Sheba Washington
Katy,TX
Summary
Detail-oriented BSN Registered Nurse with progressive clinical and administrative expertise, specializing in utilization management, medical necessity reviews, and patient advocacy. Proven ability to interpret and apply coverage guidelines, collaborate with interdisciplinary teams, and deliver high-quality clinical evaluations in remote and fast-paced settings. Proficient in EMR documentation, medical coding, and care coordination processes.
Overview
2026
2026
years of professional experience
Work History
RN Coordinator
Kelsey-Seybold Clinic
07.2016 - Current
- Collaborate with physicians, case managers, and administrative staff to streamline care plans and optimize resource utilization.
- Supervise daily clinical operations in a high-volume outpatient setting, ensuring adherence to patient care standards and regulatory compliance.
- Process insurance prior authorizations and collaborate with payers for determinations and escalations.
- Manage telephone triage and medical documentation using EPIC; provide direct and telehealth care.
- Oversee inventory, clinical supplies, and vaccination programs for pediatric, OBGYN, and adult patients.
- Work independently in emergency telehealth response and ensure continuity of care during closures.
- Mentor/Precept new nursing staff, contributing to a supportive work environment and improved retention rates.
- Conduct chart audits and quality assurance reviews to evaluate documentation accuracy and care appropriateness.
RN (Hybrid)
Starr Comprehensive Solutions
06.2010 - 07.2016
- Conducted comprehensive utilization reviews and clinical audits for workers’ compensation cases.
- Assessed level of care appropriateness and claim accuracy based on CPT/ICD guidelines.
- Advised on appeals and determinations in collaboration with physicians and medical directors.
- Delivered detailed documentation for internal and regulatory audits.
RN Team Lead
UT Physicians – Cinco Ranch Pediatrics
04.2015 - 02.2016
- Managed immunization schedules, including VFC program coordination.
- Directed staff workflow and ensured compliance with insurance and clinical policies.
- Oversaw medical documentation and referrals using Allscripts and GE Centricity systems.
Labor & Delivery/Postpartum RN
West Houston Medical Center
- Additional Clinical Experience
Pediatric RN
Memorial Hospital
- Additional Clinical Experience
Education
Bachelor of Science - Nursing
Western Governors University
Salt Lake City, UT06-2024
Associate of Science - Nursing
Angelina College
Lufkin, TX05-1996
Skills
- Clinical judgment * Compassion and empathy * Discharge planning * Utilization Review Prior Authorization Medical Necessity Determination Appeals & Denials Management CPT/ICD Coding Workers’ Compensation Case Review Remote Healthcare Delivery Telephonic Triage EMRs: EPIC, Allscripts, Meditech Managed Care Knowledge Discharge Planning Insurance Policy Interpretation Pediatric, OBGYN, Adult Patient Vital Signs EKG Referrals Fetal Monitoring Medication and Vaccine Administration Utilization Review Prior Authorization Medical Necessity Determination Appeals & Denials Management CPT/ICD Coding Workers’ Compensation Case Review Remote Healthcare Delivery Telephonic Triage EMRs: EPIC, Allscripts, Meditech Managed Care Knowledge Discharge Planning Insurance Policy Interpretation Pediatric, OBGYN, Adult Patient Vital Signs EKG Referrals Fetal Monitoring Medication and Vaccine Administration
Timeline
RN Coordinator
Kelsey-Seybold Clinic
07.2016 - Current
RN Team Lead
UT Physicians – Cinco Ranch Pediatrics
04.2015 - 02.2016
RN (Hybrid)
Starr Comprehensive Solutions
06.2010 - 07.2016
Labor & Delivery/Postpartum RN
West Houston Medical Center
Pediatric RN
Memorial Hospital
Bachelor of Science - Nursing
Western Governors University
Associate of Science - Nursing
Angelina College
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