Candidate Information Name Available: Register for Free Title Patient Care Utilization Review Target Location US-MD-Baltimore Email Available with paid plan Phone Available with paid plan	20,000+ Fresh Resumes Monthly     View Phone Numbers     Receive Resume E-mail Alerts     Post Jobs Free     Link your Free Jobs Page     ... and much more Register on Jobvertise Free
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Candidate's Name
Baltimore, MD Street Address  PHONE NUMBER AVAILABLE EMAIL AVAILABLEBold ProfileSUMMARY Patient-oriented Nurse with 30 years of diverse experience in direct patient care, staff supervision and department operations. Skilled at multitasking and prioritizing patient needs and daily assignments. Offering expertise with Hospice and Utilization review specialty. SKILLS Medication administrationPalliative careIV and venipunctureInterpersonal and writtencommunicationPatient needs assessmentStaff Development and PreceptingBody mechanics knowledgeVentilator careMedication and IV administrationColostomy care familiarityDiagnostic tools experienceIntake and dischargeGeriatric treatment knowledgeIV drug therapy managementDiabetes managementUnit administrationAcute and rehabilitative careEXPERIENCE INPATIENT HOSPICE NURSE 02/2023 to CURRENT AccentCare Hospice Baltimore, United StatesGuided patients' loved ones and caregivers in pain management, wound care and medication dosing.Listened to patients and loved ones, offering emotional support and kindness to help with end-of-life transition.Created and applied tailored care plans that would meet each patient's individualized needs.Delivered respectful, compassionate care to each patient and family member. Assessed patient conditions, monitored behaviors and updated supervising physicians with observations and concerns.Coordinated with healthcare team to establish, enact and evaluate patient care plans. Administered oral, IV and intra-muscular medications and monitored patient reactions. AGENCY REGISTERED NURSE 10/2022 to 02/2023Medix Staffing Baltimore, United StatesCollaborated with interdisciplinary teams for effective patient management, ensuring optimal treatment outcomes.Performed concurrent reviews using MCG criteria.Ensured patients admission are in compliance with Medicare by using MCG criteria. Reviewed electronic charts to provide documentation for admission/stay criteria. Analyzed appropriate data to identify trends/problems relating to delays in the delivery of care and patient placement.PATIENT CARE COORDINATOR 10/2020 to 10/2022Promedica Hospice Baltimore Maryland, United States Planned, coordinated and delivered care to patients and families as needed. Participated in Administrative On Call and On Call coverage. Delegated and assigned the patient/family to appropriate staff and team members. Maintained and facilitated interdisciplinary team/group meetings (IDG's) for continual updating of patient care plans.Monitored compliance with rules and regulations of Federal and State regulatory agencies.Reviewed case managers documentation for accuracy and compliance with all regulatory agencies.Managed and coordinated work flows within Home Care Home Base (HCHB) UTILIZATION REVIEW NURSE 05/2016 to 04/2022University Of Maryland Medical Center BaltimoreDetermined medical necessity as directed by MCG or InterQual criteria for cost-effectiveness of services through utilization review processes. Detailed documentation on all utilization reviews by using Epic. Referred cases that do not meet MCG criteria to medical director for secondary review. Provided utilization review for inpatient level of care, observation and denials management for assigned patient case load. Interfacing with case managers, medical teams, physician advisors and payers.TELEPHONIC UTILIZATION REVIEW NURSE 08/2013 to 05/2016 United Heathcare Baltimore, United StatesActively Monitored the care given in an acute rehab facility and approving bed days for continued stay authorization.provided referrals for Transitional case management nurses or Disease Management nurses that serves as a connection to proper outpatient and/or home based services. Identified care needs of individual patients and coordinated responses based on physician advice, insurance limitations and procedural costs. REGISTERED NURSE, FLEX III 09/2011 to 04/2015Bon Secour Hospital Baltimore, United StatesProvided direct patient care/physical assessment on Med/Surgical Unit. Developed / Managed care plans, discharge planning instructions and health education to maximize and meet patients health and safety goals. RN CASE MANAGER 07/2012 to 08/2013CareFirst Baltimore, MDEngaged members in case management, through coordination of care with healthcare team and discharge planning.Served as a key liaison between patients, families, and healthcare providers, fostering open communication and trust among all parties involved in the care process. Located / provided for appropriate home care/DME needs. Reviewed services and plans of care, also assessed members needs for health / medication management/ teaching needs.RN, DIRECTOR OF CARE DELIVERY 10/2011 to 04/2012HCR Manor Care Inc BaltimoreOversaw Management of over 30 patients and staff for the Subacute Unit. Coordination and provision of direct patient care utilizing the nursing process. The clinical manager operationalized the objectives, policies, and procedures of the Medical Center and Clinical Services for a specific shift. Accountable for monitoring all department activity, including, but not limited to patient flow, appropriate staffing, assignments of care, and staff development. EDUCATIONANDAssociate of Arts General StudiesTRAINING Baltimore City Community College, Baltimore, MD MBA Business 06/2016Strayer University, Washington DCBachelor of Science Nursing 06/2004University of Maryland School of Nursing, Baltimore, MD