Wilhelmina P. Mckinnon
San Antonio
Summary
- Dedicated utilization review nurse with 8 years of experience assessing medical necessity, ensuring compliance with healthcare regulations, and optimizing patient care while controlling costs. Skilled in case review, insurance authorizations, and collaborative care planning. Seeking to leverage expertise in clinical assessment and utilization management to support efficiency and quality outcomes in a healthcare organization.
Overview
9
9
years of professional experience
8
8
years of post-secondary education
Work History
UM Care Review Clinician, Inpatient and SNF
Brand New Day-Bright Healthcare-Molina Healthcare
Long Beach
11.2016 - Current
- Monitored client progress through regular follow-up meetings or phone calls.
- Developed and implemented individualized treatment plans to meet the needs of clients.
- assesses patient cases for the medical necessity and appropriateness of healthcare services, ensuring compliance with clinical guidelines and insurance policies, evaluating medical records, collaborating with physicians, coordinating care plans, identifying opportunities for cost-effectiveness, and documenting activities accurately.
- Participated in weekly case conferences with other clinicians to discuss progress of clients' treatment plans.
- Determined most appropriate treatment plan and implemented course of action.
Education
Master of Health Administration - Healthcare Administration
University of Phoenix
Online , AZ 08.1998 - 08.2001
Bachelor of Science - Nursing
La Salle Dasmarinas University
Dasmarinas, Philippines 04.1980 - 05.1985
Skills
- Treatment planning
- Case assessment
- Compliance evaluation
- Care coordination
- Multidisciplinary collaboration
- Progress monitoring
- Client relationship management
- Problem solving
- Attention to detail
- Effective communication
- Critical thinking
- Time management
- Clinical documentation
- Patient evaluations
- Patient assessments
- Ethical practice
- Clinical assessment
- Treatment determination
- Patient care
- Patient relationship management
- Healthcare systems navigation
- Multidisciplinary approach
- Managing patient cases
- HIPAA
- Therapeutic techniques
- Evidence-based practice
- Patient relations
- Patient education
- Clinical education
- Patient health education
- Patient safety
- EMR
- Patient diagnosis
- Clinical decision making
- Staff collaboration
- Diagnosis accuracy
Timeline
UM Care Review Clinician, Inpatient and SNF
Brand New Day-Bright Healthcare-Molina Healthcare
11.2016 - Current
Master of Health Administration - Healthcare Administration
University of Phoenix
08.1998 - 08.2001
Bachelor of Science - Nursing
La Salle Dasmarinas University
04.1980 - 05.1985