Summary
Overview
Work History
Education
Skills
Clinicalexperience
Timeline
Generic

THERESA M. RICHARDSON

Sacramento,CA

Summary

To secure a challenging career as a Health Care Professional utilizing technical and analytical skills with either an insurance group, a consulting firm, or a health care organization that focuses on providing quality health care.

Overview

14
14
years of professional experience

Work History

RN Eligibility Enrollment

Innovage
11.2022 - Current
  • Performing assessments for the elderly population for The PACE program at Innovage
  • At PACE, the enrollee will receive all of their medical care, DME, medication, transportation to and from the center and to and from their specialist.

Utilization and Prior Authorization Review Nurse-Remote

Magellen Rx
12.2020 - 06.2021
  • Providing Utilization Review and Prior Authorization for the MediCal population in California for prescription drugs
  • This was a remote position in which I am comfortable in a remote position
  • Used DHCS criteria for the authorizations.

Case Manager

All’s Well Health Care Services
01.2019 - 03.2019
  • Worked a a temp performing Case Management at Brown & Toland and utilization review using InterQual criteria also have Experience with MCG.

Clinical Nurse/Utilization Review

CITY OF SAN MATEO (SAN MATEO MEDICAL CENTER)
09.2015 - 03.2018
  • Performed utilization review using InterQual Criteria in an inpatient acute setting
  • Referred cases to the Medical Director when not meeting criteria or for questions regarding acuity.

Utilization Review Nurse II

HEALTH PLAN OF SAN MATEO
11.2014 - 09.2015
  • Performed utilization review for inpatient and home health reviews using Milliman Criteria Guidelines(MCG)
  • Saved the company a significant amount of money resulting in over utilization of unnecessary medical services that were being provided through home health.

Patient Care Coordinator/Case Manager

KAISER PERMANENTE
03.2010 - 06.2015
  • Role involved utilization review and discharge planning for Kaiser Permanente members and Non-Kaiser Permanente members in the Acute Care Setting
  • Used InterQual criteria.

Education

Associate Degree in Applied Science - Registered Nurse

DES MOINES AREA COMMUNITY COLLEGE
ANKENY, IA
01.1983

Skills

  • Experience using Epic, InterQual, MCG, Allscripts, MedHok, Utilization Review, Case Manager, Staff Nursing, NICU, Pediatrics, Skilled Nursing Facility, Health Plan Organization, Experience with Medicare and MediCal

Clinicalexperience

Acute Care Staff Nurse. Registered Nurse worked as a staff nurse in acute care hospital settings, sub-acute care settings, and private duty. Level 3 NICU for 12 years, PICU, and Pediatrics. Have also done Flu Shot Clinics

Timeline

RN Eligibility Enrollment

Innovage
11.2022 - Current

Utilization and Prior Authorization Review Nurse-Remote

Magellen Rx
12.2020 - 06.2021

Case Manager

All’s Well Health Care Services
01.2019 - 03.2019

Clinical Nurse/Utilization Review

CITY OF SAN MATEO (SAN MATEO MEDICAL CENTER)
09.2015 - 03.2018

Utilization Review Nurse II

HEALTH PLAN OF SAN MATEO
11.2014 - 09.2015

Patient Care Coordinator/Case Manager

KAISER PERMANENTE
03.2010 - 06.2015

Associate Degree in Applied Science - Registered Nurse

DES MOINES AREA COMMUNITY COLLEGE

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THERESA M. RICHARDSON