Summary
Overview
Work History
Education
Skills
Certification
References
Timeline
Generic

Shekinah R. Smiling-Waiters

Florence,SC

Summary

Compassionate Licensed Practical Nurse with experience in delivering patient-focused care and maintaining a safe and efficient healthcare environment. Skilled in monitoring patient conditions, administering medications, and collaborating with healthcare teams to promote patient well-being. Demonstrated ability to improve processes in fast-paced settings, enhancing patient satisfaction and workflow efficiency.

Overview

26
26
years of professional experience
1
1
Certification

Work History

LPN Home Health

Caring for You Staffing
Florence, SC
05.2023 - Current
  • Observe and report changes in the patient’s condition to the physician
  • Maintain accurate and timely medical records and documentation
  • Follow care plans established by the supervising RN
  • Monitor vital signs, including blood pressure, pulse, and temperature
  • Administer prescribed medications and treatments

HEDIS Nurse Abstractor (Remote) LPN

Change Healthcare LLC
Alpharetta, GA
02.2019 - 05.2023
  • Meet and maintain production and quality expectations for all assigned measures in the queue
  • Performed responsibilities with acute attention to detail
  • Transitioned between priorities and abstraction projects based on program or client needs
  • Use independent judgment to complete abstraction and review of medical records following program guidelines
  • Managed and utilized confidential information from medical records appropriately following designated guidelines including HIPAA and company policies/guidelines
  • Applied HEDIS concepts and principles in the completion of the abstraction and review process to ensure full recognition of delivered care for the benefit of the member
  • Knowledge of medical record abstraction, clinical reviews, and regulatory requirements according to NCQA HEDIS Technical Specifications and Change Healthcare guidelines
  • Sound knowledge of ICD diagnosis/procedure codes, CPT, and HCPCS coding guidelines

LPN, Utilization Management (UM) Long-Term Support Services (LTSS)

Monroe Plan Healthcare
Pittsford-Victor, NYC
02.2020 - 09.2021
  • Coordinator and care management of members with lower utilization of home community services (i.e., members attending adult day care services, personal care services, consumer-directed personal services, personal emergency services, or those who are stable on current medication/treatment regimens)
  • Ensured comprehensive assessments were completed within required time frames, and utilized knowledge and expertise to assess options for care, including the use of benefits and community resources
  • Educated on and coordinated community resources emphasizing medical, behavioral, and social services
  • Applies care management standards and maintains HIPAA standards and confidentiality of protected health information
  • Assisted in the development of policies and procedures according to NYS Medicaid Medical Necessity Standards, Coverage Criteria & MCG Guidelines
  • Served as the first level contact for provider, member, and staff inquiries on the LTSS benefits
  • Obtained and processed clinical information from members and providers as needed
  • Documented all utilization review activity within required standards
  • Provided care coordination for members with immediate and/or long-term medical and/or behavioral health care needs, and made referrals to prevention programs and case management services
  • Performed special projects as assigned

Grievances and Denials Nurse (Grier Letter Team) LPN

Care Core National LLC
Bluffton, SC
09.2017 - 07.2018
  • Work Denial letters for BCBST Medicaid
  • Check denial for accuracy and format and make changes if necessary
  • Reviewed letter to determine that all appropriate templates and prongs have been inserted and done correctly
  • Delegated tasks to other clinical reviewers according to their specialty to get cases processed promptly

Clinical Appeal Reviewer (Remote) LPN

Care Core National LLC
Bluffton, SC
07.2015 - 09.2017
  • Knowledge of policies and procedures of clinical certification and medical review
  • Reviewed all requests for appeals
  • Gathered all pertinent clinical information (Restart, Reconsideration, 1st, or 2nd Level Appeal Review)
  • When complete information is available and fully documented, notify the referrer of approval, or if the study does not meet the criteria, document the reasons, and forward the request to the appropriate Physician Reviewer for final review
  • Documented and reported medical review activities to the Medical Director and/or appropriate Committees

Clinical Reviewer Utilization Management (Remote) LPN

Care Core National LLC
Bluffton, SC
08.2014 - 07.2015
  • Maintained patient confidentiality when processing cases according to CCN guidelines, which are compliant with HIPAA and State regulations
  • Processed clinical information requests for services from physician offices and imaging centers via telephone or fax, material promptly
  • Obtained clinical information received, placed it to appropriate pathway/criteria, gave a decision if pathway approved or referred to physician review if criteria are not met
  • Constantly trained with inter-raters/learning modules to keep up certification in clinical as well as utilization management, URAC, and NCQA/CMA principles, policies, and procedures
  • Applied correct medical codes (ICD 9/10, CPT, HCPCS codes) to the chart
  • Experienced with clinical decision-making criteria sets (i.e., Milliman, InterQual/MCG)
  • Worked predominantly in Head/Neurology, Pulmonology, Med-Surgical, Gastrointestinal, Spine/Ortho, & Oncology cases
  • Ability to investigate, fact-find, and provide evidence for case resolution

