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Candidate's Name , RNUTILIZATION MANAGEMENT REVIEW RNCONTACTPHONE NUMBER AVAILABLEEMAIL AVAILABLEPROFILETo obtain a position as a Registered Nurse and build on years of nursing experience by providing the highest level of patient care and maintaining the mission and vision of this facilitySKILLSExcelled in MCGKnowledgeable in InterQualSkilled in verbal & written communication skillsExperienced in NCQA and URAC accreditations.Knowledgeable in HIPAA rules and regulationsKnowledgeable in CMS, HHCS, Office of Superintendent and DOD regulations.Proven abilities to problem solve, organize, & prioritize26 years of experience direct patient care: medical inpatient; ICU, telemetry, hospice, behavior health, home health/hospice, insuranceManaged multiple roles within the Christus health plan; UR/UM and transplant coordination. Followed guidelines for 4 different health plans, including an Indigent plan, Health Exchange plan, Medicare Advantage plan, and Tricare plan.Effective communicator and educator to educate patients and families regarding diagnosis, treatments, medication management, signs and symptoms, and resources. communication with medical directors with written reviews for medical necessity or denial recommendationsEXPERIENCEChristus Health SystemUtilization Management and Utilization Review RN03/2018-Present Review Clinical for medical necessity based upon evidence based clinical criteria and standard within governmental and contractual guidelines. Collaboration and coordination with case management for safe transition to next level of care Performs selected provider calls to address post-hospital discharge services, redirection to in network providers for appropriate steerage, durable equipment usage and utilization of other medical services and/or procedures and other telephonic follow-up as identified by the UM/UR Nurse, the medical Management Clinical Supervisor or Medical Management Director Transplant coordination with third party contract administrators, finding the center of excellence Transplant center to meet patient needs safely, and effectively; preventing delay in careTexas health Cleburne PACUPost Anesthesia Care Unit; Charge, RN03/2017-02/2018 Post Op Endoscopy Phase I and Phase II Moderate sedation for radiology procedures Monitor post-surgical patients (all ages); including general and moderate sedationAngel Care Home HealthPRN, Case Manager; RN01/2017-01/2018 In depth knowledge of developing patient specific care plans Functional knowledge of nursing practices and their applications Hands on experience identifying patient needs and validating medical diagnoses Devised and implemented individual plans of care to cater to specific needs of patientsUniversity Medical CenterPost Anesthesia Care Unit; RN01/2017-03/2017 Level 1 Trauma Hospital Care of multiple post-surgical patients Rhythms floated to outpatient surgery Phase I and Phase IIBeyond Faith Home Care and RehabCase Manager; RN04/2014-11/2015 Devised and implemented individuals plans of care to cater to specific needs of patients Functional knowledge of nursing practices and their applicationsCovenant Health SystemMedical Intensive Care Unit; RN02/2012-04/2014 Worked as part of an interdisciplinary team to care for critical patients Monitor Telemetry and respond to emergent calls in life saving situations Educate and support patients and families Assisted physicians with procedures and treatment protocols Rapid Response Team memberCovenant Health SystemHOSPICE OF LUBBOCK; LVN09/2007-01/2012 Provide symptom management, teaching and care of the dying patient Answering questions to clients concerning admission to hospice Managing and scheduling visits for admissions Gathering patient information and obtaining medical records Using proper IDC-9/10 codesInterim Health CareLVN Case Manager2001-2007 Communicated effectively with clients, medical providers, administration and social services Provided care to patients of all ages and varied diagnoses Resolved problems quickly Performed wound carePermian Basin MHMRLVN Case Manager1998-2001 Coordinated continuity of care to ensure that patients received proper treatment Provided management of mentally and physically handicapped clients Taught staff how to manage overall health of patients Monitored patients health and medicationsEDUCATIONDiploma of Nursing,Covenant School of NursingGpa 3.82010-2011Lubbock, TexasNursing Prerequisites, Wayland Baptist University2008-2010Lubbock, TexasVocational Nursing,Vocational Nursing1993-1996Odessa, Texas