Theresa Newbill
Mechanicsville,VA
Summary
Utilization Review Nurse with proven expertise in ensuring compliance and enhancing patient care at Anthem BC/BS. Excelled in performing critical reviews and leveraging EMR/EHR knowledge, coupled with exceptional organizational abilities and effective communication. Demonstrated leadership in cardiac rehabilitation, emphasizing teamwork and patient progress.
Experienced with managing medical practices Internal Medicine, Neurology and OB/GYN. Experienced with front desk activities and maintaining welcoming atmosphere for clients. Utilizes strong organizational skills and attention to detail to streamline office operations. Knowledge of effective communication techniques and customer service principles to enhance visitor experiences.
Overview
5
5
years of professional experience
Work History
Utilization Review Nurse
Anthem BC/BS
07.2018 - 08.2022
- Ensured compliance with regulations and accreditation standards by maintaining accurate documentation of all utilization review activities.
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Performed prior authorization review of services requiring notification.
- Performed admission reviews based for medical necessity based upon inpatient specification.
Cardiac Rehabilitation Nurse
Baycare St. Anthony’s Hospital
02.2017 - 05.2018
- Delivered all phases of cardiac rehabilitation within a multidisciplinary team.
- Supervised workout sessions for patients and recorded progress.
- Provided guidance to patients on health improvement strategies.
Education
Bachelor Of Nursing - Nursing
Liberty University
Lynchburg, VA05.2012
Skills
- Good organizational and prioritizing skills
- Attention to detail
- Effective communication skills
- EMR, EHR experience
- Dependable and friendly
- Insurance verification
- Teamwork and collaboration
- Office skills
Timeline
Utilization Review Nurse
Anthem BC/BS
07.2018 - 08.2022
Cardiac Rehabilitation Nurse
Baycare St. Anthony’s Hospital
02.2017 - 05.2018
Bachelor Of Nursing - Nursing
Liberty University
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