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Skillful Utilization Management Nurse resume
Innovative, customer-oriented healthcare clinician with background in managed, ambulatory and long-term care. Strong background in quality assurance, claims analysis and management principles and practices. Seeking a leadership role within an integrated delivery system.
Strong presentation skills
Effective staff coach
Quality improvement competency
Medicaid Management Information Systems
Independent judgment and decision making
Resource management expertise
Knowledge of Medicaid statutes and regulations
Promotes positive behavior
Planning and development
Telephonic Care Manager, 09/2013
to Current AmeriHealth Caritas Family of Companies – Philadelphia,
Processed monthly reports for department performance.
Coordinated Quality Improvement Activities (QIA's) to identify performance areas for improvement.
Authorized drug refills and provided detailed prescription information to pharmacies.
Specialized in the nursing care of patients with chemical dependency.
Effective counseling in health maintenance and disease management.
Developed patient care plans, including assessments, evaluations and nursing diagnoses.
Documented patient information obtained from interviews.
Managed care for post-operative patients through discharge.
Emergency Department Registered Nurse, 06/2008
to 10/2013 Howard University – Washington,
Followed infection control procedures.
Developed and produced all office flyer notifications for important policy changes, office news and events.
Assessed need for, ordered, obtained and interpreted appropriate lab tests.
Counseled and educated patients about reproductive health issues and wellness. Expertise in STDs, HIV and family planning.
Performed lab tests and communicated results.
Extensive experience working in homes with disabled children and adults.
Assisted doctors with surgeries and non-invasive procedures.
Performed monthly inventory and maintained office and medical supply counts.
Utilization Management Nurse Consultant, 07/2008
to 11/2011 Medical Case Management Group – Windham, ,
Consulted and coordinated with health care team members to assess, plan, implement and evaluate patient care plans
Interviewed or corresponded with physicians to correct errors or omissions and to investigate questionable claims;
Observe nurses and visit patients to ensure proper nursing care.
Initiated audit process to evaluate thoroughness of documentation and maintenance of facility standards.
Administered job knowledge assessments and competency testing for certification-level training.
Managed and directed fiscal operations, including planning budgets, authorizing expenditures, accounting, establishing service rates and coordinating financial reporting.
Organized the department in accordance with administrative guidelines in order to provide specified nursing services to meet the legal, organizational and medical staff guidelines.
Continually maintained and improved the company's reputation and positive image in the markets served.
MBA: Healthcare Management,
2018 (Projected) Ashworth College - Norcross,
Associate of Science: RN,
2008 Excelsior College - Albany,
Bachelor of Science: 2011 Ashworth College - Norcross,