Tina Wisdom
Registered Nurse
Louisville,Alabama
Summary
Results-driven Utilization Management Nurse with a strong background in patient care coordination and strategic utilization management. Recognized for effectively reducing hospital readmissions through collaborative teamwork. A critical thinker and adept problem-solver, skilled in dynamic patient care planning and well-versed in Medicare guidelines, fostering excellent rapport with treating facilities. Committed to professional integrity and continuous development while prioritizing quality outcomes and patient advocacy. Known for exceptional organizational abilities, adaptability to new environments, and a positive attitude that enhances team success and drives ongoing growth.
Overview
14
14
years of professional experience
2
2
Certifications
Work History
Utilization Management Nurse
Humana
09.2018 - Current
- Reduced hospital readmissions through effective discharge planning and coordination of post-discharge care.
- Strengthened relationships with community resources by networking, attending meetings, and establishing collaborative partnerships.
- Served as a trusted liaison between patients, healthcare providers, and insurance carriers to facilitate efficient care delivery processes.
- Enhanced patient care by conducting comprehensive assessments and implementing appropriate interventions.
- Team MCG SME for the last 2 years
- Promoted a positive work environment by mentoring new nurses and serving as a resource for clinical questions and concerns.
- Maintained up-to-date knowledge of payer-specific guidelines to ensure accurate authorizations for medically necessary services.
- Applied critical thinking skills to assess complex medical cases and determine appropriate levels of care in accordance with industry benchmarks.
- Ensured compliance with regulatory guidelines by staying current on industry standards and participating in ongoing education opportunities.
- Contributed to team success by consistently meeting productivity goals while maintaining high-quality standards in job performance.
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Performed admission reviews based for medical necessity based upon CMS specification.
- Documented treatments delivered, medications and IVs administered, discharge instructions, and follow-up care.
- Increased efficiency in case management documentation by maintaining organized records and utilizing electronic medical record systems.
- Participated in quality improvement initiatives to enhance the overall standard of care within the organization.
- Streamlined utilization review processes by collaborating with interdisciplinary teams to develop individualized care plans.
- Expedited claim resolution by effectively communicating clinical rationale for treatment recommendations to insurance reviewers.
- Submitted cases for criteria failures and helped facilitate resolutions and approvals.
Charge Nurse
Southeast Health Medical Center
01.2014 - 09.2018
- Trained new nurses in proper techniques, care standards, operational procedures, and safety protocols.
- Coordinated nursing care on unit through staff assignments, assisting and rounding with physicians, monitoring patient orders, and communicating with ancillary departments.
- Conducted daily shift briefs to inform staff of changes in patient care assignments.
- Mentored and supervised junior nurses, fostering a supportive and professional work environment.
- Optimized patient satisfaction through timely response to concerns and effective communication among staff members.
- Promoted a safe working environment by adhering to infection control policies and regularly reviewing safety protocols.
- Collaborated with other healthcare professionals to provide quality patient care.
- Served as a liaison between nursing staff, physicians, and management, fostering open communication channels among all parties involved in patient care.
- Championed a positive work culture by recognizing exemplary performance from team members and addressing conflicts promptly when they arose.
- Supervised and managed daily scheduling, tasking, and administration.
- Managed staffing schedules, ensuring adequate coverage while minimizing overtime expenses.
- Coordinated discharge planning, collaborating with patients, families, and healthcare providers to ensure seamless transitions of care.
- Contributed significantly towards Joint Commission accreditation compliance through regular audits, staff education and process improvement recommendations.
- Collaborated with interdisciplinary healthcare teams to develop and implement individualized care plans for patients.
- Optimized resource allocation, ensuring all patients received timely and adequate care without overburdening staff.
- Maintained high standards of patient care during high-volume shifts, managing patient assignments to optimize nurse workload.
- Enhanced patient satisfaction by personalizing care plans based on individual patient needs and preferences.
- Advocated for patient needs, resulting in improved patient outcomes and satisfaction.
- Quickly responded to situations impacting safety and security to unit, actualizing crisis prevention interventions to control and de-escalate situations.
- Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
- Educated family members and caregivers on patient care instructions.
- Delivered high level of quality care to diverse populations while overseeing patient admission and triaging based on acuity and appropriate department admission.
- Monitored patient reactions after administering medications and IV therapies.
- Explained course of care and medication side effects to patients and caregivers in easy-to-understand terms.
- Documented treatments delivered, medications and IVs administered, discharge instructions, and follow-up care.
