Tonya Vike
Edgerton,WI
Summary
Organized and knowledgeable Registered Nurse experienced in treating and caring for patients. Successful in providing fast and accurate assessments and working calmly under pressure. Recognized for collaborating well with doctors to maintain top-notch healthcare practices.
Overview
1
1
Certification
28
28
years of professional experience
Work History
Registered Nurse
SSM Health and Optum Healthcare
01.2020 - Current
- Utilization Review RN: Review for medical necessity for acute care services, use evidence based guidelines to recommend level of care, resource to medical staff r/t admission qualifications, resource utilization, coverage determinations, documentation improvement opportunities.
- I initially started at SSM, they contracted us to Optum in Feb 2022, then cancelled the contract, sending us all back to SSM in December of 2023.
- Reason for leaving: I have not left this position.
Registered Nurse
01.2000 - 01.2020
- Case Manager: scheduling, hiring and termination of staff, planning and implementing of patient’s specific plan of care, airway management, ventilator management, vital signs, nutrition, gastrointestinal and urinary management, diabetes management, medication administration, communication with staff and physicians and all direct personal cares.
- Supervisor: State of Wisconsin
- Reason for Leaving: Due to the ever changing conditions of patients on ventilators, the opportunity to work full time may not always be available. So I was looking for a more stable working environment. I was also seeking benefits for myself and my family.
Registered Nurse
Aetna Insurance
09.2018 - 01.2019
- Field Case Manager: Facilitate the delivery of appropriate benefits and or healthcare information which determines the eligibility for benefits while promoting wellness activities. Develop, implement and support health strategies, tactics, policies and programs to ensure the delivery of benefits, and to establish overall member wellness and timely recovery. I also complete face to face visits with our members to ensure patient safety and satisfaction with our program.
- Reason for leaving: I wanted more flexibility of hours. Returning to private duty nursing.
Registered Nurse
Wisconsin Physicians Insurance Company
04.2015 - 02.2016
- Utilization Review/Integrated Care Coordinator: Pre procedure prior authorization, precert, emergent and concurrent inpatient hospitalization, SNF, Home Health Services and DME review for medical necessity. We make our determinations based on WPS Medical policies, Milliman and Hayes criteria. Although I review all ages, I am in charge of all premature and NICU babies.
- Reason for leaving: For family reasons, I needed to have a more flexible work schedule or the potential to work from home. I returned to providing home care for ventilator patients as I was able to schedule my own work hours.
Registered Nurse
Wisconsin Physician Insurance Company
03.2014 - 04.2015
- Medical Review Analyst: Review of Medicare Part B claims that were billed by physicians and determining if they are medically necessary and payable by Medicare Part B. This is a position that requires intensive precision and knowledge of Medicare policies. We look for fraudulence and also provide additional payments in some circumstances to the providers.
- Supervisors: Dawn Ashenbrenner, Paul Hamre
- Reason for leaving: Better opportunity available within the company.
Registered Nurse
UW Health Stoughton
01.2008 - 01.2010
- Phone triage, assisting physicians with procedures.
- Supervisor: Joe Alexander
- Reason for leaving: This was a part time position only. I left to earn more money as an independent nurse.
Registered Nurse
Meriter Hospital
01.2006 - 01.2008
- I started with Meriter Home Health and later transferred to Meriter Heart Center. At Meriter Home Health I worked as an Admissions Rn and interim Case Manager. I collected information and entered it into the computer for the Case Coordinator to organize the patient’s plan of care. I also provided direct care such as IV therapy, wound care, vital signs, and safety checks. Collecting the information, proper documentation of the pts condition, and coding of the information was very important for reimbursement of our services.
- At Meriter Heart Center I worked as a Preparation and Recovery Nurse. We prepared and recovered patients for Cardiac Catheterizations, stent placements, cardioversions, transesophageal echocardiograms, pacemaker placements and electrophysiological studies and procedures.
- Supervisors: Dottie Krull and Lindsey Rosemeyer
- Reason for leaving: I left Meriter Home Health because I did not feel safe in some situations. I often had to visit patients in the middle of the night alone. I left the Heart Center because it was a new unit, and there were not enough patients to keep me working full time. I either had to use my sick or personal time to cover my expenses, or at times I was floated to other floors.
Registered Nurse
Intellistaff Healthcare
01.2000 - 01.2006
- As above at the Monroe Clinic Hospital. However, I was floated to perform these tasks at several different hospitals per week including: Meriter, Janesville, Columbus, Sauk Prairie, back to Monroe and the UW.
- Supervisor: Angie Krajowski
- Reason for leaving: Hospitals mandating their own nurses to cover nursing shortage, not enough work hours available.
Registered Nurse
Monroe Clinic Hospital
01.1999 - 01.2000
- Rotating Charge Nurse and Intensive Care Nurse: direct patient care: Assessing a patient’s condition and planning and implementing patient care plans, treating wounds and providing advanced life support, assisting physicians in performing procedures, observing and recording patient vital signs, ensuring that ventilators, monitors and other types of medical equipment function properly, administering intravenous fluids and medications, ordering diagnostic tests, collaborating with fellow members of the critical care team, responding to life-threatening situations, using nursing standards and protocols for treatment, acting as patient advocate, and finally providing education and support to the patient’s families.
- Supervisor: Amy Lowry
- Reason for leaving: Moving to Edgerton
Education
Bachelor of Science - Nursing
University of Wisconsin Milwaukee
01-2019
Associates Degree - Nursing
Waukesha County Technical College
01-1999
Associates Degree - Liberal Arts and Science
Madison Area Technical College
01-1994
High School Diploma -
Monona Grove High School
01-1988
Skills
- Clinical documentation
- Care coordination
- Patient assessment
- Medication administration
- Chart review
- Evidence-based practice
Certification
- CPC Medical Coding Specialist, AAPC, 10/01/15
- Respiratory Care Specialist, State of Wisconsin, 01/01/00
Timeline
Registered Nurse
SSM Health and Optum Healthcare
01.2020 - Current
Registered Nurse
Aetna Insurance
09.2018 - 01.2019
Registered Nurse
Wisconsin Physicians Insurance Company
04.2015 - 02.2016
Registered Nurse
Wisconsin Physician Insurance Company
03.2014 - 04.2015
Registered Nurse
UW Health Stoughton
01.2008 - 01.2010
Registered Nurse
Meriter Hospital
01.2006 - 01.2008
Registered Nurse
01.2000 - 01.2020
Registered Nurse
Intellistaff Healthcare
01.2000 - 01.2006
Registered Nurse
Monroe Clinic Hospital
01.1999 - 01.2000
Bachelor of Science - Nursing
University of Wisconsin Milwaukee
Associates Degree - Nursing
Waukesha County Technical College
Associates Degree - Liberal Arts and Science
Madison Area Technical College
High School Diploma -
Monona Grove High School