SKYLA ANDERS
RN
Kansas City,MO
Summary
Professionally trained, dual-licensed registered nurse with over 21 years of experience, ensuring high standards of culturally competent care for a wide variety of patients with diverse needs. Proven history of advocacy, quality improvement, and working as a steward of resources to lower the overall total cost of care for both patients and shareholders. I leverage my leadership and advocacy skills to mentor and support other nurses, participate in process improvement initiatives, and promote evidence-based practice and patient-centered care. Highly efficient, results-oriented, and able to work independently in fast-paced and ambiguous work environments.
Overview
22
22
years of professional experience
Work History
Clinical Review Nurse
Blue Cross Blue Shield
Kansas City, MO
03.2022 - Current
- Conducts pre-service, utilization management, prior authorization reviews to ensure appropriate use of the health care system and to maximize health care dollars
- Review provider submitted medical information to determine medical necessity for product or procedure utilizing professional knowledge, medical literature, medical records, certificate guidelines, medical policy, approved clinical guidelines, and several complex and varied computer application software systems
- Refer cases that require additional clinical insights to MD teams, ensuring a comprehensive approach to each patient's needs
- Build strong direct relationships with providers and medical directors through review of member clinical information, applying criteria, and completing authorization determinations in accordance with company policies and procedures
- Maintain current knowledge of clinical criteria guidelines
Care Guide RN
BLUE CROSS BLUE SHIELD
Kansas City, MO
11.2018 - 03.2022
- Establish a trusted partnership with the patient and build credibility through knowledge sharing and collaboration around healthcare needs
- Utilize internal, community and other healthcare resources to maximize outcomes
- Manage projects and competing priorities and deadlines to ensure the patient receives information in a timely manner
- Discuss benefits and related out of pocket expenses specific to the patients benefit plan
- Work to identify high quality care options, minimizing out of pocket costs for the patients and lowering the overall total cost of care
Nurse Case Manager
VISITING NURSES ASSOCIATION
Kansas City, MO
07.2017 - 10.2018
- Case managed up to 45 homebound patients through discharge
- Consistently complied with applicable laws and regulations and ensured facility adhered to Medicare and Medicaid regulations
- Strong leader for nursing personnel, and precepted prospective employees, nursing students and new hires
- Effectively supervised LPN's, NAs and non-clinical staff
- Participated in Quality Improvement Activities to identify performance areas for improvement and increased compliance with regulatory agencies.
Emergency Services RN
ST JOSEPH MEDICAL CENTER
Kansas City, MO
07.2014 - 07.2017
- Provided direct patient care, including stabilizing patients and determining course of action based on triage
- Precepted nursing students, paramedic students, new grads and experienced nurses.
- Collaborated with other departments within the health system to ensure continuity of care for all patients.
- Assessed and evaluated patient care needs, prioritized treatment, and maintained patient flow.
- Utilized evidence-based practice guidelines for assessment and management of common ED presentations.
Emergency Services RN
CENTERPOINT MEDICAL CENTER
Independence, MO
01.2011 - 07.2014
- Triaged and treated high-volume caseload in busy emergency room setting
- Administered critical IV medications to stabilize patients for assessment and treatment
- Responded to emergency situations with speed, expertise and level-headed approaches to provide optimal care, support and life-saving interventions
- Evaluated and adjusted life support equipment, tubing and peripheral devices providing critical assistance to fragile patients
- Trained and mentored new RNs on best practices, hospital policies and standards of care.
Medical-Surgical, Telemetry RN
LEE'S SUMMIT MEDICAL CENTER
Lee's Summit, MO
04.2009 - 12.2011
- Delivered tailored nursing care to adult patients suffering from multiple diagnoses
- Provided key information regarding diseases, medications and course of treatment to patients and caregivers
- Collaborated with multidisciplinary healthcare professionals to administer therapies and maintain continuum of care
- Utilized telemetry to monitor patient cardiac status
- Trained and mentored new RNs on best practices, hospital policies and standards of care.
Registered Nurse, Agency, Float
ALL ABOUT STAFFING
Overland Park, KS
01.2009 - 04.2009
- Patient care on med-surg/telemetry and oncology units, adeptly handling all aspects of treatment
- Trained family members in how to care for patients and manage individual conditions
- Evaluated the healthcare needs, goals for treatment and available resources of each patient and connected them with optimal providers
- Ensured efficacy of treatments through monitoring of treatment regimens
- Established and maintained effective communication with physicians, patients, family members, hospital staff, administration, and management.
Medical-Surgical, Telemetry RN
ST LUKE'S HOSPITAL
Lee's Summit, MO
12.2007 - 01.2009
- Coordinated care with physicians and other clinical staff to prepare for treatment, carry out interventions and enhance continuum of care to deliver comprehensive services
- Counseled caregivers and families on end-of-life planning and educated on patient care options
- Assessed patient conditions, monitored behaviors and updated supervising physicians with observations and concerns
- Ensured quality patient care from admission to discharge through direct supervision of all nursing and ancillary staff
- Advocated for patient needs with interdisciplinary team and implemented outlined treatment plans.
Surgical Oncology RN
LIBERTY HOSPITAL
Liberty, MO
05.2002 - 05.2007
- Conducted patient assessments and diagnostic tests to provide physician with important patient health information used to create focused treatment plans and manage ongoing care
- Executed appropriate steps for patient treatment following careful review of physician medical regimen
- Assessed patient conditions, monitored behaviors and updated supervising physicians with observations and concerns
- Trained and mentored RNs on best practices, hospital policies and standards of care
- Led the interdisciplinary unit counsel and participated regularly in performance improvement projects.
Education
BACHELOR OF SCIENCE: NURSING -
Graceland University
05.2002
ASSOCIATE OF ARTS -
Metropolitan Community College - Kansas City
05.2000
Skills
- Case management
- Prior authorization
- Milliman criteria guidelines, FEP, JAA
- Staff development and precepting
- High level of autonomy
- Acute/critical care expertise
Timeline
Clinical Review Nurse
Blue Cross Blue Shield
03.2022 - Current
Care Guide RN
BLUE CROSS BLUE SHIELD
11.2018 - 03.2022
Nurse Case Manager
VISITING NURSES ASSOCIATION
07.2017 - 10.2018
Emergency Services RN
ST JOSEPH MEDICAL CENTER
07.2014 - 07.2017
Emergency Services RN
CENTERPOINT MEDICAL CENTER
01.2011 - 07.2014
Medical-Surgical, Telemetry RN
LEE'S SUMMIT MEDICAL CENTER
04.2009 - 12.2011
Registered Nurse, Agency, Float
ALL ABOUT STAFFING
01.2009 - 04.2009
Medical-Surgical, Telemetry RN
ST LUKE'S HOSPITAL
12.2007 - 01.2009
Surgical Oncology RN
LIBERTY HOSPITAL
05.2002 - 05.2007
BACHELOR OF SCIENCE: NURSING -
Graceland University
ASSOCIATE OF ARTS -
Metropolitan Community College - Kansas City
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