Medical Nurse
Resume:
Patricia Wyatt, lpn
(C) 813-***-**** acq3ad@r.postjobfree.com
LICENSED PRACTICAL NURSE
** ***** ********** ** *** Areas of Managed Care LPN in Florida, Virginia, Texas, and California
Dedicated health care professional with broad based experience encompassing managed care, worker’s compensation case management, utilization review in a hospital setting, length of stay reduction, and telephonic case management for insurance providers. Inspiring leader with experience implementing infection control programs and providing staff training and education. Excellent interpersonal skills, proficient in fostering positive professional relationships and communicating effectively at all levels.
AREAS OF EXPERTISE
Utilization Review
Case Management
Home Care / Assisted Living
Medical Records Auditing
Prior Authorizations
Complex Problem Resolution
Interdisciplinary Collaboration
Documentation / InterQual
Critical Decision-Making
Occupational Health
Infection Control Programs
Time & Schedule Management
SNAPSHOT OF KEY SKILLS
§Reviewing and processing precertification requests for approval of service or admission.
§Assisting with all aspects of the utilization review process; consistently reducing length of stay, providing patient education to improve overall wellness, and providing information to assist with navigating through the Primary Care Physician (PCP) referral processes.
§Utilizing clinical skills to review and monitor utilization of health care services to maintain high quality and cost-effective care upon hospitalization; reviewing inpatient, outpatient, and ambulatory services.
§Telephonically reviewing inpatient hospital admissions and assisting with the coordination of discharge planning.
§Appropriately assessing member's clinical condition and identifying clinical care needs to ensure patients receive appropriate services.
§Communicating with providers and insurers regarding authorizations, ensuring accuracy and timeliness.
§Working effectively in a collaborative/interdisciplinary environment and using medical knowledge to provide timely and accurate responses to requests for information.
§Maintaining up to date knowledge of state and federal regulations governing health care.
PROFESSIONAL EXPERIENCE
WELLCARE HEALTH PLANS, 2013-Present
Inpatient Nurse / Onsite Telephonic
§Perform accurate documentation using McKesson InterQual system.
§Collaborate with various other agencies and provide information on community resources.
§Provide assistance for the Medicaid population in the State of Florida.
§Key Achievement: Consistently excel in identifying patient care requirements by using medical industry knowledge and experience to understand care requirements.
MAXIM GOVERNMENT SERVICES, 2012-2013
Case Management Contractor, United States Army Reserve
§Provided exceptional case management to achieve daily goals and objectives.
§Key Achievement: Leveraged extensive experience and expertise to review soldier’s medical readiness to make determinations on ability to remain in the Army Reserve.
MEDBRIDGE HOME CARE, 2012
Licensed Practical Nurse
§Conducted home visits to patients and caregivers to assess overall health, provide medications, take vital signs, assist with wound care, and provide patient education.
AMERICAN FAMILY IPA, 2011-2012
Licensed Practical Nurse
§Provided exceptional case management and concurrent review, as well as initial assessments and review of medical records.
§Established treatment plans in collaboration with physicians and requested referrals as needed.
§Provided psychosocial support for patients and caregivers.
Key Achievement:
§Secured health plan savings by minimizing length of patient stay as Case Manager; Provided patient education on overall wellness resources and assisted patients with navigating through referral processes and PCP visits.
FREEDOM HEALTH, 2010-2011
Licensed Practical Nurse
§Skillfully handled utilization management and concurrent review.
§Reviewed medical necessity of inpatient members in the hospital.
§Coordinated care and provided authorizations for durable medical equipment (DME).
CARILLION ROANOKE MEMORIAL HOSPITAL, 2009-2010
Licensed Practical Nurse
§Provided utilization management through review for medical necessity using InterQual system.
§Performed concurrent review and continued stay review of patient charts.
§Handled discharge planning to skilled nursing facility (SNF) and inpatient rehabilitation.
§Key Achievement: Excelled in minimizing patient stay through patient education and provision of resources.
RICHFIELD RETIREMENT CENTER, 2009-2010
Licensed Practical Nurse Staff Nurse (PT)
§Performed broad based tasks and responsibilities that included administering medications, supervising staff, coordinating care with physicians, and communicating with families.
HCA PATIENT ACCOUNT SERVICES, 2007-2009
Licensed Practical Nurse, Clinical Appeals Nurse
§Reviewed medical records to verify documentation and performed retro reviews and appeals.
TCP INSURANCE OVERLOAD (Temporary Agency), 2006-2007
Auditor Consultant
§Leveraged industry knowledge and meticulous attention to detail to audit worker’s compensation files.
SOUTHERN HEALTH/COVENTRY, 2005-2006
LPN Pre-Authorization Nurse
§Approved all outpatient services, such as MRI, Dexa scans, and injections.
§Used proficiency in InterQual for medical necessity.
§Key Achievement: Quickly acclimated to the position, reviewed outpatient requests from physicians office, and communicated effectively with physician staff upon necessity for secondary review.
EDUCATION & LICENSURE
Licensed Practical Nurse, Fairfax County School of Practical Nursing
Licensed Practical Nurse in Florida, Virginia, Texas, and California
Completed coursework at St. Petersburg College
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