Sally D. LeVine, RN, CPUR*** ****** ***** *****
• Garland, TX 75043 ▪ (845) ***-****
Seeking a Registered Nurse position in Utilization Review – where my extensive clinical background combined with my experience utilizing established criteria to determine medical necessity, appropriateness of setting and treatment can be utilized. Additional experience in varied plan interpretation, PPO, EPO, Medicare Advantage and self-funded groups.
HIGHLIGHTS OF QUALIFICATIONS
• Highly skilled and dedicated nursing professional with experience in a variety of health care settings.
• Diverse professional nursing career – including direct patient care, leadership, and instructional responsibilities.
• Exceptional assessment, prioritizing and follow through ability to achieve best patient outcome.
• Enthusiastic and energetic with the ability to work well independently or as an integral part of a team.
• Capable of learning new skills quickly and responding appropriately in emergency situations.
• Experience utilizing MedDecisions and InterQual criteria
EDUCATION / TRAINING
Registered Nurse Program, Ellis Hospital School of Nursing, Schenectady, NY – 1974
(Attended courses and maintained necessary mandates to work in critical care areas)
LICENSURE / CERTIFICATION
Professional Registered Nurse License – State of New York, Certified Professional in Utilization Review – May 2007
Registered Nurse – Med/Surg Unit, Renaissance Hospital – December 2009 – Present
• Direct patient care on a medical surgical unit; 6:1 ratio.
• Assume responsibility for the Charge Position on a regular basis and new employee training.
• Function as a resource to the healthcare team members in planning for discharge of patients.
• Initiate and evaluate patient and/or family education.
Clinical Review Nurse, MVP Health Care, Schenectady, NY – 2006 – 2009
• Review and evaluate provider requests for authorization of services prior to the initiation, continuation and extension
of care. Determine medical necessity and appropriateness of care based on predetermined criteria and/or guidelines.
• Ensure that care benefits and policies are properly interpreted and that care is rendered in the most appropriate site of
service, with a primary focus on quality care and the most cost-efficient outcomes.
• Assure timely responses to provider and member request for services per department standards.
Ambulatory Care Nurse I, Duke Hospital, Durham, North Carolina – 2004 – 2005
• Performed a broad range of medical and administrative support functions in a fast-paced, high-volume medical setting.
• Handled phone triage responsibilities for 7 physicians; followed protocol and advised patients in an appropriate manner.
• Initiated major impetus in establishing an anti-coagulant clinic within the practice.
Medical Review Specialist, Local 32-B-J Health Building Fund, New York, NY – 2003 – 2003
• Provided concurrent review and pre-certification for surgical procedures, medical equipment, and home care services.
Medical Review Specialist
MVP Insurance, Schenectady, NY – 1999 – 2001 / NYCHSRO, Inc., New York, NY 1997 – 1999
• Determined medical necessity of hospital stays based on clinical information from physicians and utilization reviews.
• Handled concurrent review, pre-certification, and requests in a timely and efficient manner. .
Clinical Supervisor, Hudson Valley Heart Center, Poughkeepsie, NY – 1995 – 1996
• Managed the clinic department for 7-cardiologists, ensuring the smooth flow of patient care in a busy medical center.
• Established entire emergency medical protocol for the practice.
• Assisted physicians with medical procedures and provided education and appropriate follow-up services to patients.
Critical Care Nurse II, Progressive Care Unit, St. Francis Hospital, Poughkeepsie, NY – 1991 – 1995
• Combined skills in the ICU and CCU with charge experience in the PCU in delivering optimum care to patients.
• Assessed, planned, implemented, documented, and evaluated care of acute care patients.
• Communicated with interdisciplinary health care team and families regarding patient care and discharge planning.
1988 – 1991 Registered Nurse – Med/Surg Unit St. Francis Hospital, Poughkeepsie, NY
1987 – 1988 Supervisor – Outpatient Clinic Hospital of the University of Pennsylvania, Philadelphia, PA
1985 – 1988 Registered Nurse – ICU/CCU Units Paoli Memorial Hospital, Paoli, PA
1974 – 1985 Registered Nurse – ICU Unit Ellis Hospital, Schenectady, NY