Experienced nursing professional bringing demonstrated clinical expertise and technical knowledge. Proficient in updating charts, monitoring medications and working with multidisciplinary teams to optimize patient care. Quality-driven and efficient with strong interpersonal abilities. Skilled in Utilization Review with knowledge in continuous assessments and clinical records oversight
Overview
28
28
years of professional experience
Work History
RN Case Manager/Utilization Review Nurse
Glenwood Regional Medical Center
West Monroe, LA
06.2018 - Current
Conducted reviews of inpatient utilization for compliance with admission criteria and concurrent review requirements.
Reviewed patient admissions to determine medical necessity as directed by Interqual/Milliman criteria.
Facilitated communication between payers, providers and patients concerning authorization issues or concerns.
Communicated regularly with family members regarding patient care needs and progress toward goals.
Collaborated with physicians, nurses and other healthcare professionals to ensure optimal patient outcomes.
Developed discharge plans for patients transitioning from acute care settings to home or alternate facilities.
Coordinated medical services between primary care providers, specialists, hospitals and outpatient clinics.
Ensured compliance with regulatory standards concerning utilization review, ethical decision making and legal aspects of case management practice.
Registered Nurse
Glenwood Home Health
West Monroe, LA
12.2016 - 12.2018
Assessed and evaluated patient's condition, including physical and psychological status, to develop individualized care plans.
Provided home health care services such as wound care, medication administration, and IV therapy.
Performed venipuncture procedures when necessary for accessing central lines or port catheters.
Administered intravenous medications and fluids to patients according to physician orders.
Utilized specialized equipment such as negative pressure therapy systems for optimal wound healing outcomes.
Educated patients and families about disease management, lifestyle changes, nutrition, and preventive healthcare measures.
Instructed family members in basic nursing skills including wound care, injections, catheterization, and other treatments as ordered by the physician.
Conducted regular re-evaluations to address changes in needs and conditions, and introduced revisions to care plans.
Registered Nurse
United HomeCare
West Monroe, LA
01.2013 - 04.2016
Assessed and evaluated patient's condition, including physical and psychological status, to develop individualized care plans.
Provided home health care services such as wound care, medication administration, and IV therapy.
Performed venipuncture procedures when necessary for accessing central lines or port catheters.
Administered intravenous medications and fluids to patients according to physician orders.
Utilized specialized equipment such as negative pressure therapy systems for optimal wound healing outcomes.
Educated patients and families about disease management, lifestyle changes, nutrition, and preventive healthcare measures.
Instructed family members in basic nursing skills including wound care, injections, catheterization, and other treatments as ordered by the physician.
Maintained accurate records of all visits made to patients' homes along with any changes in their conditions or treatments prescribed by physicians.
Conducted regular re-evaluations to address changes in needs and conditions, and introduced revisions to care plans.
Licensed Practical Nurse
St Francis Medical Center
Monroe, LA
12.1995 - 12.2012
Performed physical assessments, including vital signs and health history documentation.
Provided patient care in accordance with physicians' orders and nursing standards of practice.
Administered medications and treatments according to established protocols.
Educated patients on disease prevention and management strategies for their individual conditions.
Assisted with admissions and discharges of patients from hospital units.
Adhered to facility policies and procedures while providing quality nursing care.
Collected blood, urine or sputum from patients to perform routine laboratory tests.
Provided pre- and post-operative nursing care.
Establish, monitor and discontinue IV access as ordered
Education
Associate of Applied Science - Nursing
Excelsior College
Albany, NY
05-2014
Skills
HIPAA Compliance
Electronic Recordkeeping
RN Case Management
Care Coordination
Discharge Planning
Insurance knowledge
Utilization review
Timeline
RN Case Manager/Utilization Review Nurse
Glenwood Regional Medical Center
06.2018 - Current
Registered Nurse
Glenwood Home Health
12.2016 - 12.2018
Registered Nurse
United HomeCare
01.2013 - 04.2016
Licensed Practical Nurse
St Francis Medical Center
12.1995 - 12.2012
Associate of Applied Science - Nursing
Excelsior College
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