Experience

• 

  Jetpep

  May 2005 - Nov 2022

  Clerical
• 

  The university of alabama at birmingham

  Dec 2011 - Mar 2016

  Registered nurse
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  Shelby baptist medical center

  Mar 2016 - Jun 2016

  Registered nurse
• 

  Jackson nurse professionals

  Mar 2016 - Nov 2022

  Registered nurse
• 

  South baldwin regional medical center

  Aug 2017 - Dec 2017

  Er case manager
• 

  Ascension providence medical center

  Mar 2018 - Mar 2020

  Registered nurse

  12 bed CVICU caring for inpatient fresh open-heart surgical patients, other patients with cardiac issues along with the standard critical care patients, ventilated, on multiple drips with numerous comorbidities. Administration of medicine. In JCAHO and HIPAA standards

• 

  Ascension sacred heart hospital of pensacola

  Mar 2020 - Feb 2024

  Remote and in person position in a fast-paced organization, work independently. Daily clinical review to articulate medical necessity and levels of care through documentation; on new and concurrent patients, in the acute healthcare setting, while utilizing subject matter expertise and decision making. While using evidence-based criteria to ensure cost containment and quality assurance. Maintaining member/provider sensitive information in compliance with the Health Insurance Portability and Accountability Act (HIPAA) and professionalism with all communications through network management. Working ER cases, outpatient services, diagnostic procedures and new admissions cases. Surgical and diagnostic test with CPT coding (procedure codes), ICD-10-cm to ensure appropriate prior authorization is obtained and in the medical records. Navigation of medical information daily while demonstrating quality assurance standards within medical management systems. Works collaboratively with multidisciplinary team accurate utilization and documentation in the appropriate software, competent in Milliman Clinical Guidelines (MCG) and InterQual (IQ), using most recent criteria to clearly articulate healthcare information. Care coordination with discharge planning for any discharge needs such as home health or extended care. Reporting to a Physician Advisor for review when necessary. Telecommute and written correspondence often with insurance companies to ensure approval of case and all clinical needs when available and most current; with confidential information secured. Collaboration with discharge planning, physical therapy, and other disciplinary team members. Competent in several charting systems: Cerner, Epic, Mckension. Processed denial in a timely fashion with great overturn rate. Facilitation in obtained authorization quickly for the billing process. Providing training activities to many new employees and refreshed education for current employees, with clinical expertise. Show less

  • Lead Utilization Review Nurse

    Jun 2022 - Feb 2024

  • Utilization Review Nurse

    Mar 2020 - Feb 2024
• 

  Carecentrix

  Jan 2023 - now

  Utilization review nurse