, physicians, and other healthcare providers regarding patient status changes or concerns.
  • Cared for same day surgery patients before and after their procedures.

MDS Coordinator

NHC Healthcare, Smithville
Smithville, Tennessee
09.2020 - 03.2024
  • Provided training and education to nursing staff on current MDS regulations.
  • Collaborated with interdisciplinary teams to develop comprehensive care plans.
  • Prepared annual reviews of all residents' medical records according to federal guidelines.
  • Assisted in identifying opportunities for improvement in processes related to the completion of the MDS form.
  • Interpreted physician orders for accuracy and completeness prior to submitting them electronically into the MDS system.
  • Participated in survey preparation activities by ensuring that all necessary documents were available during surveys conducted by state agencies or accreditation organizations.
  • Conducted assessments to determine the resident's functional and cognitive abilities, as well as their level of care needs.
  • Ensured that changes made to an existing plan of care corresponded with appropriate changes made on the corresponding MDS form.
  • Analyzed trends in data collected through the Minimum Data Set.
  • Monitored residents' progress and updated MDS records accordingly.
  • Reviewed clinical documentation to ensure accuracy of information reported on the MDS forms.
  • Tailored data management plans to specific projects to effectively reach deadlines.
  • Verified quality of assessments in accurately reflecting physical, mental and psychosocial status of each resident.

Utilization Review Nurse

Saint Thomas Hospital
Smithville, Tennessee
01.2019 - 09.2020
  • Collaborated with multidisciplinary teams on developing strategies for improving care quality and controlling costs.
  • Assessed patient medical records to determine the appropriateness of requested services and procedures.
  • Served as a resource for staff members seeking guidance on utilization review matters.
  • Conducted reviews of inpatient utilization for compliance with admission criteria and concurrent review requirements.
  • Evaluated clinical documentation for accuracy and completeness in order to make decisions about coverage determinations.
  • Participated in provider meetings to discuss cases involving complex medical conditions or difficult authorization decisions.
  • Referred cases to secondary review for failure to meet criteria.

Education

Nursing

Motlow State Community College
Tullahoma, TN
05-2009

Associate of Science - Respiratory Therapy

California College of Health Sciences
National City, CA
11-1999

High School Diploma -

Dekalb County High School
Smithville
05-1993

Skills

  • Compliance analysis
  • Appeal management
  • Medical documentation
  • Data interpretation
  • Regulatory knowledge
  • Quality assurance
  • Clinical assessment
  • Problem solving
  • Effective communication

Affiliations

  • Enjoy spending time with family and friends.
  • Traveling

Certification

  • Registered Nurse
  • Certified Respiratory Therapist

Timeline

Appeals Analyst

Cigna Healthcare
11.2024 - Current

Registered Nurse, Same Day Surgery

Ascension Saint Thomas Riverpark Hospital
08.2023 - 11.2024

MDS Coordinator

NHC Healthcare, Smithville
09.2020 - 03.2024

Utilization Review Nurse

Saint Thomas Hospital
01.2019 - 09.2020

Nursing

Motlow State Community College

Associate of Science - Respiratory Therapy

California College of Health Sciences

High School Diploma -

Dekalb County High School

Similar Profiles

CREATE PROFILE
Shea Colwell
Want your own profile? Build for free at Resume-Now.com