Tracy Griffith
Land O Lakes,USA
Summary
Dynamic Clinical Review Nurse with extensive experience at Care Centrix, excelling in medical necessity reviews and compliance analysis. Proven ability to enhance patient care planning through critical thinking and process improvement. Adept at mentoring teams and fostering collaboration, ensuring optimal outcomes in utilization management and clinical documentation.
Overview
23
23
years of professional experience
1
1
Certification
Work History
Clinical Review Nurse- Commercial DME
Care Centrix
Tampa, FL
11.2009 - Current
- Reviewed clinical information to approve medical necessity for requested services, ensuring safe discharge.
- Performed medical necessity reviews of inpatient and outpatient services to ensure compliance with relevant regulations and standards.
- Executed thorough clinical reviews of patient care plans to support effective treatment strategies.
- Conducted utilization management activities such as pre-certification and pre-authorization requests for services rendered by health care providers.
- Coordinate daily with medical directors, health care providers, Nurse Liaisons, and other utilization review nurses to provide the best care with the highest value to the patient.
- Conducted comprehensive reviews of documentation submitted by providers to facilitate timely reimbursements.
- Analyzed medical documentation for compliance with regulatory standards.
- Developed training materials for nursing staff on updated policies and procedures.
Licensed Practical Nurse, Triage
Bay Area Urgent Care
Wesley Chapel, FL
07.2006 - 02.2010
- Act as a preceptor to new employees, teaching practical applications, and maintaining quality control.
- Administered injections and immunizations safely per protocol; monitored patients' response and reported any changes promptly.
- Maintained accurate documentation for each patient visit and updated electronic health records accordingly.
- Conducted patient triage assessments to determine urgency of care needs.
- Documented patient histories and vital signs in electronic health records.
- Educated patients on health management and follow-up care instructions.
- Assisted with minor procedures under the direction of registered nurses.
- Ensured compliance with safety protocols and infection control measures.
Licensed Practical Nurse- PCU
Brandon Hospital
Brandon, FL
07.2003 - 04.2007
- Monitored patient conditions throughout shift; reported any changes in condition promptly to medical staff.
- Provided direct patient care such as wound dressing changes, administering medications and IV therapy.
- Assessed vital signs, collected specimens for laboratory testing, monitored fluid intake and output levels, recorded medical history information.
- Utilized critical thinking skills to assess complex situations and develop solutions.
- Collaborated with physicians and other healthcare professionals to deliver quality care.
Education
LPN Program -
Erwin Technical Center
FL12-2002
Skills
- Utilization management
- Clinical documentation
- Case management
- Compliance analysis
- Patient care planning
- Process improvement
- Necessity review
- HIPAA compliance
- Team collaboration
- Critical thinking
- Problem solving
- Continuing education
Certification
- Current LPN license in the State of Florida
- BLS
- IV Certified
- 60hr Pharmacology Certificate
References
References available upon request
Timeline
Clinical Review Nurse- Commercial DME
Care Centrix
11.2009 - Current
Licensed Practical Nurse, Triage
Bay Area Urgent Care
07.2006 - 02.2010
Licensed Practical Nurse- PCU
Brandon Hospital
07.2003 - 04.2007
LPN Program -
Erwin Technical Center