Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

VERSHAY HUNTER

Houston,TX

Summary

Practical Nurse with 15 years of experience delivering comprehensive patient care across diverse healthcare settings. Proven ability to collaborate with healthcare teams to create effective care plans and advocate for patient needs. Strong adherence to patient privacy protocols and medical charting standards, ensuring compliance and accuracy. Demonstrates exceptional problem-solving skills and maintains composure in high-pressure situations, seeking a role as a Utilization Review Nurse.

Overview

8
8
years of professional experience
1
1
Certification

Work History

Utilization Review Nurse

Wellmed
Houston, TX
10.2024 - Current
  • Ensured compliance with HIPAA, state, and federal regulations for clinical programs.
  • Maintained detailed records of audits, investigations, and compliance activities for accountability.
  • Conducted medical necessity reviews within designated timeframes, following established policies.
  • Facilitated resolution of escalated cases through collaboration with client personnel and UM Leadership.
  • Collaborated with healthcare professionals to gather vital information and recommend care pathways.
  • Coordinated with facilities to secure approvals and organize peer reviews as needed.
  • Gained extensive experience in working with insurance processes.
  • Monitored pre-authorization requests to ensure that all necessary information was received prior to approval or denial of services.
  • Performed discharge planning including referrals for post-acute care services when appropriate.
  • Communicated with external partners such as managed care organizations or vendors on a regular basis.
  • Maintained up-to-date knowledge of health plan benefits, policies, procedures, regulations, coding guidelines.
  • Facilitated communication between payers, providers and patients concerning authorization issues or concerns.

Case Manager

Personify Health
Houston, TX
11.2022 - Current
  • Managed cases telephonically following established company guidelines and healthcare standards.
  • Conducted comprehensive assessments covering physical, psychosocial, emotional, spiritual, environmental, and financial needs.
  • Utilized claims processing tools to analyze paid claim data and identify program participation opportunities.
  • Negotiated cost management strategies to enhance quality outcomes and documented findings in monthly reviews.
  • Performed Utilization Review for assigned members to ensure appropriate care levels.
  • Responded to patient calls, resolved issues, and provided assistance within facility parameters.
  • Consistently met daily, weekly, and monthly productivity, quality, and turnaround time requirements.

Licensed Practical Nurse

Cleveland Clinic
Twins, Ohio
07.2017 - 10.2025
  • Collected and documented objective and subjective patient data and observations.
  • Contributed health information to nursing assessments, reporting findings to RN or authorized provider.
  • Implemented current nursing care plans under direction of RN or authorized provider.
  • Documented and communicated patient responses to care plans, monitoring for adverse reactions.
  • Assisted in revising nursing care plans based on patient needs and observations.
  • Educated patients and families about health information and care processes.
  • Engaged in professional growth within nursing field to enhance skills and knowledge.
  • Participated positively in departmental orientation for new employees, sharing expertise.

Education

Diploma - Practical Nursing

MDT College of Health Sciences, Inc.
Cleveland, OH
05.2010

Skills

  • Multi-tasking and prioritization
  • Patient triage
  • Regulatory compliance and requirements
  • Family education
  • Staff direction and delegation
  • Symptom tracking
  • Physician assistance
  • Critical thinking skills
  • Microsoft Office proficiency
  • Time management strategies
  • Patient records maintenance
  • Appointment scheduling
  • Attention to detail
  • Clinical documentation and charting
  • EMR system management
  • Medical necessity evaluation
  • Care coordination strategies
  • Discharge planning processes
  • Utilization management techniques
  • Data documentation practices
  • Claims processing expertise
  • Effective communication skills
  • Inpatient care
  • Outpatient care
  • Interpersonal and written communication
  • Telephonic nursing
  • Clinical assessment

Certification

  • Compact State Licensed Vocational Nurse of Texas
  • Licensed Vocational Nurse of California

Timeline

Utilization Review Nurse

Wellmed
10.2024 - Current

Case Manager

Personify Health
11.2022 - Current

Licensed Practical Nurse

Cleveland Clinic
07.2017 - 10.2025

Diploma - Practical Nursing

MDT College of Health Sciences, Inc.

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