Shelley Schmidt
Temple,TX
Summary
Results-driven Utilization Review Nurse with strong skills in clinical documentation and medical necessity analysis. Proven ability to develop insightful reports and facilitate effective communication between providers and insurers.
Overview
41
41
years of professional experience
Work History
Utilization Review Nurse
Cedar Crest Hospital & Residential Treatment Center
Belton, Texas
04.2016 - Current
- Conducted utilization reviews for inpatient and outpatient services to ensure compliance with standards.
- Analyzed treatment plans for medical necessity, efficiency, and compliance with guidelines.
- Developed reports on utilization trends for management review and strategic planning.
- Educated staff on best practices in utilization review processes to enhance understanding.
- Evaluated clinical documentation for accuracy to make informed coverage determinations.
- Facilitated communication between providers and insurance companies to streamline processes.
- Assessed patient medical records to determine appropriateness of requested services.
- Served as a resource for staff seeking guidance on utilization review matters.
PACU Staff Nurse
Kings Daughters Hospital
Temple, Texas
02.2014 - 04.2016
- Monitored patient recovery status and vital signs post-anesthesia to ensure safety.
- Administered medications and managed IV lines to optimize patient care.
- Collaborated with surgical teams for seamless patient handoffs and continuity of care.
- Educated patients and families on post-operative care protocols to enhance recovery.
- Trained new staff on PACU procedures and safety standards to maintain quality.
- Implemented rapid response protocols during emergencies to provide immediate assistance.
- Ensured compliance with hospital policies and infection control measures consistently.
- Evaluated patients to plan, implement, and document skilled nursing interventions.
Home Health Registered Nurse supervisor
Interim HealthCare
Waco, Texas
03.2008 - 02.2014
- Provided direct patient care in home settings for diverse populations.
- Administered medications and monitored responses to treatments.
- Collaborated with multidisciplinary teams to develop personalized care plans.
- Educated patients and families on health management and safety practices.
- Managed wound care and assisted with rehabilitation exercises for recovery.
- Trained new nursing staff on best practices and protocols.
- Conducted home visits to assess living environment safety for elderly or disabled clients.
- Coordinated schedules for healthcare staff to optimize coverage and efficiency.
Registered Nurse Staff, PACU
Veterans Affairs Medical Center
Temple, Texas
05.1986 - 12.1997
- Monitored patient vital signs in post-anesthesia care unit to ensure safety and recovery.
- Administered medications per physician orders, managing anesthesia side effects and promoting recovery.
- Collaborated with multidisciplinary teams to develop and coordinate effective patient care plans.
- Educated patients and families on post-operative recovery and care instructions for optimal outcomes.
- Trained new staff on departmental procedures and best practices for patient care standards.
- Implemented safety protocols to create secure recovery environments for all patients.
- Documented patient progress and responses in electronic health records for accurate tracking.
- Responded promptly to emergencies, utilizing expertise in life-saving interventions.
Licensed Practical Nurse
Colonial Nursing Home
Cameron, Texas
08.1984 - 05.1986
- Administered medications and treatments as prescribed by physicians.
- Monitored patient vital signs and reported changes to healthcare team.
- Assisted in patient assessments and developed care plans collaboratively.
- Educated patients and families on health management and disease prevention.
- Maintained accurate medical records and documentation for compliance.
- Coordinated with multidisciplinary teams to ensure comprehensive patient care.
- Provided emotional support to patients and families during treatment processes.
- Trained new nursing staff on protocols and best practices for care delivery.
- Observed changes in patient's condition and reported any significant changes to the registered nurse or physician.
- Performed physical assessments, including vital signs and health history documentation.
- Monitored vital signs, fluid intake and output levels, glucose levels, and other medical tests results.
- Provided patient care in accordance with physicians' orders and nursing standards of practice.
- Communicated effectively with patients, family members, healthcare team members, and other stakeholders regarding patient care plans or concerns.
- Conducted regular rounds to assess the status of assigned patients.
- Educated patients on disease prevention and management strategies for their individual conditions.
- Monitored patient's respiration activity, blood pressure and blood glucose levels in response to medical administration.
- Collected and documented vital signs to track current patient conditions.
- Adhered to facility policies and procedures while providing quality nursing care.
- Managed emergency situations promptly according to established protocols.
- Ensured that all clinical documentation is accurate and up-to-date in the electronic medical record system.
- Coordinated with doctors and registered nurses to develop care plans for patients.
- Communicated concerns regarding patients' status, care and environment to nursing supervisors, clinical care supervisors and case managers.
- Provided emotional support to patients dealing with illness or injury related issues.
- Looked for physical, emotional, and symptomatic changes in patient condition and obtained necessary care for medical concerns.
- Assisted patients with personal hygiene activities such as bathing, dressing, eating, grooming, and toileting needs.
- Promoted culture of safety for patients and employees through proper identification, reporting documentation and prevention.
- Assessed patient complaints accurately and provided appropriate interventions.
- Used sterile techniques to prepare patients for procedures.
- Collaborated with physicians to develop individualized care plans for each patient.
- Collected biological specimens and packaged for laboratory transport to complete diagnostic tests.
- Assisted with admissions and discharges of patients from hospital units or long-term care facilities.
- Prevented drug interactions and contributed to correct diagnosis by recording patient health information, monitoring vitals and updating patient files.
- Applied interventions to progress patients toward wellness and address maintenance of wellness.
- Followed rehabilitation and treatment care plans to accelerate patient recovery, minimize pain, and optimize patient outcomes.
Education
Bachelor of Science -
The University of Texas At Arlington
Arlington, Texas, TX08-1992
Associate of Science -
Mcclennan Community College
Waco, TX05-1985
LVN - Practical Nursing
Temple Junior Colloge
Temple, TX08-1984
Skills
- Utilization review
- Clinical documentation
- Medical necessity analysis
- Data reporting
- Compliance evaluation
- Patient care management
- Team collaboration
- Effective communication
- Training and mentoring
- Time management
- Problem solving
- Advocacy for patients
- Documentation and reporting
- Physician consultations
- Clinical assessment
- Prior authorization
- Utilization management
- Patient care assessment
- Teamwork
Timeline
Utilization Review Nurse
Cedar Crest Hospital & Residential Treatment Center
04.2016 - Current
PACU Staff Nurse
Kings Daughters Hospital
02.2014 - 04.2016
Home Health Registered Nurse supervisor
Interim HealthCare
03.2008 - 02.2014
Registered Nurse Staff, PACU
Veterans Affairs Medical Center
05.1986 - 12.1997
Licensed Practical Nurse
Colonial Nursing Home
08.1984 - 05.1986
Bachelor of Science -
The University of Texas At Arlington
Associate of Science -
Mcclennan Community College
LVN - Practical Nursing
Temple Junior Colloge