Vernita Arrington
BIRMINGHAM,ALABAMA
Summary
Seasoned Utilization Review Nurse II from Children's of Alabama Hospital, adept in Medicaid and Medicare, with a proven track record in enhancing care quality and cost control. Excels in clinical assessment and interpersonal communication, significantly improving patient service and compliance with HIPAA. Expert in insurance verification and utilization review, ensuring efficient patient care processes.
Overview
29
29
years of professional experience
Work History
Utilization Review Nurse II
Children's of Alabama Hospital
Birmingham , AL
03.2019 - 05.2023
- Assessed patient medical records to determine the appropriateness of requested services and procedures.
- Conducted reviews of inpatient utilization for compliance with admission criteria and concurrent review requirements.
- Collaborated with multidisciplinary teams on developing strategies for improving care quality and controlling costs.
- Reviewed denial letters issued by insurance companies to ensure that they were appropriate and timely.
- Provided education to providers regarding utilization management processes and protocols.
- Evaluated clinical documentation for accuracy and completeness in order to make decisions about coverage determinations.
- Monitored pre-authorization requests to ensure that all necessary information was received prior to approval or denial of services.
- Referred cases to secondary review for failure to meet criteria.
- Collaborated with case managers to facilitate timely discharge planning and transition of care.
- Contacted insurance carriers to obtain authorizations for services delivered to patients.
Supervisor Nurse (Charge)
Children's of Alabama Hospital
Birmingham, AL
01.2013 - 03.2019
- Directed and supervised team of 15 employees in daily operations.
- Developed and implemented operational policies and procedures to ensure efficiency and accuracy of workflows.
- Maintained accurate records of employee performance, attendance, leave requests, and disciplinary actions.
Registered Nurse, Medical-Surgical Unit, Pediatric
Children's of Alabama Hospital
Birmingham, AL
07.1994 - 01.2013
- Provided patient care and education to patients with chronic illnesses.
- Assessed, planned, implemented and evaluated nursing care for assigned patients.
- Performed triage assessments of walk-in patients in a clinic setting.
Education
Associate of Applied Science - Nursing
Lawson State Community College
Birmingham, AL05-1994
Skills
- Utilization review
- Insurance Verification
- Medicaid knowledge
- Inpatient Care
- Medicare knowledge
- Clinical assessment
- Interpersonal and written communication
- HIPAA Compliance
- Communication
Affiliations
- Tutors second grade reading through Birmingham Stair Reading program and in individual classrooms.
- Serves on the Stonehedge Homeowners Association as Treasurer.
- Participates in community assoications to assist enhancing educational aspects for children.
Timeline
Utilization Review Nurse II
Children's of Alabama Hospital
03.2019 - 05.2023
Supervisor Nurse (Charge)
Children's of Alabama Hospital
01.2013 - 03.2019
Registered Nurse, Medical-Surgical Unit, Pediatric
Children's of Alabama Hospital
07.1994 - 01.2013
Associate of Applied Science - Nursing
Lawson State Community College
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