Pharmacy Utilization Management (Remote) LPN

Care Core National LLC
Bluffton, SC
11.2012 - 08.2014
  • Provided summary clinical and ancillary information to Clinical Pharmacist and Medical Director for review and decision-making for targeted Part B medications
  • Received additional information and research requests for cases requiring presentation to the medical director and/or Clinical Pharmacist
  • Collected referral entries accurately identifying the covered services authorized, including ICD-9/ICD-10 coding, service groups, and appropriate medical terminology in the text
  • Answered patient questions regarding care (e.g., medication, treatment) and benefit
  • Solved problems by gathering and/or reviewing facts and selecting the best solution from identified alternatives
  • Researched and identified information needed to perform an assessment, respond to questions, or make recommendations (e.g., navigate knowledge Library resources, and websites and databases such as Micro-Medix and National Comprehensive Cancer Network)
  • Applied knowledge of pharmacological and clinical treatment protocol to determine the appropriateness of care and instruct patients as needed
  • Demonstrated knowledge of the process flow of UM including prior authorization, concurrent authorization, and/or clinical appeal and grievance reviews

Orthopedic Nurse LPN

McLeod Orthopedics Associates
Florence, SC
02.2012 - 10.2012
  • Triaged patients/gather data & have it prepared for MD
  • Complete detailed and accurate documentation relevant to patient care and treatment on the patient chart
  • Performed medical procedures such as removal of sutures/staples, dressing changes
  • Called in medicines for patients per MD order via telephone or E-scribe
  • Draw blood for minor office procedures/Medical Terminology
  • HEDIS Nurse Abstractor/Manage Workers Compensation and Disability Claim Forms
  • Acts as an advocate for injured/ill individuals (Disability management) through assessing, planning, coordinating, collaborating, evaluating, and communicating objective information regarding the medical status and state of well-being

Pulmonologists Nurse Liaison LPN

Caroling Health Care Pulmonary Department
Florence, SC
03.2008 - 12.2011
  • Assist Pulmonologists Doctors: Vinod Jona, Zothanmawii Khiangte, Asem Abdeljalil, Marwan Elya, Ziad Gharma, and Grant Breazeale
  • Nurse consultant for Dr
  • Asem Abdeljalil and Dr
  • Zothanmawii Khiangte with in-patient hospital consults and making rounds on the floor, ER, and in units including (CVICU, CVA, CCU, TSCU, MICU)
  • Made out Physician Schedules
  • Carried out MD orders accurately
  • Administered IM injections, called in prescriptions, or E-scribed to the patient pharmacy
  • Assist with teaching medication safety
  • Performed spirometry tests (pre & post) and 6-minute walks in the office
  • Draw blood for labs ordered by the physician
  • Performed prior authorization on medication, procedures, and medical equipment
  • Audit chart reviews
  • HEDIS Abstractor chart reviews
  • Float between Departments (Endocrinology, Rheumatology, and Podiatry)

Clinical Nurse Instructor LPN

Meijas Medical Training School
Florence, SC
01.2010 - 06.2010
  • Nursing instructor for the certified nursing assistant course
  • Administered tests/exams per CNA classroom curriculum
  • Assisted students with skills for lab/clinical checkoffs

Stroke Unit Nurse LPN

McLeod Regional Medical Center
Florence, SC
02.2005 - 08.2009
  • Supervised by the RN, administer medication by using the MAC system to prevent medication error, carry out tasks instructed by the physicians
  • Prioritizing nursing care for individuals by collecting ongoing objective and subjective data on the patients’ condition
  • Admitting/Transferring/Discharging patients, starting IVs performing dressing changes, removal of sutures/staples, checking off to draw blood from a PICC line, Med Comp, or TLC
  • Monitored patients on telemetry
  • Performed post-mortem care
  • Analytical Skills
  • Verbal and Communication Skills

