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
Charleston, SC
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
Tampa, FL
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
Saint Petersburg, FL
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
Saint Petersburg, FL
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
Fort Wayne, IN
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