Tamara Walker
Dothan
Summary
Proven Registered Nurse with a track record of fostering patient satisfaction and streamlining pre-authorization processes at Encompass Health Rehabilitation Hospital. Skilled in collaborating across multidisciplinary teams and proficient in medical necessity reviews. Demonstrates strong analytical abilities and a commitment to enhancing patient care through continuous professional development and effective communication.
Overview
26
26
years of professional experience
Work History
Registered Nurse Admission Liaison
Encompass Health Rehabilitation Hospital
06.2010 - 04.2024
- Participated in ongoing professional development opportunities to stay current on industry changes and best practices related to prior authorization.
- Promoted a collaborative environment among multidisciplinary teams to ensure optimal patient outcomes and resource allocation.
- Communicated with insurance companies to obtain prior authorization for treatment.
- Increased patient satisfaction by effectively communicating with patients regarding their coverage, benefits, and anticipated out-of-pocket expenses.
- Demonstrated adaptability when navigating complex insurance systems, efficiently processing authorizations across multiple carriers and platforms.
- Upheld data integrity standards by meticulously entering pertinent information into electronic health records systems during the authorization process.
- Provided ongoing education to clinical staff on pre-authorization requirements, resulting in improved compliance rates.
- Maintained up-to-date knowledge of insurance policies, guidelines, and regulations to ensure accurate pre-authorization approvals.
- Reduced denials and appeals by ensuring accurate documentation and timely submission of authorization requests.
- Expedited decision-making processes by maintaining strong working relationships with insurance representatives and clinical staff members.
- Monitored trends in denied or delayed authorizations, implementing corrective actions as needed to minimize future occurrences.
- Contributed to organizational cost savings through diligent review of proposed treatments against established criteria for medical necessity.
- Improved patient care by conducting thorough pre-authorization assessments for medical procedures and services.
- Served as a liaison between patients, providers, insurers, and support services, facilitating clear communication and coordination of care.
- Supported case management efforts by identifying potential high-risk patients during the pre-authorization process for appropriate intervention.
- Assisted in the development of internal policies and procedures related to pre-authorizations, increasing overall department efficiency.
- Provided compassionate support to patients and families during the authorization process, addressing concerns and offering reassurance as needed.
- Collaborated with healthcare providers to determine appropriate levels of care and facilitate proper utilization of resources.
- Enhanced workflow efficiency by streamlining the pre-authorization process for both inpatient and outpatient cases.
Registered Nurse, Intensive Care Unit
Community Hospital South
04.2007 - 05.2010
- Handled ventilator support, feeding tubes and central lines.
- Assisted physicians with bedside procedures, ensuring accurate treatment administration and timely patient recovery.
- Demonstrated advanced critical thinking skills while managing complex clinical situations involving multiple organ systems failures in critically ill patients.
- Improved patient outcomes by developing and implementing individualized care plans for critically ill patients.
- Reduced patient complications by promptly identifying changes in condition and initiating appropriate interventions.
- Increased family involvement in patient care by providing timely updates on their loved one''s progress and addressing any concerns or questions they may have had.
- Identified patients' current needs through careful observation, vitals monitoring and discussions with loved ones or patients.
- Participated in continuing education opportunities to remain current on best practices and advancements within the field of critical care nursing.
- Mentored new nursing staff, facilitating smooth integration into the ICU unit and promoting a supportive workplace culture.
- Administered medications accurately and effectively, preventing adverse reactions through careful monitoring of drug interactions.
- Worked with physicians and nursing staff to develop treatment protocols addressing patients' current symptom presentation as well as underlying conditions.
- Effectively managed stressors associated with working in an intensive care setting while maintaining composure under pressure.
- Promoted a safe environment by enforcing infection control policies and maintaining a clean, organized workspace.
- Maintained confidentiality of sensitive patient information in accordance with HIPAA regulations while fostering trust between medical staff and patients'' families.
- Implemented identified treatment plans for patients to maintain stable conditions and achieve reasonable improvements.
- Served as an effective liaison between patients, families, and healthcare professionals to ensure clear communication of relevant information.
- Coordinated strategies and orders of different disciplines to provide patients' with exceptional care.
- Monitored patients' respiratory status and ventilator operation and made adjustments to promote stabilization.
- Observed patients' vital signs and administered physician-prescribed medications and treatments.
- Explained health care issues and ramifications to patients and families to promote informed medical care choices.
Medical ICU Registered Nurse/Supervisor
Kindred Hospital Indianapolis Indiana
08.1998 - 04.2007
- Responded efficiently to medical emergencies within the hospital setting, providing life-saving interventions as needed.
- Assisted physicians with invasive procedures such as central line insertions or bronchoscopies while maintaining strict sterile technique.
- Collaborated with multidisciplinary teams to develop comprehensive treatment plans for critically ill patients.
- Provided emotional support to patients and families during critical illness or end-of-life situations
- Streamlined medication administration processes, ensuring accuracy and preventing adverse drug events.
- Maintained a safe and therapeutic environment, adhering to infection control protocols and promoting patient comfort.
- Reduced ICU readmissions through thorough patient assessments, timely interventions, and effective discharge education.
- Served as a preceptor for new nurses, facilitating orientation and integration into the ICU setting.
- Participated in unit-based quality improvement initiatives aimed at enhancing patient safety and satisfaction scores.
- Optimized patient outcomes by providing compassionate and culturally sensitive care to diverse populations.
- Conducted ongoing monitoring of vital signs, lab results, and diagnostic findings to promptly identify changes in patient condition.
- Enhanced patient recovery by implementing evidence-based nursing interventions and individualized care plan.
Education
Associate of Science - Nursing
IU School of Nursing
Indianapolis, IN12.1996
Skills
- Ability to work independently under general instructions and with a team
- Proven success in building relationships
- Collaborate with members, providers, provider network teams, and caregivers to ensure positive outcomes
- Good analytical skills with a strong attention to details
- Able to handle difficult situations with professionalism
- Explain complicated medical terms in pain language
- Ability to adjust tone and approach to different people
- Proficient with windows style applications and keyboard
- Compete medical necessity reviews to obtain prior authorization using medicare guidelines
- Health plan experience working with large carriers
- Proficient in application of medical necessity criteria, standards of practice, and research regarding prior authorization guidelines
Additional Information
- I am proud of being responsible for suggesting a sepsis protocol and working with our medical director to decrease significantly, the number of acute IP rehab pts that were being sent out to acute hospitals saving lives.
- I was also responsible for initiating my own training verifying insurance coverage and educating other staff members resulting in an increase in revenue.
Timeline
Registered Nurse Admission Liaison
Encompass Health Rehabilitation Hospital
06.2010 - 04.2024
Registered Nurse, Intensive Care Unit
Community Hospital South
04.2007 - 05.2010
Medical ICU Registered Nurse/Supervisor
Kindred Hospital Indianapolis Indiana
08.1998 - 04.2007
Associate of Science - Nursing
IU School of Nursing
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