accomplished nursing professional with more than 6 years experience in hospital, clinical, and private practice settings. possess excellent team leadership skills and has 1 year of nurse management experience. adapt quickly to new work environments and a fast learner. take on leadership roles and works very well independently. view any role as representing the organization in all aspects. licensed practical nurse in the state of tn and fl. has inter-qual certification. proficient in careplanner for case management, microsoft office, and xcelys authorizations and claims systems.
windsor medicare extra, nashville, tn 2008-2009
utilization review nurse (2009)
verify medical records and authorization requests from providers, hospitals, and medical facilities by utilizing interqual criteria and clinical experience.
identify correct clinical settings for surgeries as well as outpatient procedures.
processed retro authorizations and initiated the appeals process from outpatient providers.
nurse case manager (2008)
complied with cms guidelines to evaluate individual cases for quality of care, document control issues, and referral cases with questionable quality of care to the director of quality improvement.
created and distributed monthly reports to provide updates on patient s progress.
identified high-risk or high-cost patients for possible case management intervention and aligned patients with chronic disease for possible disease management intervention.
collaborated with medical service providers and equipment companies to facilitate communication, referrals, discharge planning development, and alternative treatment plan development.
suncrest home health, madison, tn 2008
private duty nurse
serve as liaison with recently discharged patients from inpatient settings in their home to provide home health care including medication administration, wound care treatments, adls, physical therapy, iv medication administration, and case management as needed.
electrophysiology doctor, nashville, tn 2007-2008
conducted diagnostic testing for patients with pacemakers and icd devices and completed lab requests for 1 of only 2 ep physicians in the nashville area.
scheduled procedures and traveled between 6 outlying clinics.
obtained preauthorization from insurance companies.
hca, nashville, tn 2003-2008
clinical hospital nurse
provided clinical nursing on medical/surgical, orthopedic/neurology, cardiac, msicu, renal, pulmonary, and telemetry floors.
performed patient vents, abgs, iv drips, feeding tube, g tube, and chest tube insertions and served as part of the crash team.
excelsior college, currently a.s.n rn
lively technical college, licensed practical nurse certification, 2002
tallahassee community college, associates of arts, 2001
business professional of america, nashville city club
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