Shawonda Bailey, LPN

210-***-****

acqawu@r.postjobfree.com:acqawu@r.postjobfree.com

**** **** ***** **. ******** Springs, Co

WORK EXPERIENCE

Utilization Review Nurse

Nexus Medical Consulting Company

Utilization Review Nurse Nexus Medical Consulting Company

September 2014 to April 2015 (48/hrs per week)

• Act as a liaison between the case manager and the provider/injured worker

• Assess the appropriateness and medical necessity of the treatment requests for utilization review on a prospective, concurrent, and retrospective basis.

• Assess quality and clinical risk issues on a concurrent basis; report any recognized issue to the Team Leader/ Supervisor

• Assess documentation of medical records for completeness and relationship to the treatment plan

• Obtain and interpret information appropriate to injured workers needs as required for assessment, treatment, and patient care services

• Provide education and guidance to all parties to the claim; this includes providing direction to any member of the five-point contact

• Work independently, efficiently, and deal with priorities

• Ensure compliance with all performance measures in regards to appeals, denials, higher level of care admission certification and concurrent review timeliness, Outpatient Treatment Report review timeliness, readmissions, and others as indicated

• Perform utilization review activities, including pre-certification, concurrent, and retrospective reviews according to guidelines.

• Refer case to a review physician when the treatment request does not meet necessity per guidelines, or when guidelines are not available.

• Complete referrals in a timely manner, allowing the review physician time to make appropriate contact with the requesting provider in accordance with departmental policy and within CMS or URAC mandated turnaround times.

LVN

Admission Nurse Air Force Village

July 2013 to March 2014

(50/hrs per week)

• Reviewing items such as policy issues and requests for waivers of eligibility rules

• Performed hands-on clinical assessment visits to external referral sources as warranted

• Thoroughly reviewed clinical paper i.e. (labs, surgical history, Medical history and Medications) to ensure patient was appropriate for admission to facility

• Communicate with physicians from hospitals and rehabilitation facilities concerning patient's medical needs

• Coordinate with Health Care Admission Agreements and collected all necessary forms and documents, verified insurance coverage and Medicare coverage, and identified of responsible party information required for admission of resident

• Responded to all inquiries and interviews potential residents, family members, and discharge planners to collect accurate data on admissions inquiries

• Conducted tours for potential residents and resident representatives of community as needed

• Communicate on at least a weekly basis with marketing staff regarding bed availability • Maintain accurate daily community census and daily bed availability and completes data entry of resident data

• Notified and cooperated with all departmental team members when a resident is admitted or discharged

• Partner with marketing to act as liaison between transferring case manager or hospital and community; sought ways to further enhance the relationship between Air Force Village and the at-large community

• Execute Common Working File for applicable Medicare clients

• Provide exceptional customer service to all potential and current clients

• Maintain statistical data concerning admissions and trends

• Interface with the Administrator, Directors of Nursing, Marketing staff, and Executive Director

LVN

Charge Nurse Regent Care

February 2013 to July 2013

(40/hrs per week)

• Conduct a physical assessments of the patient, including vital signs, physical assessment, mental status, appetite, and type of diet, etc.

• Maintain a safe working environment, complying with infection control and body mechanic procedures

• Administer resident medication

• Implement resident care plans in compliance with Company and federal guidelines, and physician's orders

• Give direction to Nurse Aides for appropriate care of residents

• Perform resident treatments

• Implement established nursing policy and procedures, educating support staff regarding care needs of resident

• Cooperates with other agencies providing nursing or related services to provide continuity of care and to implement a comprehensive care plan.

Services Apprentice Texas Air National Guard

October 2007 to July 2013

(40/hrs per week)

Managed fitness assessments test for over 500 military members

• Maintained accountability for military members on orders

• Home Station Training (HST): Taught HST in organization among several non-commissioned officers; taught comprehensive overview of deployment planning and execution procedures for bare base scenarios with team interactive/practical demonstrations

• Oversaw lodging, fitness and recreational duties for military commander

• Ensured members met fitness requirements to deploy overseas

• Benchmarked a lodging tracking sheet on excel to maintain an accurate visual on each members status

• Answered phone calls from various military officers

• Responded to email and fax inquiries

• Booked appointments for Air Force officers when flying out of state or country

• Answer Multi-phone Lines

Nursing Assistant St. Luke's Baptist Hospital - August 2011 to January 2012

Check vital signs

• Assist with ADL

• Measure blood glucose reading using Accu-check monitor

• Bladder scan incontinent patients

• Conduct bed side reporting to co-workers

Nursing Assistant

Huebner Creek Nursing and Rehabilitation Center

April 2010 to September 2010

(45/hrs per week)

Checked (temperature, blood pressure and oxygen levels) of assigned patients

• Assisted with daily activities (bathing, weights, daily meal intake)

• Assisted in weighing patients

Services Apprentice

Air Force Central Command

October 2009 to March 2010- Overseas Deployment

(60/hrs per week)

• Contacted and coordinated with civilian companies to ensure food was supplied base wide in each dining facility

• Maintained hand receipts for cost of large quantities of goods shipped on base.

• Conducted inventory on store room to maintain accountability for ordered items

• Coordinated with base Civil Engineers to maintain adequate temperatures of reefers and store rooms

• Coordinated with squadron to supply food for base functions and events

• Supplied food for the flight kitchen in support of aircrew

• Coordinated with base health inspectors to guarantee food was stored adequately

EDUCATION

Quest College November 2011 to November 2012

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