Theresa Bell
Splendora,TX
Summary
Hands-on professional proudly offering more than 20 years of expertise in nursing field. Well-rounded and personable Utilization Review Nurse talented in reporting, records oversight and performance improvement.
Overview
16
16
years of professional experience
Work History
Utilization Review Specialist
Clearlink Partners
08.2021 - Current
- Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
- Obtained authorizations from Medicaire/Medicaid carriers for various levels of care.
- Communicated with healthcare team members to plan, implement and enhance treatment strategies.
- Obtained authorizations per Medicaid/Medicare DME
- Sustained quality standards by performing routine medication audits and upholding internal and industry best practices.
- Performed admission reviews based for medical necessity based upon Medicare/Medicaid specification.
Utilization Review Nurse
Wellcareplans
09.2015 - 03.2021
- Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
- Evaluated patient histories, complaints, and current symptoms.
- Equipped patients with tools and knowledge needed for speedy and sustained recovery.
- Performed prior authorization review of services requiring notification.
- Performed admission reviews based for medical necessity based upon Medicare/Medicaid specification.
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
Staff Nurse
Nurse Core Staffing
03.2014 - 09.2016
- Led teams in driving successful patient outcomes by prioritizing standard of care and best practices.
- Used first-hand knowledge and clinical expertise to advocate for patients under care and enacted prescribed treatment strategies.
- Educated family members and caregivers on patient care instructions.
- Provided exceptional care to high-acute patients needing complex care such as ventilator management, extensive wound care and rehabilitation.
- Administered medications via oral, IV, and intramuscular injections and monitored responses.
- Performed various nursing interventions such as wound dressing, vital sign monitoring, and specimen collection.
- Documented treatments delivered, medications and IVs administered, discharge instructions, and follow-up care.
Staff Nurse
Egret Cove Center
08.2012 - 08.2014
- Evaluated patient histories, complaints, and current symptoms.
- Performed various nursing interventions such as wound dressing, vital sign monitoring, and specimen collection.
- Observed and documented patient factors such as diets, physical activity levels and behaviors to understand conditions and effectively modify treatment plans.
- Vaccinated patients to protect individuals from illnesses of concern.
- Conducted ongoing monitoring and evaluations of behaviors and conditions, and updated clinical supervisors with current information.
Staff Nurse
Vibra Specialty Hospital
09.2007 - 06.2012
- Assessed medical status of patients pre- and post-operation by checking vital parameters and supervising food intake.
- Provided exceptional care to high-acute patients needing complex care such as ventilator management, extensive wound care and rehabilitation.
- Implemented care plans for patient treatment after assessing physician medical regimens.
- Conducted ongoing monitoring and evaluations of behaviors and conditions, and updated clinical supervisors with current information.
- Managed patients recovering from medical or surgical procedures.
- Monitored patient reactions after administering medications and IV therapies.
- Ordered, interpreted, and evaluated diagnostic tests to identify and assess patient condition.
- Documented treatments delivered, medications and IVs administered, discharge instructions, and follow-up care.
- Identified patient care requirements by establishing personal rapport with patients and families.
Education
Technical Certificate - Nursing License Practical Nursing
Ivy Tech Community College
Fort Wayne, INSkills
- Benefits Guidelines
- Intramuscular Injections
- Physician Consultations
- Medication Side Effect Knowledge
- Determine Medical Necessity
- Infection Control Procedures
- Documentation
- Pressure Wound Treatment
- Utilization Review
- InterQual Criteria
- McKesson System
- Electronic Medical Record Software
- Skilled in Microsoft Word
Timeline
Utilization Review Specialist
Clearlink Partners
08.2021 - Current
Utilization Review Nurse
Wellcareplans
09.2015 - 03.2021
Staff Nurse
Nurse Core Staffing
03.2014 - 09.2016
Staff Nurse
Egret Cove Center
08.2012 - 08.2014
Staff Nurse
Vibra Specialty Hospital
09.2007 - 06.2012
Technical Certificate - Nursing License Practical Nursing
Ivy Tech Community College
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