Versatile and adaptable Registered Nurse with experience in multidisciplinary fields of nursing, eager to apply my problem-solving and critical thinking skills as a Utilization Management Nurse Specialist, seeking to remain within the work-at-home and virtual nursing atmosphere.
Hi, I’m
Kathleen Watts
Knoxville,United States
Summary
Overview
18
years of professional experience
1
Certification
Work History
Anthem Insurance Company
Utilization Management Nurse
01.2020 - Current
Job overview
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Performed prior authorization review of services requiring notification.
- Supervised and maintained all utilization review documentation through Facets, Macess & ACMP.
- Works with medial directors in interpreting appropriateness of care, accurate claims payment including appeals and/or denials, and rounds discussions.
- Steer providers to appropriate programs and community resources, including discharge planning for home health DME, skilled nursing needs, acute inpatient rehabilitation, and/or long term acute care with some assistance from subacute team members
- Obtained authorizations from multiple insurance carriers for various levels of care.
Morristown Hamblen Hospital
Cardiopulmonary Rehabilitation Nurse
10.2015 - 01.2020
Job overview
- Educated family members and caregivers on patient care instructions.
- Evaluated patient histories, complaints and current symptoms.
- Accurately documented treatment, medications and IVs administered, discharge instructions and follow-up care.
- Advocated for and strived to protect health, safety and rights of patient.
- Performed various diagnostic stress tests including treadmill stress tests, TEE/cardioversion procedures and nuclear stress tests.
- Diabetic Resource Nurse Certification for Cardiac Rehab Patients.
Jefferson Memorial Hospital
Cardiac Stress Test and Radiology RN, Med/Surg RN,
06.2005 - 10.2015
Job overview
- Performed various diagnostic stress tests including treadmill stress tests, TEE/cardioversion procedures and nuclear stress tests.
- Interim Educator and Clinic Nurse PRN when staff member absent for sickness or vacation
- Clinical direct patient care RN on the Medical/Surgical Unit.
- Involved in local community health fairs, public speaking encounters, and community vaccination events.
- Diabetic Resource Nurse Certification for Cardiac Rehab Patients
Education
Carson-Newman UniversityJefferson City, TN
Bachelor of Science from Nursing
05.2009
University Overview
The University of Tennessee - KnoxvilleKnoxville, TN
Bachelor of Science from Exercise Physiology
08.2001
University Overview
Skills
- Project Management
- Regulatory Compliance
- Proactive
- Record Analysis
- Physician Consultations
- Utilization Management
- Utilization Review
- Continuous Assessments
- Interpersonal and Written Communication
- Accurate Documentation
- Leadership
- Patient Health Information Access
- Compliance Issues
- Microsoft Office
Accomplishments
Accomplishments
- Cardiac Service Award of Excellence, Covenant Health Executive Leadership & Cardiac Services Council, Morristown Hamblin Healthcare System, June 2017
- 2016 AACVPR (American Association of Cardiovascular and Pulmonary Rehabilitation) national program certification for Cardiac and Pulmonary Rehab Services at Morristown Hamblen Healthcare System.
- Daisy Award Recipient for Nurses, Jefferson Memorial Hospital, August 2011
Certification
Licensed Registered Nurse, State of Tennessee – License No. RN0000170673
Timeline
Utilization Management Nurse
Anthem Insurance Company
01.2020 - Current
Cardiopulmonary Rehabilitation Nurse
Morristown Hamblen Hospital
10.2015 - 01.2020
Cardiac Stress Test and Radiology RN, Med/Surg RN,
Jefferson Memorial Hospital
06.2005 - 10.2015
Carson-Newman University
Bachelor of Science from Nursing
The University of Tennessee - Knoxville
Bachelor of Science from Exercise Physiology
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