- Offered exceptional care and support to individuals recovering from acute incidents and dealing with chronic conditions.
- Evaluated patient histories, complaints, and current symptoms.
- Equipped patients with tools and knowledge needed for speedy and sustained recovery.
- Promoted patient and family comfort during challenging recoveries to enhance healing and eliminate non-compliance problems.
- Managed patients recovering from medical or surgical procedures.
- Performed frequent checks on life support equipment and made necessary adjustments to preserve optimal patient conditions.
- Sustained quality standards by performing routine medication audits and upholding internal and industry best practices.
- Conveyed treatment options, diagnosis information and home care techniques to patients and caregivers to continue care consistency.
- Reported findings to quality departments after conducting routine restraint audits and worked with team to devise corrective actions for deficiencies.
Pediatric Registered Nurse
Southeast Health Medical Center
12.2011 - 01.2014
- Educated children about their medical conditions in age-appropriate language, empowering them to take an active role in managing their health.
- Administered vaccinations and medications accurately, ensuring optimal treatment efficacy and patient safety.
- Demonstrated excellent time management skills by prioritizing tasks and efficiently delegating responsibilities, ensuring all patients received timely care.
- Utilized critical thinking skills to quickly respond to emergency situations, stabilizing patients until further medical assistance arrived.
- Developed strong rapport with patients and families, fostering trust and confidence in the nursing team’s abilities.
- Delivered high-quality patient care consistently, adhering to unit protocols and hospital policies while maintaining a professional demeanor under pressure.
- Enhanced patient satisfaction through compassionate and empathetic communication with children and families.
- Advocated for patients’ needs during multidisciplinary meetings, ensuring appropriate resources were allocated for optimal care outcomes.
- Monitored vital signs closely during procedures or treatments, intervening swiftly when necessary to maintain patient stability.
- Maintained accurate documentation of patient progress, enabling informed decision-making among healthcare providers.
- Participated in ongoing professional development to stay abreast of the latest advances in pediatric nursing practices.
- Conducted thorough physical assessments to identify potential health concerns before they escalated into more serious conditions.
- Implemented evidence-based nursing practices to optimize patient care quality and effectiveness.
- Managed complex cases involving multiple specialists while maintaining clear communication channels between all parties involved in a child’s care plan.
- Collaborated with interdisciplinary teams for comprehensive patient care, resulting in improved overall health outcomes.
- Mentored new nurses and provided guidance on best practices in pediatric nursing, elevating the standard of care within the department.
- Promoted healthy lifestyles through teaching preventative measures such as proper nutrition, exercise habits, and hygiene routines.
- Provided education to parents on proper home care techniques, minimizing hospital readmissions and promoting long-term wellbeing.
- Maintained continuous growth of professional knowledge and competencies through ongoing education opportunities.
- Improved patient outcomes by developing individualized care plans tailored to the needs of pediatric patients.
- Interacted with child welfare personnel and social workers in cases involving concerns about overall well-being.
- Advocated for patient needs with healthcare providers, securing necessary interventions for optimal health results.
- Enhanced infection control measures, significantly decreasing incidence of hospital-acquired infections in pediatric unit.
- Tailored nutritional plans for pediatric patients with specific dietary needs, contributing to overall health and faster recovery.
- Supported patients through pain management techniques, enhancing comfort and reducing anxiety during treatment.
- Enhanced patient recovery by developing and implementing individualized care plans for pediatric patients.
- Utilized up-to-date technology for patient monitoring and data management, ensuring accurate and efficient care delivery.
- Streamlined patient admission and discharge processes, significantly reducing wait times and improving patient flow.
- Participated in continuous education to remain current with pediatric nursing best practices, directly impacting patient care quality.
- Monitored patient progress and adjusted care plans accordingly, ensuring timely recovery milestones were met.
- Improved patient and family satisfaction with compassionate and effective communication about treatment plans.
- Explained course of care and medication side effects to patients and caregivers in easy-to-understand terms.
Education
Bachelor of Science - Nursing
Troy University
Troy, AL12.2011
Skills
Protecting Patient Information
Certification
MCG certification
Timeline
Utilization Management Nurse
Humana
09.2018 - Current
Charge Nurse
Southeast Health Medical Center
01.2014 - 09.2018
Pediatric Registered Nurse
Southeast Health Medical Center
12.2011 - 01.2014
Bachelor of Science - Nursing
Troy University
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