Susan Weeks-Reynolds
Dumfries,Va
Summary
Utilization Review Nurse
Highly talent, resourceful and caring Patient Care Coordinator and registered nurse with over thirty years of experience. Huge clinical care in health insurance industry. Deep knowledge of concurrent, utilization management and discharge planning. Sound knowledge of Medicare, InterQual Criteria and Milliman Care Guidelines. Outstanding ability to interpret policies, procedures and communicate effectively.
Overview
34
34
years of professional experience
Work History
Patient Care Coordinator/Case Manager
Kaiser Permanente
01.2002 - Current
- Performs utilization review with the application of approved utilization review Milliman Guideline Criteria; coordinates, assesses, and collaborates with physicians and team regarding effectiveness of generated nursing care plan through daily patient rounds; performs effective discharge planning while collaborating with team members, patients and families in regards to appropriate discharge options; generate referrals for homecare durable medical equipment, inpatient rehabilitation/skilled nursing and outpatient services for patients; performs and variance management through timely steps in the identification patterns and trends that may require corrective action; performs Quality screening with assesses all aspects of care across the continuum for variations for quality and utilization standards, optimizes productive working environment by functioning as liaison, problem solver and consultant for community social services, health care agencies, providers and various Kaiser Permanente Departments.
Nurse Case Manager/Discharge Planner/Healthcare Consultant
Aetna U.S Healthcare/NYLCARE
01.1998 - 01.2002
- Case managed high volumes of members from various hospital facilities; assessed needs of the members for continuing care, developed, coordinated and implemented a plan of care in order to meet the patient needs; increased emphasis placed on reducing cost, length of stays, and overall resource utilization review; reviewed complex medical cases with Medical Director for medical necessity for continued hospital stays; negotiated rates and coordinated home care services for members; applied Medicare guidelines and ICD9 coding and exhibited proficient usage of InterQual Criteria applied admission and continued stays.
Registered Nurse
Veterans Affairs Medical Center
01.1994 - 01.1998
- Provided efficient and effective nursing care to an assigned group of patients in Intensive Care Unit and Emergency Room.
Registered Nurse
Washington Hospital Center
01.1991 - 01.1994
- Provided efficient and effective nursing care to an assigned group of patients in a variety of specialty areas.
Education
Working toward BSN -
Chamberlain College of Nursing Online
Associated Degree in Nursing -
Norfolk State University
01.1989
Timeline
Patient Care Coordinator/Case Manager
Kaiser Permanente
01.2002 - Current
Nurse Case Manager/Discharge Planner/Healthcare Consultant
Aetna U.S Healthcare/NYLCARE
01.1998 - 01.2002
Registered Nurse
Veterans Affairs Medical Center
01.1994 - 01.1998
Registered Nurse
Washington Hospital Center
01.1991 - 01.1994
Working toward BSN -
Chamberlain College of Nursing Online
Associated Degree in Nursing -
Norfolk State University