Whitney Pollard
Walnut Springs,TX
Summary
Registered Nurse with 16+ years experience in office, clinical, and home settings providing nursing care to diverse populations. 5 years of managed care experience. Seeking an RN utilization review/preservice review position.
Overview
17
17
years of professional experience
Work History
RN Case Manager
Devoted Medical Group
Eagan, MN
08.2023 - Current
- Provided emotional support to patients coping with chronic illness or end-of-life decisions, fostering resilience during difficult times.
- Managed complex cases involving multiple comorbidities, requiring close monitoring and coordination of various healthcare services.
- Collaborated closely with physicians to develop individualized treatment plans, supporting optimal patient outcomes.
- Educated patients and families on available community resources, facilitating access to necessary support services.
- Reduced hospital readmission rates through effective case management and patient education on self-care techniques.
- Promoted adherence to treatment plans by conducting regular follow-up visits and providing ongoing support to patients.
RN Clinical Claims Review
Optum, UnitedHealth Group
Eden Prairie, MN
08.2022 - 06.2023
- Obtained necessary information to complete proper evaluation of medical claims.
- Reviewed data to verify validity of claims and determine if payment should be authorized.
- Investigated questionable claims to determine payment authorization.
- Identified and obtained evidence to ascertain claim value.
- Performed in-depth reviews to check compliance with applicable policies and regulations.
- Provided timely information and work output to supervisors and team members.
Service Coordinator-Star Plus Waiver
UnitedHealth Group
Sugar Land, TX
09.2021 - 08.2022
- Managed 70+ Medicaid members to include completion of bi-annual and yearly assessments following NCQA guidelines.
- Collaborated with various healthcare providers to facilitate delivery of services.
- Coordinated support services and optimum communication between healthcare workers and patients.
- Attended weekly team meetings and monthly department meetings.
RN Case Manager/Population Health Manager
WellMed Medical Management - United Health Group
Dallas , TX
08.2019 - 09.2021
- Collaborated with various healthcare providers to facilitate delivery of services.
- Coordinated support services and optimized communication between healthcare workers and patients.
- Optimized program resource utilization to prevent unnecessary hospital admissions.
- Created/updated patient care plans.
- Attended weekly physician update meetings.
- Attended weekly meetings to discuss patients with a recent transition of care.
Team Leader, Case Manager
DFW Home Health
Fort Worth, TX
01.2015 - 08.2019
- Team leader for up to 200 patients.
- Responsibilities included: organizing patient care, reviewing documentation, communicating with physicians, processing physician orders, leading weekly case conference for all staff, assisting with scheduling.
- Worked in the field as an RN case manager.
- Responsibilities included: performing patient assessments, oasis documentation, communicating with physicians, wound vac changes/management, wound care, venipuncture for lab draws, TPN administration, IV med administration, Picc/central line dressing changes, trach suction/care, teaching on wide variety of diseases and medications.
RN Case Manager
Always Better Care Home Health
Sherman, TX
06.2014 - 12.2014
- Performing patient assessments, oasis documentation, communicating with physicians, wound vac changes/management, wound care, venipuncture for lab draws, TPN administration, IV med administration, picc/central line dressing changes, trach suction/care, teaching on wide variety of disease processes and medications.
RN Case Manager
Integracare Home Health
Granbury, TX
12.2011 - 05.2014
- Performing patient assessments, oasis documentation, communicating with physicians, wound vac changes/management, wound care, venipuncture for lab draws, IV med administration, picc/central line dressing changes, trach suction/care, teaching on wide variety of disease processes and medications.
Medical - surgical nurse
Scott and White Hospital
Temple, TX
05.2011 - 12.2011
- Performing patient assessments, blood administration, communicating with physicians, venipuncture for lab draws, TPN administration, IV med administration, Picc/central line dressing changes, teaching on wide variety of disease processes and medications.
LVN/RN staff nurse
Glen Rose Medical Center
Glen Rose, TX
05.2008 - 04.2011
- Performing patient assessments, oasis documentation, communicating with physicians, wound vac changes/management, wound care, venipuncture for lab draws, TPN administration, Picc/central line dressing changes, trach suction/care, teaching on wide variety of disease processes and medications.
Education
Associate of Science - Nursing
McLennan Community College
Waco, TX2009
Nursing -
Hill College Vocational Nursing
Glen Rose, TX2007
Skills
- Timely/proficient documentation
- Team leading
- Organizing
- Presenting
- Scheduling
- Teaching
- Patient care planning
- Patient Management
- Patient education and counseling
- SBAR communication
Timeline
RN Case Manager
Devoted Medical Group
08.2023 - Current
RN Clinical Claims Review
Optum, UnitedHealth Group
08.2022 - 06.2023
Service Coordinator-Star Plus Waiver
UnitedHealth Group
09.2021 - 08.2022
RN Case Manager/Population Health Manager
WellMed Medical Management - United Health Group
08.2019 - 09.2021
Team Leader, Case Manager
DFW Home Health
01.2015 - 08.2019
RN Case Manager
Always Better Care Home Health
06.2014 - 12.2014
RN Case Manager
Integracare Home Health
12.2011 - 05.2014
Medical - surgical nurse
Scott and White Hospital
05.2011 - 12.2011
LVN/RN staff nurse
Glen Rose Medical Center
05.2008 - 04.2011
Associate of Science - Nursing
McLennan Community College
Nursing -
Hill College Vocational Nursing