Summary
Overview
Work History
Education
Skills
Timeline
Generic

Tawanna Riker

Boiling Springs,SC

Summary

Experienced Utilization Management Representative with a background in managing patient case reviews and ensuring adherence to healthcare policies. Strengths include strong analytical skills, ability to interpret medical records and make informed decisions based on findings. Proven track record of streamlining workflow processes, fostering patient satisfaction, and upholding compliance standards in previous roles.

Self-motivated professional promoting attention to detail and the drive to resolve issues effectively. Calm and poised in the most stressful environments. Seeking the opportunity to join new organization in the role of Utilization Review Nurse.

Overview

9
9
years of professional experience
9
9
years of post-secondary education

Work History

Utilization Management RepresentativeI’m

Evolent Health
Arlington, VA
04.2020 - Current
  • Evaluated patient care needs to ensure appropriate resource utilization.
  • Reviewed medical records for compliance with policies and regulations.
  • Collaborated with healthcare teams to coordinate patient services efficiently.
  • Maintained up-to-date knowledge of healthcare regulations and best practices.
  • Trained new staff on utilization management processes and procedures effectively.
  • Contributed to appeals process by providing pertinent clinical information upon request from appeals department personnel.
  • Coordinated utilization review processes for healthcare services and treatments.
  • Evaluated medical necessity of requested services based on clinical guidelines.

Pharmacy Manager

Clinical Solutions
Greenville, SC
11.2016 - 03.2020
  • Oversaw daily pharmacy operations and staff scheduling at Clinical Solutions.
  • Managed inventory levels and ensured compliance with safety regulations.
  • Implemented training programs for pharmacy staff on new protocols.
  • Developed policies to enhance workflow efficiency in the pharmacy department.
  • Conducted regular audits to maintain quality assurance standards.
  • Facilitated communication between pharmacy team and patients ( inmates) regarding medication use.
  • Managed daily operations of the pharmacy, including staffing, scheduling and inventory control.
  • Interview, hire, train all new hires and acclimated to facility procedures for medication administration.

Education

License Pharmacy Technician - Pharmacy Technician

Clinical Solutions Medication Administration
Greenville , SC
09.2018 - 09.2025

Associate of Applied Science - Business Administration

Essex College of Business
Newark, NJ
09.1984 - 05.1986

Skills

  • Resource utilization
  • Medical compliance
  • Clinical evaluation
  • Policy development
  • Training and Development
  • Certified in State Regulatory Guidelines

Timeline

Utilization Management RepresentativeI’m

Evolent Health
04.2020 - Current

License Pharmacy Technician - Pharmacy Technician

Clinical Solutions Medication Administration
09.2018 - 09.2025

Pharmacy Manager

Clinical Solutions
11.2016 - 03.2020

Associate of Applied Science - Business Administration

Essex College of Business
09.1984 - 05.1986

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