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Skillful Utilization Review Nurse resume

Cynthia Marshall
Professional Summary
Responsible RN  with excellent communication skills demonstrated by over 30 years of experience in healthcare.
Skills
  • Preceptor
  • Successfully directs staff meetings
  • High level of autonomy
  • Problem resolution capability
  • Adept at prioritizing/managing deadlines
  • Adept at prioritizing/managing deadlines
  • Strong clinical judgment
  • Palliative care awareness
  • Problem resolution capability
  • Professional bedside manner
Work History
Fidelis Care - Buffalo Regional Office Supervisor , Medical Management | Getzville, New York, United States | December 2016 - August 2017
    Supervisor with 11 direct reports responsible for case review , preauthorization and appeals for the Medicare population . Responsibilities include work assignments , staff assistance , collaboration with other departments and the Medical Directors to ensure Medicare timeframes are met . Additional responsibilities  to review Medical and claim appeals .
  • Self-directed with astute judgment skills. High level of personal accountability.
  • Processed monthly reports for department performance.
  • Demonstrated ability to lead and motivate outstanding healthcare teams.
  • Participated in unit-based Quality Assurance Program.
  • Delegated staff nurse duties.
Fidelis Care - Buffalo Regional Office Clinical Auditor , Medical Management | Getzville, New York, United States | November 2015 Responsible for monthly audits for clinical review staff . Also participated in External audit case preparation , focused audit reviews and direct collaboration with Management staff to correct errors and re educate . 
Aetna Inc. Utilization Management Nurse | Hartford, Connecticut, United States | August 2010 - November 2015

Clinical review of medical management cases for hospital admissions, pre hospital admissions, therapies and Rehabilitation . Coordinated member care with Medical Directors and Case management to ensure smooth transition of care for members .

Was main preceptor for new UM staff and was part of the team assigned to onboard a new site in Atlanta where I was the UM preceptor for 10 new staff . 

Working with a peer provided  educational updates to staff on new processes using both meetings and power point presentations.


Empire Blue Cross Blue Shield Multiple RN positions | Albany, New York, United States | January 1998 - April 2010

I had multiple roles at this company including : 

Utilization Management 

Case Management 

Appeals Coordinator 

Selected to be part of  a Radiology Review pilot program 



Fidelis Care - Buffalo Regional Office Utilization Review Nurse | Getzville, NY | September 2017 - Current Review of Pre service and Concurrent requests for Subacute and Acute rehabilitation for Medicaid and Medicare lines of business.
Collaborated with FIdelis Medical Directors.
Worked with providers in assigned geographic areas to ensure appropriate length of stay and safe discharge. 
Collaborated with Case Management on complex cases. 
Adhered  to HIPAA regulations and NCQA timeframes to complete requests . 
Education
Associate of Science Registered Nurse Buffalo General Hospital School of Nursing Buffalo NY , | 1977 I actually received a diploma in Nursing .
Additional Information
Additional work history and references available on request
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