Kimberly Price

LVN, Case Management, Utilization Management 14 years’ experience

Houston, TX 77077

ac73e6@r.postjobfree.com - 713-***-****

Authorized to work in the US for any employer

WORK EXPERIENCE

LVN Case Manager/ Utilization

MERIDA HEALTHCARE GROUP - Houston, TX - February 2016 to Present

Perform telephonic reviews for enrollees across the service continuum (pre-certification/authorization, concurrent and retrospective reviews) utilizing InterQual criteria to check providers to ensure the quality, quantity, timeliness and effectiveness of service. Perform case management/complex case management on identified members to increase compliance and help with coordination of care. Developing care plans individualized to the needs of each infant and his/her family

Skills Used: Good judgement as well as being well informed about my patient's disease processes to help them better their health. Collaborate Health Systems and help physicians and healthcare professionals set up quality of care utilizing InterQual.

Dispensary Nurse

ARS - Houston, TX - August 2015 to December 2016

Coaching/ Educating patients on health and self-care topics

Provided guidance to patients and caregivers along the neurological continuum of care

Identified key red flag symptoms with their associated triggers and creating a mitigation plan,

defined key social determinants of health and their impact on a patient’s health status

Providing care coordination to connect patients with appropriate services

Skills Used: Good judgement as well as being well informed about my patient's disease processes to help them better their health. Collaborate with physician and staff. Utilized EMR & Kinnser.

Pharmaceutical Nurse

Grifols - Houston, TX December 2016-January 2017

Determined donor suitability in a timely manner, consult with a donor center physician as needed. Provide limited emergency care including the administration of any medications or treatments in accordance with your certification, training and standard operating procedures. Conducted evaluations to ensure criteria of normal plasma donors are met, reviewed medical histories and performed suitability examinations, maintained communication logs regarding any communications with the licensed physician regarding donor suitability. Reviewed normal and abnormal test results and determined continued donor eligibility, Counseled donors with abnormal test results and defers donors accordingly & completed cross trainings as required by management.

Skills Used: Good judgement as well as being well informed about my patient's disease processes to help them better their health. Partnered with physician and staff. Utilized EMR & InterQual

Treatment Nurse

Windsor Houston - Houston, TX - May 2013 to April 2016

Responsible for coordinating the clinical components of the facility wound program to help ensure the residents skin integrity is maintained or improved in a SNF. Administer treatments as prescribed within standard nursing practice guidelines and in full compliance with established infection control protocols.

Case Management Nurse

Bio Home Health - May 2008 to September 2012

Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings

Collaborate with various staff within provider networks and case management team electronically or telephonically to coordinate member care. Educated providers on utilization and medical management processes. Provided clinical knowledge and act as a clinical resource to non-clinical team staff. Enter and maintained pertinent clinical information in various medical management systems

Case Management/ Field Nurse

DPM Alliance Home Health - July 2005 to June 2007

Case management over geriatric and pediatric patients. Responsible for coordination of daily Utilization Management functions in accordance with DPM policies & procedures. Coordinate primary care visits, surgery, radiation, and chemotherapy. Provided a comprehensive array of high quality, confidential outpatient psychological services for adolescents & adults. Obtaining information from providers on outpatient requests for treatment.

Long term health LVN

Manor Care Nursing Home - December 2004 to June 2005

Responsible for all resident’s medications are received in a timely manner. Performed trachea care for patients as needed. Assessed all patients' skin as well as care for G tube patients per MD protocol. Administer suppositories as needed for constipation. Repositioned patients every 2 hours or as needed per skin assessment. Reported all abnormalities to MD/Charge RN immediately. Arrange all out-patient procedures such as x-rays, CT scans, MRI's or ultrasounds. Communicate Patient's family when necessary.

Customer Care Associate

Aetna - July 2000 to December 2002

Customer Care Ensured that patient issues were resolved in a timely manner, and that medical operations ran in a smoothly manner. Processed medical claims and performed reimbursement on a case by case bases. Performed AP/ AR as needed. Exceptional interpersonal skills and medical terminology knowledge. Scheduled necessary procedures with facilities to include: out patients MRI's, x-rays, EEG's or GI scans.

EDUCATION

St Phillips College 1995 to 1997

CERTIFICATIONS

LVN June 2004 to June 2017

Most prompt Nurse Award 2010-2012

Great Documentation Award 2012, 2014, 2016-2017

ADDITIONAL INFORMATION

SKILLS LVN highly skilled in all aspects of home health, nursing home care, pediatric care, wound care/wound vac, and IV infusion. Computerized documentation skills, excellent assessment skills, history of working with mentally handicap patients. Strong ability to effectively manage multiple complex tasks simultaneously and coordinate with staff. Proven ability to communicate efficiently in order to obtain optimal patient outcomes. Swift critical thinking during emergency situations.

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