Urology and Rapid Access Nurse LPN

Medical University of Charleston, South Carolina
Charleston, SC
08.2008 - 05.2009
  • Made assignments/schedules for nursing staff
  • Assisted with setting up certain sterile procedures, for example, cystoscope, video urodynamics, and prostate biopsy
  • Assisted with data collection, formulation of plans for patient care, and participated in the evaluation of outcomes of nursing actions
  • Performed EKGs to collect specimens for U/A’s, Rapid Beta Strep, and Rapid Influenza A&B test, set up for Pap Smears, placed Foley’s, I&O Cath according to the patient PVR by use of the Bladder Scan, start IVs, and take vital signs

Phlebotomist

McLeod Regional Medical Center
Florence, SC
01.2002 - 02.2005
  • Performed routine phlebotomy procedures
  • Transport specimens to the lab
  • Give immediate hematoma care

Clinical (Nurse Extern)

Heritage Nursing Home
Florence, SC
01.2003 - 01.2004
  • Cared for geriatrics patients by assisting with their activities of daily living (ADLs)
  • Distributed medications safely to the patients under clinical instructor supervision
  • Documented promptly
  • Carried out patients’ goals from the plan-of-care

Administrative/Clerical

McLeod Regional Medical Center
Florence, SC
08.2001 - 01.2002
  • Familiar with the McLeod OAS-GUL system for putting in MD orders
  • Scheduled appointments for outpatient testing/procedures, and doctor office follow-ups’
  • Purchased office supplies and kitchen nutrition supplies for patients/floor employees
  • Answered and directed telephone calls to the appropriate place

Certified Nursing Assistant/MST

McLeod Regional Medical Center
Florence, SC
06.1999 - 01.2002
  • Worked with primary observations and stroke patients
  • Followed treatment strategy revised by a licensed nurse
  • Assist patients with basic needs of comfort, hygiene, nutrition, and exercise

Education

Associate of Science - Nursing

Florence-Darlington Technical College
Florence, SC
12-2004

Bachelor of Arts - Biology

Francis Marion University
Florence, SC
12-2002

High School Diploma -

Wilson High School
Florence, SC
06-1998

Bachelor of Science - Nursing

Francis Marion University
Florence, SC

Skills

  • Medication administration
  • Patient assessment
  • Care coordination
  • Medical record documentation
  • Obtaining Vital Signs and Monitoring
  • Health Education
  • Patient Advocacy
  • Detail-oriented
  • Effective communication with the patient, family members, and interdisciplinary team
  • Effective Time Management
  • Effective Task Prioritization
  • Attentive Engagement
  • Lab specimen collection
  • Patient documentation
  • Patient safety protocols

Certification

  • Licensed Practical Nurse (LPN)

Multi-state License

State of SC LLR, License # P34336

obtained February 2005 - current

  • BLS

Certified through American Heart Association

E-card number: 245413671004

Expires: 11/2025

References

References available upon request.

Timeline

LPN Home Health

Caring for You Staffing
05.2023 - Current

LPN, Utilization Management (UM) Long-Term Support Services (LTSS)

Monroe Plan Healthcare
02.2020 - 09.2021

HEDIS Nurse Abstractor (Remote) LPN

Change Healthcare LLC
02.2019 - 05.2023

Grievances and Denials Nurse (Grier Letter Team) LPN

Care Core National LLC
09.2017 - 07.2018

Clinical Appeal Reviewer (Remote) LPN

Care Core National LLC
07.2015 - 09.2017

Clinical Reviewer Utilization Management (Remote) LPN

Care Core National LLC
08.2014 - 07.2015

Pharmacy Utilization Management (Remote) LPN

Care Core National LLC
11.2012 - 08.2014

Orthopedic Nurse LPN

McLeod Orthopedics Associates
02.2012 - 10.2012

Clinical Nurse Instructor LPN

Meijas Medical Training School
01.2010 - 06.2010

Urology and Rapid Access Nurse LPN

Medical University of Charleston, South Carolina
08.2008 - 05.2009

Pulmonologists Nurse Liaison LPN

Caroling Health Care Pulmonary Department
03.2008 - 12.2011

Stroke Unit Nurse LPN

McLeod Regional Medical Center
02.2005 - 08.2009

Clinical (Nurse Extern)

Heritage Nursing Home
01.2003 - 01.2004

Phlebotomist

McLeod Regional Medical Center
01.2002 - 02.2005

Administrative/Clerical

McLeod Regional Medical Center
08.2001 - 01.2002

Certified Nursing Assistant/MST

McLeod Regional Medical Center
06.1999 - 01.2002

Associate of Science - Nursing

Florence-Darlington Technical College

Bachelor of Arts - Biology

Francis Marion University

High School Diploma -

Wilson High School

Bachelor of Science - Nursing

Francis Marion University

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Shekinah R. Smiling-Waiters